Chiropractic Care: Does the benefit outweigh the risks?

Are there risks to chiropractic treatment?  Well, some, but most of the adverse events (side effects) that can occur with chiropractic care of the neck and low back are benign and self-limiting.  This means they are mild, do not affect a person’s activities of daily living and typically go away on their own after a few days.  This generally means post-adjustment soreness, nausea, that sort of thing.

A study recently published in the Journal of Manipulative and Physical Therapeutics (Rubenstein SM. JMPT 2008;31:461-464) asked the question “Do the benefits of chiropractic care outweigh the risks.”  I’ll save you some reading….YES.

The author examined the minor and occasionally serious events associated with chiropractic care and found that the best evidence suggests that chiropractic care is a useful treatment for patients with low back or neck pain and the risks of serious adverse events should be considered negligible.

I once heard it described that if you drive more than a mile or so to your chiropractor’s office, the chances of having a serious injury are much greater on your drive to the office than during any time actually spent in the office.  And any link between chiropractic treatment and stroke has not been without flaws.  In fact, a recent study showed that the risk of stroke following a chiropractic visit was equal to the risk of stroke following a medical doctor visit.  It seems that patients who are about to have a stroke tend to self-refer to chiropractors and medical doctors.  Go figure.

Risks with any treatment shouldn’t be taken lightly but certainly we should use a rational and intelligent approach to them.  As far as chiropractors peforming spinal manipulation, we should keep studying the risks but I believe that no sleep should be lost worrying them.


Neck Pain Task Force


The Bone and Joint Decade 2000-2010 Task Force on Neck Pain has issued some of their key findings in the peer-reviewed journal Spine.  The work of a multidisciplinary team of researchers and clinicians led by Task Force President Scott Haldeman, MD, Phd, DC, the task force concluded that neck pain is common, typically has no single cause or one single effective treatment.  They stated that chiropractic treatment is as safe as any treatment offered by primary-care medical doctors.


The task force found that neck pain should be classified into four grades. Grade 1 (pain that causes little or no interference with daily activities); Grade 2 (pain that limits daily activities); Grade 3 (pain accompanied by radiculopathy); and Grade 4 (pain with serious pathology, such as tumor, fracture, infection, or systemic disease). Grade 4 was beyond the mandate of the task force to study.


Grades 1 or 2 neck pain can benefit from a variety of treatments including: education, exercise, mobilization, manipulation, acupuncture, analgesics, massage, and low-level laser therapy.

No ‘best’ treatment exists. A variety or combination of therapies, according to what the patient wants is ideal. The task force also concluded that risk of vertebrobasilar (VBA) stroke associated with a visit to a chiropractor appears to be no different from the risk of stroke following a visit to an MD’s office. 


Very useful data to be produced from one task force publication.  We are pleased that not only is one of our primary methods of treatment, spinal manipulation, validated in this report, but also the use of cold laser therapy has validity in this study.

Does back pain go away on its own?

 Eighty percent of people suffer from back pain at some point in their lives. Back pain is the second most common reason for visits to the doctor’s office, outnumbered only by upper-respiratory infections. Most cases of back pain are mechanical or non-organic—not caused by serious conditions, such as inflammatory arthritis, infection, fracture, or cancer.

The back is a complicated structure of bones, joints, ligaments, and muscles. You can sprain ligaments, strain muscles, rupture disks, and irritate joints, all of which can lead to back pain. While sports injuries or accidents can cause back pain, sometimes the simplest of movements—for example, picking up a pencil from the floor— can have painful results. In addition, arthritis, poor posture, obesity, and psychological stress can cause or complicate back pain. Back pain can also directly result from disease of the internal organs, such as kidney stones, kidney infections, blood clots, or bone loss.

Back injuries are a part of everyday life, and the spine is quite good at dealing with these often “pulled” muscles. These very minor injuries usually heal within 1 or 2 days. Some pain, however, continues. What makes it last longer is not entirely understood, but researchers suspect that the reasons may include stress, mood changes, and the fear of further injury that may prevent patients from being active. In addition, sometimes a painful injury or disease changes the way the pain signals are sent through the body, and, even after the problem has gone away or is inactive, the pain signals still reach the brain. It is as if the pain develops a memory that keeps being replayed.

Until recently, researchers believed that back pain would heal on its own. We have learned, however, that this is not true. A recent study showed that when back pain is not treated, it may go away temporarily, but will most likely return. The study demonstrated that in more than 33% of the people who experience low back pain, the pain lasts for more than 30 days. Only 9% of the people who had low-back pain for more than 30 days were pain free 5 years later.

Another study looked at all of the available research on the natural history of low-back pain. The results showed that when it is ignored, back pain does not go away on its own, but continues to affect people for long periods after it first begins.

If your back pain is not resolving quickly, visit your doctor of chiropractic. Your pain will often result from mechanical problems that your doctor of chiropractic can address. Many chiropractic patients with relatively long-lasting or recurring back pain feel improvement shortly after starting chiropractic treatment.

The relief is often greater after a month of chiropractic treatment than after seeing a family physician. Chiropractic spinal manipulation is a safe and effective spine pain treatment. It reduces pain, decreases medication, rapidly advances physical therapy, and requires very few passive forms of treatment, such as bed rest.

How Can I Prevent Back Pain?

  • Don’t lift by bending over. Instead, bend your hips and knees and then squat to pick up the object.
  • Keep your back straight, and hold objects close to your body when lifting.
  • Don’t twist your body while lifting.
  • Push, rather than pull, when you must move heavy objects.
  • If you must sit for long periods, take frequent breaks and stretch.
  • Wear flat shoes or shoes with low heels.
  • Exercise regularly. An inactive lifestyle contributes to lower-back pain.


1. Hestbaek L, Leboeuf-Yde C, Engberg M, Lauritzen T, Bruun NH, Manniche C. The course of low-back pain in a general population. Results from a 5-year prospective study. J Manipulative Physiol Ther 2003 May; 26(4):213-9.

2. Hestbaek L, Leboeuf-Yde C, Manniche C. Low-back pain: what is the long-term course? A review of studies of general patient populations. Eur Spine J 2003 Apr;12(2):149-65.

3. Stig LC, Nilsson O, Leboeuf-Yde C. Recovery pattern of patients treated with chiropractic spinal manipulative therapy for long-lasting or recurrent low-back pain. J Manipulative Physiol Ther 2001 May;24(4):288-91.

4. Nyiendo J, Haas M, Goodwin P. Patient characteristics, practice activities, and one-month outcomes for chronic, recurrent low-back pain treated by chiropractors and family medicine physicians: a practice based feasibility study. J Manipulative Physiol Ther 2000 May;23(4):239-45.

5. Time to recognize value of chiropractic care? Science and patient satisfaction surveys cite usefulness of spinal manipulation. Orthopedics Today 2003 Feb; 23(2):14-15.


 Dr. Brett L. Kinsler is a chiropractor practicing in Rochester, NY.  Visit his website at



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