The Safety of Chiropractic Adjustments

Learn the benefits and risks of spinal adjustment

In This Article

Chiropractic adjustment, also called spinal manipulation, is a procedure done by a chiropractor using the hands or small instruments to apply controlled force to a spinal joint. The goal is to improve spinal motion and physical function of the entire body. Chiropractic adjustment is safe when performed by someone who is properly trained and licensed to practice chiropractic care. Complications are rare, but they are possible. Learn more about both the benefits and risks.

Chiropractic adjustment
Verywell / Brianna Gilmartin 

Chiropractic Adjustment 

One of the most important reasons people seek chiropractic care is because it is a completely drug-free therapy. Someone dealing with joint pain, back pain, or headaches might consider visiting a chiropractor.  

The goal of chiropractic adjustment is to place the body into a proper position so the body can heal itself. Treatments are believed to reduce stress on the immune system, reducing the potential for disease. Chiropractic care aims to address the entire body, including a person’s ability to move, perform, and even think. 

What Research Shows

Many people wonder how helpful chiropractic care is in treating years of trauma and poor posture. There have been numerous studies showing the therapeutic benefits of chiropractic care.

Sciatica 

Sciatica is a type of pain affecting the sciatic nerve, the large nerve extending from the low back down the back of the legs. Other natural therapies don’t always offer relief and most people want to avoid steroid injections and surgery, so they turn to chiropractic care.  

A double-blind trial reported in the Spine Journal compared active and simulated chiropractic manipulations in people with sciatic nerve pain. Active manipulations involved the patient laying down and receiving treatment from a chiropractor. Stimulated manipulations involved electrical muscle stimulation with electrodes placed on the skin to send electrical pulses to different parts of the body.  

The researchers determined active manipulation offered more benefit than stimulated. The people who received active manipulations experienced fewer days of moderate or severe pain and other sciatica symptoms. They also reported no adverse effects. 

Neck Pain 

One study reported in the Annals of Internal Medicine looked at different therapies for treating neck pain. They divided 272 study participants into three groups: one that received spinal manipulation from a chiropractic doctor, a second group given over-the-counter (OTC) pain relievers, narcotics, and muscle relaxers, and a third group who did at-home exercises. 

After 12 weeks, patients reported a 75 percent pain reduction, with the chiropractic treatment group achieving the most improvement. About 57 percent of the chiropractic group achieved pain reduction, while 48 percent received pain reduction from exercising, and 33 percent from medication. 

After one year, 53 percent of the drug-free groups continued to report pain relief compared to only 38 percent of those taking pain medications. 

Headaches 

Cervicogenic headaches and migraines are commonly treated by chiropractors. Cervicogenic headaches are often called secondary headaches because pain is usually referred from another source, usually the neck. Migraine headaches cause severe, throbbing pain and are generally experienced on one side of the head. There are few non-medicinal options for managing both types of chronic headaches.

Research reported in the Journal of Manipulative and Physiological Therapeutics suggests chiropractic care, specifically spinal manipulation, can improve migraines and cervicogenic headaches.  

Frozen Shoulder 

Frozen shoulder affects the shoulder joint and involves pain and stiffness that develops gradually and gets worse. Frozen shoulder can be quite painful, and treatment involves preserving as much range of motion in the shoulder as possible and managing pain. 

A clinical trial reported in the Journal of Chiropractic Medicine described how patients suffering from frozen shoulder responded to chiropractic treatment. Of the 50 patients, 16 completely recovered, 25 showed a 75 to 90 percent improvement, and eight showed a 50 to 75 percent improvement. Only one person showed zero to 50 percent improvement. The researchers concluded most people can get improvement by treating frozen shoulder with chiropractic treatment. 

Preventing Need for Surgery 

Chiropractic care may reduce the need for back surgery. Guidelines reported in the Journal of the American Medical Association recommend people suffering from back pain should first try spinal manipulation before deciding on surgical intervention.

Low Back Pain 

Studies have shown chiropractic care, including spinal manipulation, can provide relief from mild to moderate low back pain. In fact, spinal manipulation may work as well as other standard treatments, including pain-relief medications. 

A 2011 review of 26 clinical trials looked at the effectiveness of different treatments for chronic low back pain. What they found was that spinal manipulation is just as effective as other treatments for reducing back pain and improving function. 

Safety

Risks and side effects associated with chiropractic adjustments may include:

  • temporary headaches
  • fatigue after treatment
  • discomfort in parts of the body that were treated

Rare but serious risks associated with chiropractic adjustment include:

  • stroke
  • cauda equina syndrome, a condition involving pinched nerves in the lower part of the spinal canal
  • worsening of herniated disks (although research isn't conclusive)

In addition to effectiveness, research has focused on the safety of chiropractic treatments, mainly spinal manipulation. 

One 2017 review of 250 articles looked at serious adverse events and benign events associated with chiropractic care. Based on the evidence the researchers reviewed, serious adverse events accounted for one out of every two million spinal manipulations to 13 per 10,00 patients. Serious adverse events included spinal or neurological problems and cervical arterial strokes (dissection of any of the arteries in the neck).  

Benign events were more common and included more pain and higher levels of neck problems, but most were short-term problems.

The researchers confirmed serious adverse events were rare and often related to other preexisting conditions, while benign events are more common. However, the reasons for any types of adverse events are unknown.

A second 2017 review looked 118 articles and found frequently described adverse events include stroke, headache and vertebral artery dissection (cervical arterial stroke). Forty-six percent of the reviews determined that spinal manipulation was safe, while 13 percent expressed concern of harm. The remaining studies were unclear or neutral. While the researchers did not offer an overall conclusion, they determined spinal manipulation can significantly be helpful, and some risk does exist.

A Word From Verywell 

When chiropractors are correctly trained and licensed, chiropractic care is safe. Mild side effects are to be expected and include temporary soreness, stiffness, and tenderness in the treated area. However, you still want to do your research. Ask for a referral from your doctor. Look at the chiropractor’s website, including patient reviews. Meet with the chiropractor to discuss his or her treatment practices and ask about possible adverse effects related to treatment.

If you decide a chiropractor isn’t for you, consider seeing an osteopathic doctor. Osteopaths are fully licensed doctors who can practice all areas of medicine. They have received special training on the musculoskeletal system, which includes manual readjustments, myofascial release and other physical manipulation of bones and muscle tissues. 

Was this page helpful?

Article Sources

  • American Chiropractic Association. Chiropractic: A Safe Treatment Option.  

  • Bronfort G, Evans R, Anderson AV, et al. Spinal Manipulation, Medication, or Home Exercise With Advice for Acute and Subacute Neck Pain: A Randomized Trial. Ann Intern Med. 2012;156(1_Part_1):1-10. DOI: 10.7326/0003-4819-156-1-201201030-00002.

  • Bryans R, Descarreaux M, Duranleau M, et al. Evidence-based guidelines for the chiropractic treatment of adults with headache. Manipulative Physiol Ther. 2011 Jun;34(5):274-89. DOI: 10.1016/j.jmpt.2011.04.008.

  • Goodman DM, Burke AE, Livingston EH. Low Back Pain. JAMA. 2013;309(16):1738. DOI:10.1001/jama.2013.3046.

  • Murphy FX, Hall MW, D’Amico L, et al. Chiropractic management of frozen shoulder syndrome using a novel technique: a retrospective case series of 50 patients. J Chiropr Med. 2012 Dec; 11(4): 267–272. DOI: 10.1016/j.jcm.2012.07.001.

  • Rubenstein SM, van Middlekoop M, Assendelft WJ, et al. Spinal manipulative therapy for chronic low-back pain. Cochrane Database Syst Rev. 2011 Feb 16;(2):CD008112. DOI: 10.1002/14651858.CD008112.pub2.

  • Santilli V, Beghi E, Finucci S. Chiropractic manipulation in the treatment of acute back pain and sciatica with disc protrusion: a randomized double-blind clinical trial of active and simulated spinal manipulations. Spine J. 2006 Mar-Apr;6(2):131-7. DOI: 10.1016/j.spinee.2005.08.001.

  • Swait G, Finch R. What are the risks of manual treatment of the spine? A scoping review for clinicians. Chiropr Man Therap. 2017; 25: 37. DOI: 10.1186/s12998-017-0168-5.