This is the question asked by the American Chiropractic Association. And this is their answer [the numbers in square brackets were inserted by me and refer to my comments below]:

Chiropractic is widely recognized [1] as one of the safest drug-free, non-invasive therapies available for the treatment of neuromusculoskeletal complaints [2]. Although chiropractic has an excellent safety record [3], no health treatment is completely free of potential adverse effects. The risks associated with chiropractic, however, are very small [4]. Many patients feel immediate relief following chiropractic treatment [5], but some may experience mild soreness, stiffness or aching, just as they do after some forms of exercise [6]. Current research shows that minor discomfort or soreness following spinal manipulation typically fades within 24 hours [7]…

Some reports have associated high-velocity upper neck manipulation with a certain rare kind of stroke, or vertebral artery dissection [8]. However, evidence suggests that this type of arterial injury often takes place spontaneously in patients who have pre-existing arterial disease [9]. These dissections have been associated with everyday activities such as turning the head while driving, swimming, or having a shampoo in a hair salon [10]. Patients with this condition may experience neck pain and headache that leads them to seek professional care—often at the office of a doctor of chiropractic or family physician—but that care is not the cause of the injury. The best evidence indicates that the incidence of artery injuries associated with high-velocity upper neck manipulation is extremely rare—about one to three cases in 100,000 patients who get treated with a course of care [11]. This is similar to the incidence of this type of stroke among the general population [12]…

When discussing the risks of any health care procedure, it is important to look at that risk in comparison to other treatments available for the same condition [13]. In this regard, the risks of serious complications from spinal manipulation for conditions such as neck pain and headache compare very favorably with even the most conservative care options. For example, the risks associated with some of the most common treatments for musculoskeletal pain—over-the-counter or prescription nonsteroidal anti-inflammatory drugs (NSAIDS) and prescription painkillers—are significantly greater than those of chiropractic manipulation [14]…

Doctors of chiropractic are well trained professionals who provide patients with safe, effective care for a variety of common conditions. Their extensive education has prepared them to identify patients who have special risk factors [15] and to get those patients the most appropriate care, even if that requires referral to a medical specialist [16].


  1. Appeal to tradition = fallacy
  2. and every other condition that brings in cash.
  3. Not true.
  4. Probably not true.
  5. The plural of anecdote is anecdotes, not evidence.
  6. Not true, the adverse effects of spinal manipulation are different and more severe.
  7. Not true, they last 1-3 days.
  8. Not just ‘some reports’ but a few hundred.
  9. Which does not mean that spinal manipulation cannot provoke such events.
  10. True, but this does not mean that spinal manipulation cannot provoke such events.
  11. There are other estimates that gives much higher figures; without a proper monitoring system, nobody can provide an accurate incidence figure.
  12. Not true, see above.
  13. ‘Available’ is meaningless – ‘effective’ is what we need here.
  14. The difference between different treatments is not merely their safety but also their effectiveness; in the end it is the risk/benefit balance that determines their value.
  15. Not true, there are no good predictors to identify at-risk populations.
  16. Chiropractors are notoriously bad at referring to other healthcare professionals; they have a huge conflict of interest in keeping up their cash-flow.

So, is chiropractic a safe treatment?

My advice here is not to ask chiropractors but independent experts.


13 Responses to Is chiropractic treatment safe?

  • @ Edzard

    What do you think of Roger Kerry’s work on manipulation and mobilisation of the cervical spine and cervical artery dysfunction?

  • @ Edzard

    I think I asked you first!

      to answer the question, I would like to know what you think it shows.
      because, if you thought that it shows that ‘at-risk’ patients can be identified before treatment, I beg to differ. and in that case, I would not think highly of the authors to mislead people in thinking so.

  • @ Edzard

    I think the article is providing guidance in the assessment of patients for the likelihood of stroke in advance of cervical manipulation.

    Personally, I still don’t think cervical manipulation or even mobilisation should be used for patients with neck pain.

    But it seems to me an independent expert like Roger Kerry has a different opinion to you about cervical spine manipulation.

      I am not sure because the document is not about spinal manipulation.
      It is a suggestion how to prevent adverse events from spinal manipulation.
      My problem with it is that I have no idea whether the suggestion works – neither has he.

  • The events of 1940 were the end of what ALL Physicians in the US must always do first to be able to “first do no harm.” In that year, a surgeon was allowed to use x-ray evidence, witnessed on an image, to diagnose arthritis, to justify removing “a bad hip joint” for the treatment of chronic hip pain.

    What a giant leap forward in medical science and technology!?
    NO, it was not!
    The removal of any joint structures to treat chronic physical pain is ALL WRONG! This single misstep was, in reality, a giant leap backward into the dark ages of barbarism and federally protected legalize quackery.

    In reality, the most common, ordinary, reasonable, logical, and all natural site and location for physical pain is within muscle tissues. The treatment for muscle tissues from a historical standpoint fall along a “force-energy” spectrum of daily flexing and stretching, range of motion, hands-on and manipulative deep muscle tissue release, lots of manual labor in the form of massage, kneading, pushing, and pulling.

    The most spectacular ways and means to help and assist deeply seated wounds and scars within muscle tissues is with the help of thin and hypodermic needling.

    In reality, muscles are the only tissues within the human body that has an absolute daily requirement for assistance to pull out the kinks, knots, to release the contractions, which will allow natural healing to occur from the inside.

    In reality, muscles which do not receive their allotment of care and services will fill up with stresses, strains, wounds, and scars over time and choke normal functioning. This is muscle failure. Muscle failure is chronic pain, dysfunction, malfunction, dysregulation, physical, weakness, muscle atrophy, and dystrophy, ultimately corrupting all of the other ten organ systems. Muscles which are full of stresses strains wounds and scars is muscle failure, and muscle failure will eventually lead to multiple organ systems failure.

    Once you replace the muscle system back into the standard of care. It becomes clear that there is an expert system step process of 1-2-3 of what physicians must always do first to be able to “first do no harm.”

    Step 1: The most common reason for office visits are related to life and living, stresses, strained, contusions, collisions, concussions, fictions, and fractures. The remedy for the stresses and strains of life and living requires a daily recipe of actions. I refer to this daily restoration recipe prescription as RX1. The ACTIONs of RX1 can be viewed on a pneumonic SSRMD; Sleep, Stretching, Retreat, Muscle maintenance and Divine maintenance.

    Step 2: the 2nd most common reason for office visits are related to infectious diseases and other TRUE medical problems which require drug regimens.

    Step 3: The least common reason for office visits are related to catastrophic deadly events which require surgical intervention.

    Within this complete paradigm, most all of the modern medical terminology must be archived because it didn’t fit the all-inclusive, holistic, human lifestyle and diseases. For example, there is no such disease as a migraine. There are various degrees of a headache all of which are due to stress and strain from life and living.

    The resolution of headaches requires daily actions. Thus there is no need for Doctor to invent a diagnosis because there are no medications which will replace the actions which are needed to resolve the stresses and strains of life and living.

    Within this paradigm, there is no such thing as a migraine because all headaches are treated with RX1.

    All of these paradigms are worthless and valueless because they are flawed and must be archived for educational, historical and entertainment purposes:
    • Stress and strain pain and use of ancillary radiologic services.
    • Opium and cocaine derivatives for the treatment of stress and strain resolved with RX1.
    • Migraines and the use of medication.
    • Nerve pain in the use of drugs.
    • Low back pain in the use of surgical interventions.
    • Sciatica and the use of surgical interventions.
    • Leg pain in the use of joint replacements.
    • Hand pain in the use of surgical interventions.


      • In case you are not aware, Stephen Rodrigues, MD is an actual medical doctor who has turned his back on real science and now only believes in acupuncture. He was a very prolific poster on Science Based Medicine for a long time, where he was, much like Iqbal, one of the resident laughingstocks. He hasn’t posted there in years. I assumed he had been banned.

        Just so you know with whom you are dealing.

  • Hi Stephen!
    Hace mucho que no te veo 🙂

    It’s a pity you do not seem to have learnt anything about medicine or health care since we were trying to teach you hygiene on the SBM-blog a couple years back. If anything, your incoherent ramblings above are less in harmony with reality than back then.

    I am wondering if I should be surprised, sad or both, to see, when looking at your latest YouTube videos, that you are still not using basic hygienic precautions!! You were told off by the gang at SBM about your filthy fingering habits when needling people… and yourself. We did try to teach you to think of pathogens when you stick people, and yourself. I recall seeing some video after that, where you had a glove on one hand when sticking? Perhaps it was the one where you were ardently trying to give the poor customer a pneumothorax by trying to puncture the apex of his lung at the neck? (Can’t find that video. Did you take it away because we told you off about the perils you were playing with?
    Anyway, now this only glove of yours seems to have been discarded and you are again happily puncturing your poor customers with both hands bare – and even prattling on at the same time, without a mask. Try talking like that over a fresh petri dish with blood agar (stuff that bacteria grow in) and see all the nasty streptococci and other bugs growing from the tiny speckles of spittle that are always ejected when you speak. These buggers can cause very severe infections when they get carried into the soft tissues by your beloved but soiled needles. Of course an infection after needle puncture is an uncommon event but the consequences can be severe, even deadly. When you stick someone, or even yourself for your trigeminal neuralgia, you need to use precautions. An infection in the upper part of the face i.e. above the nostril level, may even seed into your brain via venous channels.
    Not so long ago, a man died from sepsis in Norway after being stuck in the hand by an acupuncturist. I don’t think you would like that to happen to miss Alice, do you Stephen?

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