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Chiropractic safety

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Chiropractic care in general is safe when employed skillfully and appropriately. Manipulation is regarded as relatively safe, but as with all therapeutic interventions, complications can arise, and it has known adverse effects, risks and contraindications. Absolute contraindications to spinal manipulative therapy are conditions that should not be manipulated; these contraindications can include (the practitioner must take the extent of the condition into account) rheumatoid arthritis, certain cancers, fracture and other conditions known to result in unstable joints. Relative contraindications are conditions where increased risk is acceptable in some situations and where low-force and soft-tissue techniques are treatments of choice; these conditions include osteoporosis.[1] Although most contraindications apply only to manipulation of the affected region, some neurological signs indicate referral to emergency medical services; these include sudden and severe headache or neck pain unlike that previously experienced.[2]

Chiropractic "reaction"

Spinal manipulation can be associated with, mild and temporary discomfort, or irritation, known as Chiropractic reaction, [3][2] including new or worsening pain or stiffness in the affected region.[4] They have been estimated to occur in 33% to 61% of patients, and frequently occur within an hour of treatment and disappear within 24 to 48 hours.[5], and the best means of getting past this phase, is continue to be treated, and communicate with your doctor.


Anthony Rosner, PhD, presentation on Stroke risk in CMT, ANJC Convention, NJ 2011

There are those who have always wished to destroy Chiropractic and of course liars figure, and figures lie. So, when in the extremely rare occurrence that some one has a stroke sometime after a Chiropractic adjustment, there are those who would love to point a finger at chiropractic, but science shows that is ridiculous. In 1997 a landmark metasurvey was conducted by Haldemann, et al, for the World Chiropractic Congress in Tokyo, held under sponsorship of the World Health Organization, which showed that the incidence of spontaneous strokes is actually HIGHER in the general population, then among chiropractic patients. Still there are those in organized medicine, whose estimates vary widely for the incidence of these complications,[5] and the actual incidence is unknown, due to high levels of under-reporting and to the difficulty of linking manipulation to any adverse effects such as stroke.[3] Several case reports show temporal associations between interventions and potentially serious complications. Despite the evidence against this, some continue to state that Vertebrobasilar artery stroke is statistically associated with chiropractic services in persons under 45 years of age, but it is similarly associated with general practitioner services, and at rates 4-10 times as high, suggesting that these associations are likely explained by preexisting conditions.[6][7] Weak to moderately strong evidence supports causation (as opposed to statistical association) between cervical manipulative therapy (whether chiropractic or not) and vertebrobasilar artery stroke.[8]

In 2009, at the World Congress of Chiropractic, another, follow-up survey was presented by Haldemann, et al, which shows pretty conclusively that the incidence of strokes is certainly less in the population of Chiropractic patients, then in the general population. This pretty much proves that there is NO relationship of Chiropractic care to the causation of strokes. Then in JMPT, in another landmark study, J. David Cassidy, et al, found that there were There were 818 VBA strokes hospitalized in a population of more than 100 million person-years, thus even if such incidents were a real risk factor for cervical adjustments, it would still be a "very rare event". However, the conclusions of this study were that; "We found no evidence of excess risk of VBA stroke associated chiropractic care compared to primary care.".

Use of X-Ray

Chiropractors, like other primary care providers, sometimes employ diagnostic imaging techniques such as X-rays and CT scans that rely on ionizing radiation; practice guidelines aim to reduce unnecessary radiation exposure,[9] which increase cancer risk in proportion to the amount of radiation received.[10]


  1. World Health Organization (2005) (PDF). WHO guidelines on basic training and safety in chiropractic. ISBN 92-4-159371-7. Retrieved 2008-02-29. 
  2. 2.0 2.1 Anderson-Peacock E, Blouin JS, Bryans R et al. (2005). "Chiropractic clinical practice guideline: evidence-based treatment of adult neck pain not due to whiplash" (PDF). J Can Chiropr Assoc 49 (3): 158–209.$file/jcca-v49-3-158.pdf. 
    Anderson-Peacock E, Bryans B, Descarreaux M et al. (2008). "A clinical practice guideline update from The CCA•CFCREAB-CPG" (PDF). J Can Chiropr Assoc 52 (1): 7–8.$file/jcca-v52-1-007.pdf. 
  3. 3.0 3.1 Ernst E (2007). "Adverse effects of spinal manipulation: a systematic review". J R Soc Med 100 (7): 330–8. doi:10.1258/jrsm.100.7.330. PMID 17606755. PMC 1905885. Lay summary – Med News Today (2007-07-02). 
  4. Thiel HW, Bolton JE, Docherty S, Portlock JC (2007). "Safety of chiropractic manipulation of the cervical spine: a prospective national survey". Spine 32 (21): 2375–8. doi:10.1097/BRS.0b013e3181557bb1. PMID 17906581. 
  5. 5.0 5.1 Gouveia LO, Castanho P, Ferreira JJ (2009). "Safety of chiropractic interventions: a systematic review". Spine 34 (11): E405–13. doi:10.1097/BRS.0b013e3181a16d63. PMID 19444054. 
  6. Hurwitz EL, Carragee EJ, van der Velde G et al. (2008). "Treatment of neck pain: noninvasive interventions: results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and It's Associated Disorders". Spine 33 (4 Suppl): S123–52. doi:10.1097/BRS.0b013e3181644b1d. PMID 18204386. 
  7. Paciaroni M, Bogousslavsky J (2009). "Cerebrovascular complications of neck manipulation". Eur Neurol 61 (2): 112–8. doi:10.1159/000180314. PMID 19065058. 
  8. Miley ML, Wellik KE, Wingerchuk DM, Demaerschalk BM (2008). "Does cervical manipulative therapy cause vertebral artery dissection and stroke?". Neurologist 14 (1): 66–73. doi:10.1097/NRL.0b013e318164e53d. PMID 18195663. 
  9. Bussières AE, Taylor JAM, Peterson C (2008). "Diagnostic imaging practice guidelines for musculoskeletal complaints in adults—an evidence-based approach—part 3: spinal disorders". J Manipulative Physiol Ther 31 (1): 33–88. doi:10.1016/j.jmpt.2007.11.003. PMID 18308153. 
  10. Committee to Assess Health Risks from Exposure to Low Levels of Ionizing Radiation, Board on Radiation Effects Research, U.S. National Research Council (2006). Health Risks from Exposure to Low Levels of Ionizing Radiation: BEIR VII Phase 2. Washington, DC: The National Academies Press. ISBN 0-309-09156-X.