Manipulative therapy — commonly known in Chiropractic care as an adjustment—has been recognised as a generally safe and effective treatment for many conditions. However, as with any form of healthcare, it carries certain risks. It’s important to weigh the potential benefits against these risks and make informed decisions based on professional advice and personal circumstances.
What is a Chiropractic Adjustment?
A chiropractic adjustment involves a trained professional, a chiropractor, applying controlled force to specific joints in the spine. The goal is to enhance spinal mobility and support the nervous system, ultimately promoting better overall function and well-being.
Many individuals experience noticeable relief from pain or discomfort with Chiropractic care. Still, it’s essential to be aware of potential risks and side effects associated with this form of treatment.
Are Chiropractors Dangerous?
Generally, chiropractic care is safe when performed by a qualified and licensed chiropractor. However, certain risks and complications, while rare, are worth thinking about.
Neck Manipulation and Stroke Risks
One of the most debated concerns is whether cervical (neck) manipulation can lead to a stroke. The rare but possible complication is vertebral artery dissection, which can lead to a stroke.
- Risk Estimate: Approximately 1 in 5.85 million neck adjustments
- Clarification: Chiropractors do not break necks; adjustments involve high-velocity but
controlled movements. - This risk is statistically lower than the risks associated with driving or using NSAIDs for
pain relief.
Herniated Discs
Adjustments may aggravate pre-existing herniated discs or, in rare cases, cause new disc problems. Chiropractors screen patients carefully to avoid such outcomes.
Nerve Compression
In rare instances, spinal manipulation has been associated with nerve compression syndromes such as Cauda Equina syndrome, a serious condition requiring immediate attention.
General Chiropractic Reactions
Most side effects are minor and temporary, such as:
Local discomfort (53%)
Headache (12%)
Tiredness (11%), or radiating discomfort (10%)
Reactions were mild or moderate in 85% of patients. Sixty-four percent of reactions appeared within 4 hours of treatment, and 74% had disappeared within 24 hours.
Uncommon reactions were dizziness, nausea, hot skin, or “other” complaints, each accounting for 5% or less of reactions. It was unusual that symptoms commenced later than on the day of or the day after treatment,
More serious complications, such as fractures or joint injuries, are extremely rare and often linked to improper technique or pre-existing conditions.
Who Should Avoid Chiropractic Care?
A relative contraindication means caution should be used when two drugs or procedures are used together, and it is only acceptable to do so if the benefits outweigh the risk.
An absolute contraindication is an event or substance that could cause a life-threatening situation. A procedure or medicine that falls under this category must be avoided.
It has been recommended that therapists using high velocity low amplitude (HVLA) spinal manipulation within their practice must screen for contraindications before manipulation is performed.
Relative contraindications/precautions are:
- Articular hypermobility and instability – localised, spondylolysis – with no stability, post-surgical joint or segments with no evidence of instability, previous adverse reactions to manual therapy, spondylitis, spondylolisthesis – without slippage/instability, osteoporosis – localised, benign bone tumours, severe or painful disc pathology, such as discitis or disc herniation, anticoagulant therapy, aneurysm – distal manipulation, psychogenic – malingerers, hysterics, hypochondriacs and those with dependent personalities, subacute and chronic ankylosing spondylitis and other chronic arthropathies, pregnancy, growing children.
Absolute contraindications are:
- Inflammatory joint conditions – localised, fractures and dislocations, spondylolisthesis – progressive, atlantoaxial instability, avascular necrosis, malignancies, localised infection, vertebrobasilar insufficiency syndrome, aneurysm – localised, acute myelopathy, increased ICP, meningitis, cauda equina syndrome, anomalies such as dens hypoplasia, unstable os odontoideum, haematomas, whether spinal cord or intracanalicular, discogenic pathology with worsening neurological status, congenital dysplasia/instability, pregnancy if complications are present, and uncontrolled hypertension.
You will note that some of these conditions are located in both the relative and absolute contraindications. This is due to the contraindication being circumstantial. Therefore, clinical judgement and/or further medical consult may be needed to clarify particular cases.
Safety Tips for Chiropractic Care
✅ Choose a licensed and certified Chiropractor
✅ Disclose all medical history and medications
✅ Report new or unusual symptoms promptly
✅ Attend regular reassessments during ongoing care
Beyond Pain Relief: Reported Health Improvements
Some patients report unexpected health benefits beyond musculoskeletal relief. In one study, 23%
of people reported improvement in other health aspects. Reported health improvements are
- Respiratory function: 26%
- Digestive function: 25%
- Vision: 14%
- Circulation/heart function: 14%
- Hearing or Tinitus 4%
Specific improvements:
- Easier breathing: 21%
- Better digestion: 20%
- Sharper vision: 11%
- Improved circulation: 7%
- Blood pressure/heart rythm changes: 5%
While promising, these findings should be interpreted cautiously as they may not reflect outcomes for all people.
Understanding the Safety of Chiropractic Care for Children
Chiropractic care for children focuses on supporting the health of the spine, muscles, and nervous system using gentle, hands-on techniques. It is commonly used to help manage musculoskeletal issues, improve function, and support overall wellness. Treatments are tailored to a child’s age, size, and condition, and may be part of a broader, holistic approach to health that includes advice on posture, nutrition, and development.
- Specialised Training: Chiropractors are educated in anatomy, physiology, and paediatric health. Many also pursue additional training specifically focused on working with children.
- Gentle, Age-Appropriate Techniques: The techniques used for children are carefully adjusted to suit their age, size, and developmental stage. These are much softer and more subtle than those used with adults.
- Low Risk of Side Effects: When side effects do occur, they are usually very mild—things like slight soreness or fussiness. Serious adverse events are extremely rare.
- Whole-Child, Collaborative Care: Chiropractic care often works best when part of a team approach. Chiropractors can collaborate with paediatricians and other healthcare professionals to help ensure safe and effective care for each child.
Key Takeaways
- Chiropractic care is elective and wellness-oriented, often used to support spinal and nervous system function, not necessarily to treat specific symptoms.
- It is not a replacement for medical treatment, diagnosis, or prescription by medical doctors.
- Chiropractic care focuses on spinal tension, vertebral subluxations, and their impact on
overall spinal and neural integrity. - Outcomes vary, and each treatment plan will be unique and based on a thorough
clinical assements.
Refrences
- Dvorak in Principles and Practice of Chiropractic, Haldeman, 2nd Ed.
- Haldeman S, et al. CMAJ 2001; 165(7):905-906.
- Herzog W, Symons B. J Can Chiropr Assoc 2002; 46(3):134-136.
- Dabbs V, Lauretti W. J Manipulative Physiol Ther 1995; 18(8):530-536.
- Lauretti W. JACA 1999; 36(9):42-47.
- Leboeuf-Yde C. J Manipulative Physiol Ther 1997; 20(8):511-515.
- Senstad O, et al. Spine 1997; 22(4):435-440.
- Ebejer, A., To Manipulate Or Not To Manipulate, online.omttraining.co.uk [ONLINE] 16.06.2025
- J Manipulative Physiol Ther 1999; 22:559-564.
- Vallone, S. A., Miller, J., Larsdotter, A., & Barham-Floreani, J. (2010). Chiropractic approach to the management of children. Chiropractic & Osteopathy, 18(16). https://doi.org/10.1186/1746-1340-18-16