How safe is chiropractic?
Modern Chiropractic dates back to 1895, and it grew from humble beginnings predominantly by helping ill people get well, and only in recent times with a focus on its pain relieving effects. A repeat question is; how safe are chiropractic adjustments, with the topics falling into a few differing categories.
IMMEDIATE REACTION
Every treatment method can result in a reaction. The vast majority of our patients respond positively. We advise however that the following could occur, but should mostly subside within 24 hours: stiffness, headache, local discomfort, fatigue. A small number of patients may react with stronger symptoms, such as pain at the site of treatment, however long-lasting effects are not expected. There is essentially no evidence to suggest risk of any significance following a well delivered adjustment.
LIGAMENT OVER-STRETCHING
Especially prevalent in Germany, this question possibly comes from the ‘einrenken’ method used by many doctors and therapists in the name of Chiropractic. In our opinion this unspecific joint manipulation likely has more risk of damage than classical, specific chiropractic adjustments. When overstretched, ligaments exhibit a condition known as ‘creep’, much like an over-stretched elastic band, but which over time return to normal length. Ligaments with creep are sensitive and likely painful, as in whiplash, or after long periods of poor sitting posture. One study(1) showed that ligaments stretched for 60 minutes needed ca 24 hours to return to normal, which if reducible to the fraction of a second of a chiropractic adjustment, means any possible overstretching will resolve itself effectively immediately. A joint is at most adjusted twice a week initially, so the likelihood of the joint becoming unstable is not based in logic. Conversely, joints left to stagnate through poor movement, do not maintain quality ligaments as they require movement. So fragile ligaments are more likely in the absence of chiropractic care.
CAN A BONE Break?
The way in which an individual is adjusted takes into account their known health conditions. The chance of a normal adjustment breaking a bone is remote, and we could not find any research or meaningful reporting of such. The main exception would be in the treatment with unreported / un-diagnosed osteoporosis. Since the bone weakening increases the potential for the bone to break under normal forces, with adjusting the ribs would be most likely affected. For this reason it’s important to let us know if you have a bone density problem..
INSURANCE PERSPECTIVE
Risk is the hallmark of insurance, and if chiropractic adjusting really was such a risky treatment, after 120 years of history, then the yearly premiums for chiropractors would reflect this. This is not the case, and even in the USA insurance rates for chiropractors are reasonable, and drastically cheaper than for medical doctors. In Germany we pay around €300 per year.
IS STROKE A CONCERN?
Either side of the neck bones run 2 vertebral arteries, within the bone structures themselves. The argument is that a risk exists during an adjustment that may damage the interior lining of the artery (dissection), leading to a clot which if it floats loose will then reach the brain and cause a stroke. This topic is extensively covered in the literature, but is best summarised by explaining how medicine came up with an answer.
The United Nations and the World Health Organisation created the Neck Pain Task Force in 2002. They were partly tasked with reviewing the stroke / chiropractic issue. Their findings resulted from a 6-year review of more than 31.000 research citations, and a subsequent analysis of over 1000 studies.
The medical opinion(2) is that in the early stages of dissection, neck pain &/or headache are common, and a patient is as likely to seek chiropractic care or their doctor due to the symptoms. The risk of stroke for the patient is considered identical as a result of this review. The researched medical opinion is that the risk of stroke seeing your doctor is the same as seeing your chiropractor. In other words, there is no additional risk from the adjustment(2).
This does not mean that it cannot occur, but the link is due more to timing of the appointment and the stroke event itself, and not the treatment. Reported events occur 0,000008% of the time(3).
Isn’t it dangerous for children or older adults?
Chiropractic techniques are modified to suit the individual. There is no known specific dangers with adjusting children, pregnant women, or older adults. This has been the subject of a major review in Australia in 2019, with the conclusion that while research is weak, there is no evidence of danger adjusting children / babies. Each group has special considerations, but when taken into account, we do not consider there to be significant concern in adjusting anyone of any age.
WHAT DOES RISK MEAN?
Risk is ultimately a question of statistics. The risk of dying a car accident is around 1 in 7000, from medication 1 in 40,000, and from surgery 1 in 100,000. Yet because so many medical / surgical interventions take place, in the USA for example, medical care is the third leading cause of death.
There are perhaps too few Chiropractors in Germany to have any statistics, the majority are in the USA with around 70,000 DCs. It would be fair to say that several million people would be adjusted every day, and yet you will never see chiropractic appear on any risk list, simply because almost nothing adverse occurs. ,
The intention here is to put risk into perspective. A short duration reaction to an adjustment is relatively common, but typically with no long term detrimental effects. Muscle soreness, headache, stiffness are most commonly reported, lasting typically less than 24 hours. The risks associated with almost all forms of medical intervention are catastrophically higher, with medical intervention being the leading cause of unintentional death(7). If the calculated risk associated with chiropractic adjustments was applied to a medical treatment, that treatment would be considered 100% safe.
It can be quite difficult to obtain good facts and research about chiropractic (there is not as much of it as we need), so mostly when others accuse chiropractic of some hidden danger, it mostly comes from a pre-conceived opinion. For that reason this ChiroNews was created to address these issues and clarify any concerns you may have
REFERENCES
Twomey L, Taylor J. Flexion creep deformation and hysteresis in the lumbar vertebral column.Spine. 1982 Mar-Apr; 7(2):116-22.
Risk of Vertebrobasilar Stroke and Chiropractic Care SPINE 2008, Feb 15; 33: S176–183
Cohn A. A review of the literature regarding stroke and chiropractic. J Vertebral Subluxation Res 2001;4: 52-9
Coile RC Jr. Internet-driven surgery. Russ Coiles Health Trends . 2003 Jun;15(8):2-4
G Singh. Recent considerations in nonsteroidal anti-inflammatory drug gastropathy. American Journal of Medicine 1998 105(1B): 31S-38S
www.nsc.org/learn/safety-knowledge/Pages/injury-facts.aspx
www.webdc.com/pdfs/deathbymedicine.pdf