Chiropractic care is a treatment focusing on the body’s musculoskeletal system, particularly the spine. The primary therapeutic approach is spinal manipulation, often referred to as an adjustment. This procedure involves a trained practitioner applying a controlled, sudden force to a spinal joint using their hands or a small instrument. The goal of this high-velocity, low-amplitude thrust is to improve spinal motion and overall physical function. While the treatment is generally considered safe and effective for many patients seeking relief from neck, back, and joint pain, like any physical intervention, it carries potential risks and adverse events. This article focuses on these potential risks, ranging from common, minor discomforts to extremely rare, serious complications.
Expected Minor Discomfort
The most common reactions following a spinal adjustment are mild and temporary. Many patients report experiencing localized soreness or stiffness in the area that was treated, often likened to the feeling after a strenuous workout. This discomfort occurs as the adjustment may activate muscles that were previously restricted.
Mild headaches and fatigue are also frequently reported side effects. These transient symptoms typically appear shortly after the treatment session and are short-lived, resolving completely within 24 to 48 hours. They are considered a normal post-treatment reaction as the body adjusts to changes in joint mechanics.
Some individuals may experience a temporary worsening of pre-existing pain or mild flu-like symptoms. Less common reactions include a brief sensation of dizziness or tingling, which usually dissipates quickly. These minor side effects do not typically require medical intervention and are managed with rest and hydration.
Vascular and Neurological Complications
A more serious, though rare, category of risk involves vascular and neurological complications, primarily associated with high-velocity manipulation of the cervical spine (neck). The most publicized complication is vertebral artery dissection (VAD). The vertebral arteries travel through the cervical vertebrae to supply blood to the brain, and the rapid, rotational movements of a high-velocity neck adjustment can cause a tear in the artery lining.
A dissection can lead to the formation of a clot, which may subsequently dislodge and travel to the brain, resulting in an ischemic stroke or a transient ischemic attack. The incidence of a serious adverse event like a stroke following cervical manipulation is extremely low, with estimates placing the risk in the range of one event per several hundred thousand to one million manipulations.
Beyond VAD, other neurological risks exist. Lumbar (lower back) manipulation has been linked, in isolated cases, to a herniated disc progressing to cauda equina syndrome (CES). CES is a medical emergency where nerve roots at the end of the spinal cord become compressed, potentially leading to loss of bladder or bowel function and permanent paralysis. Nerve root compression or damage, resulting in persistent numbness, tingling, or muscle weakness, can also occur following spinal manipulation.
Conditions That Preclude Treatment
A thorough patient history and physical examination are essential because certain underlying health issues represent contraindications, or conditions where spinal manipulation should be avoided or significantly modified. These conditions can make the patient more susceptible to injury from the forces applied during an adjustment. Absolute contraindications are conditions where manipulation should never be performed due to an unacceptable risk of severe harm.
Examples of absolute contraindications include severe or advanced osteoporosis, which significantly weakens the bone structure and increases the risk of vertebral fracture. Acute, unstable spinal fractures, dislocations, or tumors affecting the spine also make manipulation unsafe. Furthermore, acute disc herniation accompanied by progressive neurological deficits, such as rapidly worsening muscle weakness, is an absolute contraindication, as manipulation risks exacerbating the nerve compression.
Infections of the spine, such as osteomyelitis, or certain inflammatory conditions like rheumatoid arthritis with demonstrated cervical instability are also reasons to avoid manipulative techniques. Relative contraindications are conditions that require caution and modification of the technique, such as milder forms of osteoporosis or some types of disc herniations without severe neurological symptoms. The identification of these conditions is a necessary step in the pre-treatment screening process to ensure patient safety.
Patient Safety Measures and Selection
Patients can take steps to minimize their risk and ensure a safe treatment experience. Clear communication with the practitioner is crucial, particularly regarding all current symptoms, past medical history, and any pre-existing conditions like osteoporosis or vascular issues. Patients should immediately inform their chiropractor if they experience any new or unusual neurological symptoms, such as dizziness, changes in vision, severe headache, or uncharacteristic weakness. These symptoms can sometimes be warning signs of a vascular issue and require immediate medical referral rather than manipulation.
Informed consent is a foundational element of safe care, meaning the patient must fully understand the proposed treatment plan, including the potential risks and benefits, before proceeding. Patients should not hesitate to ask detailed questions about the specific techniques the chiropractor intends to use, especially for neck adjustments.
It is important to select a chiropractor who is properly licensed and accredited by the relevant state or national regulatory bodies. A licensed practitioner has met specific educational and training requirements, which helps ensure they are competent in proper diagnostic screening and technique application. Taking these actions empowers the patient to participate in a safe therapeutic relationship.