Chiropractic care, primarily involving spinal manipulation (an adjustment), is widely used for managing musculoskeletal issues. This treatment applies controlled force to a spinal joint to improve mobility and reduce pain. Given the hands-on nature of the procedure, public concern about the safety of spinal adjustments, particularly for the back, is common. This article examines the evidence surrounding chiropractic safety, distinguishing between minor side effects and the statistical reality of serious adverse events. Understanding the factors that increase risk and the proactive steps a patient can take provides an objective perspective on this treatment.
Understanding the Potential Adverse Events
It is important to differentiate between common, temporary side effects and rare, serious adverse events. Mild to moderate post-treatment reactions are frequent (33% to 61% of patients), typically involving temporary stiffness, localized soreness, or general fatigue. Most minor symptoms are short-lived, resolving completely within 24 to 48 hours.
Serious adverse events involving the back are statistically rare. These include the aggravation of a pre-existing disc herniation or new nerve root compression in the lumbar spine. One review found that lumbar spine injuries accounted for 44% of non-vascular adverse effects reported in a small review of serious cases.
The most severe non-vascular complications include disc herniation progressing to cauda equina syndrome, a medical emergency involving nerve root compression. Estimates of serious complications like a new herniated disc suggest a rarity of about 1 in every 100,000 chiropractic adjustments. Nerve compression or damage is reported at a frequency of about 1 in every 50,000 visits.
It is also possible for forceful manipulation to contribute to a vertebral fracture, particularly in patients with compromised bone density. The overall risk of serious injury to the back is significantly lower than the risks discussed in relation to the neck (vascular events like stroke). Low back manipulation is generally considered a safe procedure for most people.
Variables That Increase Risk
The safety of chiropractic manipulation depends on the patient’s underlying health status and the practitioner’s judgment and technique. Certain patient factors make spinal structures more vulnerable to injury. Severe osteoporosis, which causes bones to become fragile, significantly increases the risk of a compression or pathological fracture during an adjustment.
Patients with recent spinal surgery or diagnosed spinal instability, such as inflammatory arthritis, are at a higher risk of adverse events. Conditions affecting the vascular system, like an aortic aneurysm or dissection, present a contraindication due to the potential for rupture from mechanical stress. Patients on long-term anticoagulant therapy face an increased risk of internal bleeding following manipulation.
The competence and thoroughness of the provider play a substantial role in minimizing risk. Injury may result from a failure to take a comprehensive medical history or perform an adequate physical and neurological examination before treatment. Injuries occur when a practitioner fails to recognize a contraindication and uses overly aggressive force or an incorrect technique.
Patient Steps for Safe Chiropractic Care
A patient’s proactive engagement is significant in ensuring safe chiropractic care. Before treatment, verify that the chiropractor is properly licensed and certified. Reviewing patient testimonials and researching their experience helps in selecting a qualified professional.
During the initial consultation, be completely forthcoming with your medical history, even details that seem unrelated to your back pain. This includes disclosing pre-existing conditions like severe osteoporosis, history of spinal surgery, or the use of blood-thinning medications. Bringing recent imaging results, such as X-rays or MRI reports, allows the chiropractor to fully assess your spinal structures.
It is appropriate to ask specific questions about the planned treatment, including the type of manipulation that will be used. Seek informed consent, ensuring the practitioner clearly explains the procedure and any expected sensations. If you feel nervous or uncomfortable during the session, you have the right to ask the chiropractor to stop or modify the technique.
A red flag suggesting inappropriate techniques is feeling significant, sharp, or radiating pain during the adjustment, beyond the expected pressure. A practitioner who dismisses your medical history or insists on a high-force technique without considering alternatives should prompt you to seek a second opinion.