The Safety of Chiropractic Adjustments

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. There are many different conditions that have been treated using chiropractic manipulation, and the goal is to improve spinal motion and relieve symptoms.

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.

Chiropractic Adjustment

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

The goal of a chiropractic adjustment is to restore normal joint function and muscle balance. Treatments are also promoted for reducing stress on the immune system or reducing the potential for disease—although there is no evidence that chiropractic treatment impacts the immune system or the susceptibility to disease. Chiropractic care aims to treat the entire body, including a person’s ability to move, perform, and even think.

What Research Shows

Here's what some of the research says about the benefits and safety 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. Treatment options include exercise, natural therapies, medications, steroid injections, and surgery.

Research Trial

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. 
• Simulated manipulations involved electrical muscle stimulation with electrodes placed on the skin to send electrical pulses to different parts of the body.

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

Study Limitations

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 in the study. Therefore these results may not apply to all types of sciatica and/or back pain.

Furthermore, this study included one type of manipulation, and may not reflect the efficacy of all types of manipulations.

Neck Pain

Neck pain is very common, especially as a result of prolonged postures—like sitting at a computer for hours on end. Neck pain can be caused by spine disease, nerve compression, muscle stiffness, and more.

Research Trial

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:

• 57% of the chiropractic group achieved pain reduction
• 48% received pain reduction from exercising
• 33% achieved pain reduction from medication

Limitations

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

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.

Research Results

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.

Limitations

The authors reported evidence that chiropractic care might 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

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).

A second 2017 review looked at 118 articles and found frequently described adverse events included 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. It is not recommended for people 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 healthcare provider. 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 (DO). 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.