Chiropractic spinal manipulation (CSM) is the hallmark treatment of chiropractors worldwide. Close to 100% of patients consulting such a practitioner will receive CSM. While often promoted as safe, CSM can cause various harms, some of which are serious. Here’s a (probably incomplete) list:
Common Harms of CSM
- Musculoskeletal discomfort: Temporary soreness, stiffness, or pain in the muscles or joints after treatment.
- Headaches: Some individuals may experience headaches following spinal manipulation.
- Fatigue: Feeling tired or experiencing fatigue after treatment.
These harms occur after CSM in about 50% of all patients. They impact on their quality of life and usually last 1-3 days.
Serious Harms of CSM
- Vertebral artery dissection (VAD) and stroke: A tear in the vertebral artery can lead to stroke; the harm can be permanent.
- Death: A stroke can be fatal.
- Atlantoaxial dislocation
- Spinal cord injury: Damage to the spinal cord, potentially resulting in numbness, weakness, or paralysis.
- Herniated discs: Manipulation can exacerbate existing disc issues or cause a new disc herniation.
- Fractures: Osteoporotic patients or those with bone conditions are at risk of vertebral fractures.
- Cauda equina syndrome: Compression of nerves in the lower spine, potentially causing bowel or bladder dysfunction.
- Nerve damage: Injury to spinal nerves, leading to numbness, tingling, or weakness.
- Eye Injuries: these include central retinal artery occlusion, nystagmus, Wallenberg syndrome, ptosis, loss of vision, ophthalmoplegia, dipiopia and Horner’s syndrome.
The frequency of these harms is not known.
Other Risks
- Neglect: This happens whenever a chiropractor treats a condition that can more effectively be treated with another therapy.
- Misleading advice: This occurs whenever a chiropractor gives advice outside his area of competence, for instance, a recommendation against immunisations.
- False diagnoses: Chiropractors often diagnose a ‘vertebral subluxation’, a condition that exists only in their fantasy.
- Worsening of existing conditions: Manipulation may exacerbate underlying spinal problems or conditions like spinal instability.
- Waste of money: This occurs each time a patient pays for ineffective CSM.
The frequency of these risks is not well-documented but can be estimated to be very high.
_____________________________
I have often pointed out that the value of a therapy is not solely determined by its potential for harm. It depends crucially on the risk/benefit profile. The benefits of CSM are few and mostly uncertain. Thus the question arises:
DO THE BENEFITS OF CSM OUTWEIGH ITS RISKS?
I let you, the reader, answer this question.
PS
References for the above statements can be found in my book.
27 Responses to Chiropractic spinal manipulation: what harm can it cause?
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As usual the position speaks lowder than the science in your case…
1. Spinal manipulation is not “chiropractic”
2. Many cases are not suitable for SMT and chiropractors has many other Techniques to employ.
3. Please provide proof of your claim SMT causes vertebral / carotid artery stroke (quoting your previous false claims is not enough)
References for the above statements can be found in my book.
What a pathetic attempt to whitewash chiropractic.
The first sentence of the article:
“Chiropractic spinal manipulation (CSM) is the hallmark treatment of chiropractors worldwide.”
As is obvious to those of us who’ve visited physiotherapists, osteopaths, and chiropractors: chiropractic spinal manipulation is not a synonym of spinal manipulation.
You have deployed an ambiguity fallacy:
“Description: When an unclear phrase with multiple definitions is used within the argument; therefore, does not support the conclusion.”
Chiros often claim that they didn’t cause the dissection, but that the person sought treatment for neck pain because they already had a vertebral artery dissection.
Even if that were the case, since chiros have no clinical way of excluding an existing dissection, how could they EVER justify applying high velocity force to the neck? It’s the breakage and throwing off of clot that causes stroke.
hear, hear!
Healthcare is based on probabilities not possibilities.
Healthcare is based on probabilities and chiropractic on BS.
DC,
There are 10 reasons listed on this website: https://wellfamilychiro.com/10-reasons-to-take-your-child-to-a-pediatric-chiropractor/ to take your kid to a pediatric chiro.
How many of those ten reasons are based on probabilities vs possibilities vs bullshit?
Please allow me to address the vile crap that you linked to in more detail:
“Pediatric chiropractic care is a specialty that concentrates on treating infants, toddlers, children, and teens in order to help align their spine …”
This is a lie.
Children’s spines do not need ‘alignment’ unless they have scoliosis or similar conditions – which would require treatment that chiro’s can’t offer.
“… and balance their nervous system.
This is a lie.
In what way is these kids’ nervous system ‘unbalanced’? What does ‘unbalanced’ even mean in this context? And how on earth can yanking the spine, neck and some muscles ‘balance’ the nervous system?
“It promotes a broad spectrum of benefits such as supporting growth milestones, …
This is a lie. How on earth does yanking the spine, neck and some muscles ‘support growth milestones’?
“… enhancing immune health,…”
This is a lie. Yanking the spine, neck and some muscles has no influence on the immune system whatsoever.
“… aiding in digestion,…”
This is a lie. Yanking the spine, neck and some muscles has no influence on children’s digestive health.
“… reducing ear infections and allergies,…”
This is a lie. Yanking the spine, neck and some muscles has no influence on any infections or allergies.
“… improving sleep,…”
Well, maybe this one has a kernel of truth: I wouldn’t be surprised if kids sleep better from exhaustion after being subjected to maltreatment by a chiro yanking their spine, neck and some muscles.
” and more. A pediatric chiropractor is has undergone specialized training…”
But this training is NOT pediatrics or proper medicine. Most of it is not even science-based or evidence-based.
“… to ensure that the care, evaluation, and adjustments they provide to kids correspond properly to their specific age, body type, and unique requirements.”
Kids have only a few essential requirements: love, good nutrition, plenty of exercise and education. Oh, and vaccines to keep them healthy, with regular health checks. Chiropractic is not among those requirements, ever.
“On bigger kids, we can incorporate fun activities into their adjustments, such as jumping.”
I suggest the fun activity of running. Away. Fast.
These are all lies from chiro’s in order to suck money out of hapless people by scaring them about their kid’s health.
Should any chiro beg to disagree on one or more of the above points: please get convincing evidence before responding.
So no one wants to discuss the topic that Sue brought up.
DC, We are discussing your response to Sue’s post. If you had something useful to say in that matter, you wouldn’t be making proclamations such as:
Here is another blog post by the same chiro, on benefits of chiropractic adjustments: https://wellfamilychiro.com/womens-health-chiropractic/.
Here is another chiro making similar claims: https://monittochiro.com/blog/15-unexpected-benefits-of-chiropractic-care
Since you appointed yourself as the resident chiro expert, I am asking you this question:
In light of the risks outlined in the professor’s post, do you think the claims made in the posts I linked above are based on possibilities or probabilities or BS? Understanding this distinction would help readers make a more informed decision about whether or not to pursue chiropractic care.
Talker: Sue brought up a specific concern regarding VAD. It is that concern that I responded to. If i wanted to branch into all the topics that Ernst blogged about I would have responded to him.
You neither addressed VAD nor answered Sue’s question. But sure, keep trying to gaslight the readers.
I will rephrase my last question: In light of risk of VAD, do you think the claims made in the posts I linked above are based on possibilities or probabilities or BS?
I’ll respond to Sue’s post. Sue, you are correct that dislodging a clot from an existing dissection is what causes stroke in cases of immediate post-manipulative stroke. However, numerous peer reviewed studies have been published with clinical examination strategies to exclude cervical artery dissection prior to cervical spine manipulation. These studies come from researchers in chiropractic, medicine, osteopathic medicine and physical therapy. For your consideration, see these links:
https://www.tandfonline.com/doi/full/10.1080/07853890.2019.1590627?rfr_dat=cr_pub++0pubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org#abstract
https://www.jospt.org/doi/10.2519/jospt.2022.11147
https://pmc.ncbi.nlm.nih.gov/articles/PMC7708008/
https://www.sciencedirect.com/science/article/pii/S0303846724005146?via%3Dihub
“numerous peer reviewed studies have been published with clinical examination strategies to exclude cervical artery dissection prior to cervical spine manipulation”
yes, but how reliable are the strategies?
Dr. E, the fourth reference above discusses validation.
I can say from my personal experience that I have reviewed 48 cases of stroke following CSM, 30 of which occurred immediately after CSM. If the strategies in the 2019 Chaibi study had been followed, erring on the side of caution, none of those strokes would have occurred.
You will likely ask for a clinical trial that shows the reliability of these strategies. I don’t know of one. But I would agree that more studies testing the reliability of these strategies would be helpful. Just not sure how it could be done when dealing with potentially life-threatening conditions such as CAD and stroke.
I think the standard of care is to err on the side of caution. If CAD cannot be excluded with these clinical examination strategies, don’t adjust. If there is any doubt, don’t adjust. Unfortunately, “not adjusting” is something the majority of chiropractors are not good at.
I’ve ordered a neck CTA exam eight times to exclude dissection prior to CSM. Never found it, but I erred on the side of caution.
If the victims had not been to a chiropractor, erring on the side of caution, none of those strokes would have occurred.
If …
“If” is all about POSSIBILITIES, not PROBABILITIES.
Those strokes did occur; probability = 1.
https://edzardernst.com/2025/01/katie-may-died-after-chiropractic-manipulation-but-thats-not-the-chiros-fault-or-is-it/#comment-154714
“If there is any doubt, don’t adjust.”
Unfortunately, “not adjusting” is something the majority of chiropractors are not good at. Key word: “MAJORITY” Adjusting is what they do, along with selling vitamin pills & warning their customers not to follow the advice of real doctors.
Mr. Brown has supplied us (inadvertently, no doubt) with the perfect answer to why chiropractic should not exist.
I do agree HVLA is often used too much and too soon.
https://pmc.ncbi.nlm.nih.gov/articles/PMC2786244/#:~:text=Manual%20manipulation%20of%20the%20neck,25%25%20in%20only%202%20others.
If the strategies in the 2019 Chaibi study had been followed, Katie May’s stroke would not have occurred.
I specifically said the stroke WAS the chiropractor’s fault for failure to diagnose and refer an existing left vertebral artery dissection to medical emergency.
I don’t understand how my paper could possibly be interpreted as saying the stroke was not the chiropractor’s fault.
Mr Brown wrote:
Perhaps you normally get away with issuing vacuous truth statements to whitewash chiropractic on other forums.
You wrote:
FALSE ANTECEDENT therefore it has the same vacuous truth value as the Wikipedia example:
Are chiropractors really this uneducated? Or is it a poor attempt at pious fraud?
Thanks for another (inadvertent, no doubt) illustration of why chiropractic should not exist.
“I don’t understand how my paper could possibly be interpreted as saying the stroke was not the chiropractor’s fault.”
That is not the point! The point is that chiros should keep their f***ing hands off their customers’ necks. Great risk, no conceivable benefit.
No conceivable benefit? That’s interesting since many MA and SR found otherwise.
The main “risk” appears to occur when the practitioner doesn’t do a proper history and exam.
The “proper history and exam” procedures are documented where?
I occasionally try to post in this forum when someone makes an intelligent comment, like Sue did earlier. But you are the most rude and disrespectful group of people I have ever encountered. You are incapable of having a rational conversation or debate without immediately resorting to insults and name-calling. Best of luck to you all.
@ Steven Brown
“you are the most rude and disrespectful group of people I have ever encountered. You are incapable of having a rational conversation or debate without immediately resorting to insults and name-calling.”
Sir, you omitted one other adjective…. arrogant.
arrogant = revealing an exaggerated sense of one’s own importance or abilities
I’m glad you mentioned your predominant quality, RG!