The Safety of Chiropractic Adjustments

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 generally considered safe when performed for the right condition 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.

Common Reasons for 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 restore normal joint function and muscle balance. 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 benefits than stimulated. The people who received active manipulations experienced fewer days of moderate or severe pain and other sciatica symptoms. They also had greater likelihood of reduced pain and sciatica, but the success rates were still low, at 26% and 55%. They also reported no adverse effects. However, it should be noted that patients with any significant spine conditions such as spondylolisthesis, chronic low back pain, or any disc herniations that were deemed to need surgery were not included as patients in the study. Therefore these results may not apply to all types of sciatica and/or back pain and may reflect modest improvements. Furthermore, this study included one type of manipulation, and may not reflect the efficacy of all types of manipulations.

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% pain reduction, with the chiropractic treatment group achieving the most improvement. About 57% of the chiropractic group achieved pain reduction, while 48% received pain reduction from exercising, and 33% from medication.

However, at 52 weeks after treatment, the percentage of patients reporting complete reduction in pain was only 27% with spinal manipulation, and fared better at 37% in the group who underwent home exercises.

For relief of acute or subacute neck pain, spinal manipulation and home exercises were similarly effective, and both were more effective than medication alone.

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.  

Low Back Pain

Studies have shown chiropractic care, including spinal manipulation, can provide relief from mild to moderate low back pain. In some studies, spinal manipulation has been compared to other standard treatments, including exercise or pain-relief medications, for certain types of back pain.

A 2011 review of 26 clinical trials looked at the effectiveness of different treatments for chronic low back pain. What they found was evidence that spinal manipulation may be as effective as other treatments such as exercise for reducing back pain and improving function. However, the authors also reported there was also evidence that it may not be more effective than placebo. Further studies are needed to understand the true efficacy of spinal manipulations on low back pain.

Safety

Risks and side effects associated with chiropractic adjustments may include:

  • Headaches
  • Fatigue
  • 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 that can lead to permanent paralysis
  • Worsening of herniated disks

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 10,000 patients. Serious adverse events included spinal cord injuries including paraplegia or quadriplegia, worsening of disk herniations, and cervical arterial strokes (dissection of any of the arteries in the neck).

Benign events were common and occurred in 23-83%, including more pain, stiffness, and headache, but most resolved within 24 hours.

The researchers confirmed serious adverse events were rare and often related to other preexisting conditions, while benign events are more common. 

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% reported it was harmful. The remaining studies were unclear or neutral. While the researchers did not offer an overall conclusion, they concluded that serious adverse events after manipulation can be significant, and that some risk does exist.

A Word From Verywell

When chiropractors are correctly trained and licensed, chiropractic care is generally considered to be safe for some conditions. However, it is not recommended for patients with osteoporosis, spine deformities, spine cancer, increased stroke risk, and more serious conditions that may require surgery. 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 their treatment practices and ask about possible adverse effects related to treatment.

If you decide a chiropractor isn’t for you, another option may be to see 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.

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  1. 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 manipulationsSpine J. 2006;6(2):131‐137. doi:10.1016/j.spinee.2005.08.001

  2. Bronfort G, Evans R, Anderson AV, Svendsen KH, Bracha Y, Grimm RH. Spinal manipulation, medication, or home exercise with advice for acute and subacute neck pain: a randomized trialAnn Intern Med. 2012;156(1 Pt 1):1‐10. doi:10.7326/0003-4819-156-1-201201030-00002

  3. Bronfort G, Assendelft WJ, Evans R, Haas M, Bouter L. Efficacy of spinal manipulation for chronic headache: a systematic reviewJ Manipulative Physiol Ther. 2001;24(7):457‐466.

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