For years doctors have said that Chiropractic treatment is dangerous.
“Watch out they can hurt you”. They have claimed that neck manipulation is particularly dangerous, “It causes stroke” and “it is a regular occurrence” and “it should be banned”. There are some alarmists out there who try to exaggerate the risks.
Chiropractic manipulation is a very controlled manoeuvre and side effects from the treatment are very rare. There has been a lot of research into our treatment and patient satisfaction is always reported to be very high.
But as with any therapeutic procedure there are possible side effects and risks involved. Did you know that the frequency of serious side-effects from taking over the counter painkillers are higher that Chiropractic treatment!
So what are the side effects of Chiropractic treatment?
About half the patients have some form of reaction to the treatment, but fortunately symptoms in the majority (85%) are mild. Local discomfort and tiredness are the most common side effects, which disappear within 24 hours for most (74%). This study done in 1997 included 4712 treatments on 1058 new patients. LINK to research.
A more recent study, published in Spine in 2007, had very similar findings. It included 19,722 treatments, which is a very big study. The aim of the study was to find out what effects the treatment had and possible side effects of the treatment. The findings were very similar to the study above. LINK to research.
In both studies above no serious side effects were reported.
The most serious, but rare risk, is that of a vertebral or carotid artery dissection and stroke following cervical manipulation.
The incidence of stroke in previous studies has ranged between 1 in 100,000 to 1 in 5.85 million treatments. The important thing to remember is that these studies never showed that chiropractic treatment had caused the stroke but that there was an association with the treatment (which mean that the person had been to a chiropractor before the incident).
A research article in 2001 determined the risk of such a stroke to occur in 1 in 5.85 million neck manipulations. LINK to research.
Another study determined that there was a risk of 1.3 strokes per 100,000 manipulations one week after a manipulation. But in this study they couldn’t be sure the cause was the manipulation due to the time delay.LINK to research.
This should be put in comparison to the rate of spontaneous vertebral artery dissections, ie. without manipulation, which is estimated to be about 1-3 per 100,000 persons. LINK to research, LINK to more research.
Those figures suggests that it is more likely to have a stroke from everyday activities such as turning the head reversing the car, looking up at fire works, painting the ceiling, having your hair washed at the hair dressers, doing pilates and yoga, and many more common activities.
Research has shown that the arteries in the neck do not undergo any more strain in chiropractic treatment compared to neck movements in normal daily activities. This probably came as no surprise to most chiropractors as a normal adjustment of the neck rarely involves much more than 45° of rotation and slight extension. This is a position that most people do routinely in normal activities several times every day. LINK to research.
Some important recent research into the safety of neck manipulation has shown that chiropractic neck manipulation is a very low-risk treatment if performed by skilled manipulators such as chiropractors. In fact there are more risks associated with taking non-steroidal anti-inflammatory painkillers (NSAID’s), the painkillers commonly bought over the counter and regularly prescribed by doctors, such as ibuprofen and aspirin.
In the USA 16,500 people die each year from the use of NSAID’s. Read more about painkillers here.
Recent reviews are also seriously questioning the effectiveness of using painkillers for lower back pain, especially considering the risks. LINK to research.
New research by the prominent researcher, Dr David Cassidy, published in January 2008, a nine-year study that showed that the incidence of vertebral artery (VBA) stroke is not higher after seeing a chiropractor than a GP (family physician)!
Family physicians do not manipulate, so why did people suffer stroke after seeing their GP? Well, the explanation is that the people already where in the middle of having a stroke when they contacted their chiropractor or GP. Neck pain and headache are common symptoms of VBA dissection and typically precede VBA stroke and people experiencing headache and neck pain may choose to consult a chiropractor or GP. Read more. LINK to research.
In October 2007 a study, done in the UK, looking at the safety of chiropractic neck manipulation, collecting data from 19,722 patients, concluded:'...the risk of a serious adverse event...was low to very low'. LINK to research.
Everybody have agendas, including chiropractors and you might argue that as a chiropractor we would like to understate any risk.
Any responsible person would like to know if what they are doing or planning to do would carry any risks both to themselves and to other people, some might not. But the majority of chiropractors, in my opinion, certainly would. I have never met a chiropractor that doesn’t treat their colleagues, friends, family members and even their own children. If there was a serious risk, I am sure they would want to know.
If the risk were as high as some people claim, we would see several thousands, or even hundreds of thousands of cases being reported every year in the medical literature and in the media, based on the number of treatments performed every year, and that is not the case.
So the studies that say that the incidence of stroke is 1 in 5.85 million are probably right, but it seems that the stroke that occurs is not down to the chiropractor but is an event that is already in progress when the patient arrives to the chiropractor. LINK to research.
In fact, there is a greater risk of death from activities such as driving a car, pregnancy, taking birth control pills and other normal activities than from receiving neck manipulation. Dinman, B.D.; The Reality and Acceptance of Risk; Journal of the American Medical Association, Vol. 244 (11): 1126-1128, 198. LINK to research.
Less conservative treatments such as neck surgery are also used for conditions very similar to the conditions treated with spinal manipulation. According to research there is a 3-4% rate of complication for cervical spine surgery, and 4,000-10,000 deaths per million neck surgeries. (Source: The cervical spine research society editorial committee. The Cervical Spine, Second edition. Philadelphia: J.B. Lippincott Company 1990: 834.)
And if you are considering lumbar spinal surgery, there is a risk of death of 7 persons per 10,000 surgeries.
Let us look at other activities and the risks they carry. This information is taken from a research article from the Journal of the American Medical Association in 1980.
|Activity||Risk of Death per Person per Year|
|Smoking: 20 cigarettes/day||1 in 200|
|Drinking: 1 bottle of wine per day||1 in 13,300|
|Football (Soccer)||1 in 25,500|
|Automobile racing||1 in 1,000|
|Automobile driving (UK)||1 in 5,900|
|Motorcycling||1 in 50|
|Rock climbing||1 in 7,150|
|Taking contraceptive pills||1 in 5,000|
|Power boating||1 in 5,900|
|Canoeing||1 in 100,000|
|Horse racing||1 in 740|
|Amateur boxing||1 in 2 million|
|Professional boxing||1 in 14,300|
|Skiing||1 in 430,000|
|Pregnancy (United Kingdom)||1 in 4,350|
|Abortion: Legal: <12 wk||1 in 50,000|
|Abortion: Legal: >14 wk||1 in 5,900|
(Source: Dinman BD. The reality and acceptance of risk. Journal of the American Medical Association 1980; 244(11): 1226-1228.)
Why would anybody want to exaggerate the risk of chiropractic treatment?
First of all, exaggerating the risk would serve to undermine the treatment and put people off using it, so who would benefit from that?
Probably anybody who is treating similar conditions would benefit, anybody who manufactures pain medication would benefit and anybody who feel threatened, or has an axe to grind may be motivated to do it.
In the 1970’s the medical profession in the USA (American Medical Association (AMA)) was taken to court by four chiropractors claiming that they were undermining the chiropractic profession. The AMA and its officials were guilty, as charged, of attempting to eliminate the chiropractic profession. They lost, so there must be a few people who felt hurt. Maybe they are still hurt? Read more about the trial.
There have been some very elaborate attempts in the UK to discredit chiropractic in recent times. For example, Professor Edzard Ernst has made several statements to the press over the last few years on the risk of chiropractic treatment, which were published. Unfortunately he muddled up the facts and exaggerated the risk, which was great for the press because it sold papers. In one of the articles he said that chiropractors should get their act together and research the subject – and he was right on that point.
In 2007 Professor Ernst published a research review on reviews on chiropractic treatment. It was a very skilful attempt to discredit chiropractic. He found that there was no evidence that chiropractic treatment was effective and on top of that, it was dangerous. The press loved it! LINK to Ernst's JRSM article.
In November 2007 several UK newspapers reported on a piece of research from Australia, where physiotherapists had used manipulation and compared it to taking painkillers for helping acute back pain. They found no benefit of using manipulation.
The headline in UK newspapers where ‘Chiropractic treatment found to be ineffective’.
They failed to notice that the manipulators where not Chiropractors but manipulating physiotherapists.
All this study proved was that physiotherapeutic mobilisation in isolation is not more effective than the other treatments in this study.
If they had researched the subject a bit more thoroughly they would have noticed that there is a fundamental difference between mobilisation, which was used in this study, and manipulation used by Chiropractors.
They would also have known that Chiropractors do not only use manipulation, but we combine our treatment with exercise, nutritional advice, give advice on life style changes etc. So this study could not have been further from representative of Chiropractic treatment if they had tried. LINK to research.
Now, several good research articles have been published since then but none of them have been mentioned in the press. The reason being that ‘our readers wouldn’t be interested in reading about that’. Fair enough, you wouldn’t expect a newspaper to print something that wouldn’t sell papers.
These are a few examples of how people are trying to discredit chiropractic treatment. One benefit of this is that it keeps us on our toes and spurs on the researchers to continue to provide top class research for the chiropractic profession.
Chiropractors are trained in finding out who is at risk to a certain treatment method and can select the method that is going to be most appropriate and safe for you. Chiropractors are trained in medical diagnosis in order to rule out underlying medical conditions that are not suitable for our treatment, and can refer you to the appropriate person for other treatment if needed.
Chiropractors are highly trained in manipulation and therefore know how to use it safely, compared to other therapists who have taken a short course in manipulation.
We are always trying to give our patients the best possible care and research has shown that the risk of side effects of chiropractic treatment is very small.
We are also happy to say that the Isis Chiropractic Centres have not had any patients with any serious side effects as a result of our treatment since we started in 1986.
If you want to discuss any of the subjects, please feel free to contact us.