Is Chiropractic Manipulation Safe?

Is Chiropractic Manipulation Safe?

Chiropractic manipulation is regularly sought for treatment of neck pain and headache as there is evidence that it can improve neck pain and certain headaches. Yet, there is concern that chiropractic manipulation may cause stroke despite its being very rare.

For years, there has been much discussion on whether stroke is related to manipulation. A literature review showed that there have been five case-controlled studies addressing the issues with no conclusive result.

In 2016, a study published in the Journal of Stroke and Cerebrovascular Disease investigated the relationship between the risk of vertebrobasilar stroke and chiropractic care. The study showed that stroke might not have been the result of manipulation. In this study, the researchers compared the association between both chiropractic services and primary care physician services prior to stroke from damage to the vertebral artery. Results showed that there were strong associations between chiropractic services and stroke in those less than 45 years of age, but similar associations were seen for the primary care physician services. There was no significant difference of incidence of stroke of patients taken care of by the two different types of health care practitioners. This suggested that the patients with impending stroke seek chiropractic treatment. Regardless of whether chiropractic treatment is provided, the patient would have the stroke ultimately, giving the false impression that chiropractic manipulation had caused the stroke.

In 2015, WHO published a report stating that chiropractic manipulation by a registered chiropractor is safe. Different studies have put the incidence of arterial stroke syndrome to be less than 1 in 2 million to 5.6 million chiropractic manipulations.

All in all, it is possible that there might be an association between chiropractic manipulation and vertebrosilar stroke (many patients with severe occipital headache and posterior nuchal pain seek chiropractic treatment), but manipulation does not cause stroke.

  • sharp and severe occipital headache
  • posterior nuchal pain
  • nausea and vomiting
  • diplopia
  • vertigo

1. World Health Organization. WHO guidelines on basic training and safety in chiropractic. 2005
2. Coulter ID, Hurwitz EL, Adams AH, et al. The Appropriateness of Manipulation and Mobilization of the Cervical Spine. Santa Monica, CA; RAND 1996.
3. Haldeman S, Carey P, Townsend M, Papadopoulos C. Arterial dissections following cervical manipulation: the chiropractic experience. Can Med Assoc J 2001;165(7):905-6.
4. Cassidy JD, Boyle E, Côté P, Hogg-Johnson S, Bondy SJ, Haldeman S. Risk of Carotid Stroke after Chiropractic Care: A Population-Based Case-Crossover Study. J Stroke Cerebrovasc Dis. 2016 Nov 21
5. Cassidy JD, Boyle E, Cote P, et al. Risk of vertebrobasilar stroke and chiropractic care: results of a population-based case-control and case-crossover study. Spine 2008;33(No. 4S):S176-83.
6. Triano J, Kawchuk G. Current Concepts in Spinal Manipulation and Cervical Arterial Incidents. Clive IA: NCMIC Chiropractic Solutions; 2006.