Chiropractic services are some of the safest drug-free, noninvasive therapies available for the treatment of back pain, neck pain, joint pain of the arms or legs, headaches and other neuromusculoskeletal complaints. Although chiropractic has an excellent safety record, no health treatment is completely free of potential adverse effects. The risks associated with chiropractic, however, are very small.
Many patients feel immediate relief following chiropractic treatment, but some may experience mild soreness or aching (like that experienced after some forms of exercise), headaches and tiredness. Current literature shows that minor discomfort or soreness following spinal manipulation typically fades within 24 hours.1
In addition to being a safe form of treatment, spinal manipulation is incredibly effective, in some cases getting patients back on their feet faster than traditional medical care. A clinical comparative trial published by the Journal of the American Medical Association found that chiropractic care combined with usual medical care for low back pain provides greater pain relief and a greater reduction in disability than medical care alone.2 In addition, a study in the Annals of Internal Medicine found that spinal manipulative therapy and exercise are more effective at relieving neck pain than pain medication.3
Safety of Neck Manipulation
Neck pain and some types of headaches are treated through precise cervical manipulation. Cervical manipulation, often called a neck adjustment or neck manipulation, works to improve joint mobility in the neck, restoring range of motion and reducing muscle spasm, which helps relieve pressure and tension. Patients typically notice a reduction in pain, soreness and stiffness, along with an improved ability to move the neck. Neck manipulation is a remarkably safe procedure. While some reports have associated high-velocity, upper-neck manipulation with a certain kind of stroke, or vertebral artery dissection, research suggests that patients are no more likely to suffer a stroke following a chiropractic neck treatment than they are after visiting their primary care medical doctor’s office. Researchers who examined the issue closely concluded that vertebrobasilar artery (VBA) stroke is a very rare event, and that this type of arterial injury often takes place spontaneously or following everyday activities such as turning the head while driving, swimming or having a shampoo in a hair salon.4
It’s important to note that patients with this condition may experience neck pain and headache that leads them to seek professional care—often at the office of a doctor of chiropractic or medical doctor—but the care they receive there is not the cause of the injury. The best evidence indicates that the incidence of artery injuries associated with high-velocity, upper-neck manipulation is extremely rare – about 1 case in 5.85 million manipulations.5 To put this risk into perspective, if you drive more than a mile to get to your chiropractic appointment, you are at greater risk of serious injury from a car accident than from your chiropractic visit.
When assessing treatment options, patients should understand the risks associated with some of the most common treatments for neck and back pain—prescription nonsteroidal anti-inflammatory drugs (NSAIDs) as well as prescription opioid pain medications—as these options carry risks significantly greater than those of manipulation.
According to a study from the American Journal of Gastroenterology, approximately one-third of all hospitalizations and deaths related to gastrointestinal bleeding can be attributed to the use of aspirin or NSAID painkillers such as ibuprofen.6 In addition, as many as one in four people who receive prescription opioids long term for non-cancer pain in primary care settings struggle with addiction.7
Surgery for conditions for which manipulation may also be used carries risks many times greater than those of chiropractic treatment. Even prolonged bed rest carries some risks, including muscle atrophy, cardiopulmonary deconditioning, bone mineral loss and thromoembolism.8
A comprehensive review of scientific evidence related to neck pain treatments found at least as much evidence supporting the safety and effectiveness of common chiropractic treatments, including manipulation, as compared with other treatments such as prescription and non-prescription drugs and surgery.9
If you are visiting your doctor of chiropractic for neck pain or headache, be very specific about your symptoms. This will help your doctor to determine the safest and most effective treatment, even if it involves referral to another health care provider. If the issue of stroke concerns you, do not hesitate to discuss it with your chiropractor. Depending on your clinical condition or preferences, he or she can forego manipulation and can instead recommend joint mobilization, therapeutic exercise, soft-tissue techniques or other therapies.
Ongoing Research and Education
The American Chiropractic Association believes that patients have the right to know about the health risks associated with any type of treatment, including chiropractic. Today, chiropractic researchers are involved in studying the benefits and risks of spinal adjustment in the treatment of neck and back pain through clinical trials, literature reviews and publishing papers reviewing the risks and complications of neck adjustment.
All available evidence demonstrates that chiropractic treatment holds an extremely small risk. The chiropractic profession takes the issue of stroke and the safety of patients very seriously and engages in training and postgraduate education courses to recognize risk factors in patients and to continue rendering treatment in the most effective and responsible manner.
- Senstad O, et al. Frequency and characteristics of side effects of spinal manipulative therapy. Spine 1997 Feb15; 435-440.
- Goertz CM et al. Effect of usual medical care plus chiropractic care vs usual medical care alone on pain and disability among US service members with low back pain: A comparative effectiveness clinical trial. JAMA Network Open, 2018; 1(1): e180105. doi:10.1001/jamanetworkopen.2018.0105.
- Bronfort G, Evans R, Anderson A, Svendsen K, Bracha Y, Grimm R. Spinal Manipulation, Medication, or Home Exercise With Advice for Acute and Subacute Neck Pain: A Randomized Trial. Annals of Internal Medicine. 2012; 156(1):1-10.
- Cassidy D, et al. Risk of Vertebrobasilar Stroke and Chiropractic Care. Spine 2008; 33: S176–S183.
- Haldeman S, et al. Arterial dissection following cervical manipulation: a chiropractic experience. Can Med Assoc J 2001;165(7):905-06.
- Lanas A, et al. A nationwide study of mortality associated with hospital admission due to severe gastrointestinal events and those associated with nonsteroidal anti-inflammatory drug use. Am J Gastroenterol 2005; 100:1685–1693.
- Boscarino JA. Risk factors for drug dependence among outpatients on opioid therapy in large US health-care system. Addiction. 2010 Oct;105(10):1776-82. doi: 10.1111/j.1360-0443.2010.03052.x. Epub 2010 Aug 16.
- Lauretti W. “The Comparative Safety of Chiropractic.” In Daniel Redwood, ed., Contemporary Chiropractic. New York: Churchill Livingstone, 1997, p.230-8.
- Hurwitz E, et al. Treatment of neck pain: noninvasive interventions. Spine 2008;33(4S):S123-S152.