Safe and Effective

Chiropractic care includes a variety of non-drug and noninvasive treatments; because of this, it is one of the safest options for back pain, neck pain, joint pain of the arms or legs, headaches and other neuromusculoskeletal complaints. While chiropractic services have an excellent safety record, no health treatment is completely free of potential adverse side-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 (similar to what they might experience after some forms of exercise), headaches and tiredness. Minor discomfort or soreness following spinal manipulation, one of the most common chiropractic treatments, typically fades within 24 hours.1

In addition to being safe, spinal manipulation is effective, getting patients back to their regular activities sooner than traditional medical care alone. 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 Another 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

Neck Adjustments

Doctors of chiropractic treat neck pain and some types of headaches through precise cervical (neck) manipulation, often called a neck adjustment. Cervical manipulation works to improve joint mobility in the neck, restoring range of motion and reducing muscle spasm, which helps relieve pressure and tension. Following this treatment, patients typically notice a reduction in pain, soreness and stiffness, along with an improved ability to move the neck.

Cervical manipulation is a remarkably safe procedure. While some reports have associated high-velocity, upper-neck manipulation with a certain rare kind of stroke resulting from a tear (also called a dissection) in one of the cervical arteries, research suggests 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 not only concluded that this type of stroke is a very rare event, but also that that cervical arterial injuries often can take place spontaneously or following everyday activities such as turning the head while driving, swimming, or having a shampoo in a hair salon.4

Patients with this condition may experience neck pain and headache that leads them to seek professional care at the office of a doctor of chiropractic or medical doctor; however, researchers say that care is not necessarily the cause of the injury.4 The best evidence indicates the incidence of arterial injuries associated with high-velocity, upper neck manipulation is extremely rare.5 A review of the available research authored by six neurologists affiliated with Penn State University concluded that, “There is no convincing evidence to support a causal link between chiropractic manipulation and CAD [Cervical Artery Dissection].”6

Adding Perspective

When deciding on the best course of treatment, it is important for patients to understand the risks associated with some of the most common treatments for neck and back pain such as prescription nonsteroidal anti-inflammatory drugs (NSAIDs) and prescription opioid pain medications, as these options carry risks significantly greater than those of cervical manipulation.

According to a study published in The American Journal of Gastroenterology, about one-third of all hospitalizations and deaths related to gastrointestinal bleeding can be attributed to the use of aspirin or NSAID pain medications like ibuprofen.7 The Centers for Disease Control and Prevention estimates that as many as one in four people who receive prescription opioids long term for non-cancer pain struggle with addiction.8 Surgery carries risks many times greater than those of chiropractic treatment. Even prolonged bed rest carries some risks, such as muscle atrophy, cardiopulmonary deconditioning, bone mineral loss and thromoembolism.9

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 for other treatments such as prescription and nonprescription drugs and surgery.10

Ongoing Research

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.

Talk to Your Doctor

If you visit a doctor of chiropractic for neck pain or headache, be very specific about your symptoms. This will help your doctor determine the safest and most effective treatment, even if that involves referral to another healthcare provider. If the issue of stroke concerns you, don’t hesitate to discuss it with your chiropractor. Depending on your clinical condition, they can forego manipulation and instead recommend joint mobilization, therapeutic exercise, soft-tissue techniques, or other therapies.



  1. Senstad O, et al. Frequency and characteristics of side effects of spinal manipulative therapy. Spine 1997 Feb 15;435-440.
  2. 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.
  3. 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.
  4. Cassidy D, et al. Risk of Vertebrobasilar Stroke and Chiropractic Care. Spine 2008; 33:S176–S183.
  5. Haldeman S, et al. Arterial dissection following cervical manipulation: a chiropractic experience. Can Med Assoc J 2001;165(7):905-06.
  6. Church EW, Sieg EP, Zalatimo O, Hussain NS, Glantz M, Harbaugh RE. Systematic Review and Meta-analysis of Chiropractic Care and Cervical Artery Dissection: No Evidence for Causation. Cureus. 2016 Feb 16;8(2):e498. doi: 10.7759/cureus.498. PMID: 27014532; PMCID: PMC4794386.
  7. 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.
  8. 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.
  9. Lauretti W. “The Comparative Safety of Chiropractic.” In Daniel Redwood, ed., Contemporary Chiropractic. New York: Churchill Livingstone, 1997, p.230-8.
  10. Hurwitz E, et al. Treatment of neck pain: noninvasive interventions. Spine 2008;33(4S):S123-S152.