Are Chiropractic Adjustments Safe?

One of the most common questions we hear from people is: Is chiropractic safe?  

And what they typically mean by this is: Do adjustments cause strokes?  

Let’s dive into this.  

In terms of research, many studies we have do not support adjustments as a cause of stroke:

• A 2019 study published in Annals of Medicine concluded that there is no excess risk of stroke for chiropractic manipulation compared to primary (medical doctor) care. (1)
• A 2016 systematic review published in Cureus, Journal of Medical Science stated that there is “No causal link between chiropractic manipulation and coronary artery dissection (stroke).” (2)
• A 2008 study with 9 years of compiled information published in Spine Journal concluded that there is “No evidence of excess risk of stroke associated with chiropractic care compared to primary (medical doctor) care.” (3)
• A 2015 case-control study published in Chiropractic Manual Therapy concluded, “We found no significant association between exposure to chiropractic care and risk of VBA stroke. We conclude that manipulation is an unlikely cause of vertebral artery stroke.” (4)

Depending on the source of information, the risk of stroke occurring following a chiropractic adjustment is somewhere between 1 in 250,000  to 1 in 10 million.  

Additionally, these studies indicate that strokes occur at the same rate in chiropractic offices as they do in medical offices. Why? It is likely because these patients are already in the process of having a stroke before they come in. The reason they have neck pain and headaches is because a stroke is already in progress.

I hope I have demonstrated that the risk of stroke with chiropractic adjustments is extremely low. It’s worth mentioning that this is reflected in the cost of chiropractic malpractice insurance, as this is roughly 1/10th the cost of medical doctor malpractice insurance as chiropractic care typically does not cause harm in patients.  

But let’s be clear that there ARE RISKS. The number is not 0. There are risks in all medical treatments and chiropractic adjustments are not absolved from this.  

So, what do we do to mitigate this?  

First, we take an extremely thorough history. We identify any risk factors that are associated with increased risk of stroke. We discuss the progression of the patient's symptoms. We discuss the intensity of the patient's symptoms. We identify any red flags.  

Second, we take a thorough physical exam. Strokes often have some sort of numbness or paresthesia associated with them, so we do a thorough neurological exam. We perform the Cincinnati Pre-hospital Stroke Scale in our office. We also perform orthopedic exams. We further try to pin down any red flags.  

The results of this history and examination guide our treatment, not the other way around. The unfortunate truth is that there are many chiropractors out there who’s only tool is the adjustment, so the adjustment actually guides any clinical decision-making…which is backwards and potentially dangerous.  

Ultimately, if we have determined that this patient is not having a stroke in progress nor is at increased risk of stroke, we STILL weigh the benefits of cervical (neck) adjustments against other treatment modalities. Will this person benefit from a cervical adjustment? Do they not want to get a cervical adjustment? (A factor far too many chiropractors ignore.)  

Cervical adjustments are fantastic for decreasing pain and improving joint mobility SO THAT we can do other treatments, such as rehab and soft-tissue work. But they are not required.

If we have clinically determined that a cervical adjustment will be of benefit to the patient, that they are not at increased risk of stroke based on a thorough assessment, and that they are comfortable with receiving cervical adjustments, then we can be confident in using it as a part of our treatment plan.  

If your chiropractor is not taking these precautions when treating your neck condition, then I would recommend seeking someone else for your care.                  

References:

1) Chaibi A, Russell MB. A risk-benefit assessment strategy to exclude cervical artery dissection in spinal manual-therapy: a comprehensive review. Ann Med. 2019 Mar;51(2):118-127. doi: 10.1080/07853890.2019.1590627. Epub 2019 Apr 6. PMID: 30889367; PMCID: PMC7857472.  

2) Church E W, Sieg E P, Zalatimo O, et al. (February 16, 2016) Systematic Review and Meta-analysis of Chiropractic Care and Cervical Artery Dissection: No Evidence for Causation. Cureus 8(2): e498. doi:10.7759/cureus.498

3) Cassidy JD, Boyle E, Côté P, He Y, Hogg-Johnson S, Silver FL, Bondy SJ. Risk of vertebrobasilar stroke and chiropractic care: results of a population-based case-control and case-crossover study. Spine (Phila Pa 1976). 2008 Feb 15;33(4 Suppl):S176-83. doi: 10.1097/BRS.0b013e3181644600. Erratum in: Spine (Phila Pa 1976). 2010 Mar 1;35(5):595. PMID: 18204390.  

4) Kosloff TM, Elton D, Tao J, Bannister WM. Chiropractic care and the risk of vertebrobasilar stroke: results of a case-control study in U.S. commercial and Medicare Advantage populations. Chiropr Man Therap. 2015 Jun 16;23:19. doi: 10.1186/s12998-015-0063-x. PMID: 26085925; PMCID: PMC4470078.