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Back Pain | Cost Effectiveness | Patient Satisfaction | Utilization | Government Recommendations | Safety

SAFETY

Chiropractic is recognized as one of the safest, drug-free, non- invasive treatments available for headache, neck, and back pain. During the last 25 years there have been five formal government inquiries into chiropractic, all of which have found the profession to be both safe and effective.1 Based on the results of more than 85 studies into the safety and efficacy of chiropractic treatment, no other profession, including medicine, can demonstrate greater effectiveness or a better safety record for the treatment of spinal pain syndromes.

The risk of stroke from manipulation of the upper neck is small. Current published reports put the risk at between one or two out of one million treatments with the risk of serious consequences being even less likely.2

In fact, strokes may occur from normal everyday activities such as cradling a phone between your ear and shoulder during a prolonged conversation.3 Strokes have also been associated with simple activities such as having one's hair washed at a beauty parlour, dental procedures, painting a ceiling, and turning one's head while driving.4 Occurrences like this cannot be predicted.

Other likely treatments for head, neck and back pain carry a notably higher risk. For example:

  • The risk of gastrointestinal bleeding, caused by common pain relievers, such as ASA, is 400 times greater than the risk of damage from neck manipulation.5
  • Serious neurological complications from cervical spine surgery are more than 15,000 per million, and the mortality rate is almost 7,000 per million.6

Informed Consent

The chiropractor makes a diagnosis by taking a thorough health history and performing a physical examination. After determining any contraindications to treatment, an appropriate plan of care is developed.

Prior to starting treatment, chiropractors are required to obtain informed consent from their patients. A consumer's choice of health care should always be based on informed consent. Health consumers must receive adequate and accurate information to assist them in evaluating their health care choices, and in balancing the relative risks of treatment options with the benefits.

Ongoing research

Chiropractic researchers continue to be actively involved in studying the benefits and risk of manipulation in the treatment of neck and back pain. Faculty from the Canadian Memorial Chiropractic College have played a leadership role in this research through participation in clinical trials and literature reviews.

Currently a large-scale, multi-disciplinary trial is underway to assess the efficacy of different types of treatment, including chiropractic care, for managing tension-type headache. In addition, the profession has published papers reviewing the risks and complications of cervical manipulation.

Attention has recently been directed to cervical manipulation by Dr. John Norris of the Canadian Stroke Consortium. His data, which is preliminary, and has yet to be analysed and published, will hopefully contribute to a better understanding of the relationship between cervical manipulation and stroke.

The chiropractic profession continues to conduct research that will ensure that care is provided as effectively and safely as possible.

  1. Chiropractic in the United States: Training, Practice and Research, U.S. Department of Health and Human Services, AHCPR Research Report, Dec.1997.
    Chiropractic in New Zealand, Report of the Commission of Inquiry, Hasselberg PD, Government Printer, Wellington, 1979.
    Medicare Benefits Review Committee, Thompson CJ, Commonwealth Government Printer, Australia, 1986
    Legitimization for Vissa Kiropraktorer, Commission on Alternative Medicine, SOU, 1987.
    The Effectiveness and Cost-Effectiveness of Chiropractic Management of Low-Back Pain, Manga P, Angus D, et al. Commissioned by the OCA and funded by the Ontario Ministry of Health. Pran Manga & Associates, University of Ottawa, 1993.
  2. The Appropriateness of Manipulation and Mobilization of the Cervical Spine: A Systematic Review of Literature, Hurwitz EL, Aker PD, Adams AH, Meeker WC, Shekelle PG, Spine, 21(15); 1753-1755, 1996.
    Risk Factors and Precipitating Neck Movements Causing Vertebrobasilar Artery Dissection After Cervical Trauma and Spinal Manipulation, Haldeman S, Kohlbeck FJ, McGregor M, Spine, 24(8); 785-794, 1999.
  3. Carotid Artery Dissection due to Elongated Styloid Process, Zuber M, Meder JF, Mos JI, Neurology, Nov. 1999.
  4. Beauty Parlour Stroke Syndrome: Report of Five Cases, Weintraub MI, Journal of the American Medical Association, 269:2085-86, 1993.
    Abrupt Change in Head Position and Cerebral Infarction, Sherman DG, Hart RG, Easton JD, Stroke, 12:2-6, 1981.
    Vertebral Artery Occlusion Following Hyperextension and Rotation of the Head, Okawara S, Nibbelink D, 5:640-42, 1974.
    Cervical Manipulation and Stroke, Stroke, 8:594-97, 1977.
  5. A Risk Assessment of Cervical Manipulation v. NSAIDS for the Treatment of Neck Pain, Dabbs V, Lauretti WJ, Journal of Manipulative and Physiological Therapeutics, 18.530-36, 1995.
  6. Ibid.