This is a question we get asked all the time, along with ‘is manipulation effective?’
Why don’t we start with the safety issue first. In the last few decades, numerous independent researchers and various government agencies have conducted studies into the efficacy, safety, appropriateness and cost-effectiveness of chiropractic treatment.
Just so we are clear as to what we are discussing. The terms ‘manipulation’ and ‘adjustments’ can be used interchangeably. Both terms describe a high velocity low amplitude (HVLA) thrust technique, which aims to correct vertebral subluxations.
Vertebral Subluxations is a term applied to a vertebra which has lost its normal position and/or motion in relation to the vertebrae above or below.
Vertebrae, which do not function properly within the spinal framework, generate mechanical stress and can lead to ‘wear and tear’ within the spine, pain, inflammation, reduced spinal mobility and may compromise function elsewhere within the body.
So the phrase “putting my spine back in place” is probably not the most accurate terminology. A more appropriate statement would be “having my spine adjusted.”
You may have also heard people call chiropractors “bone crunchers” as well. In most cases this is a slanderous term used by the medical community to discredit the chiropractic profession. But that’s an entirely different Q & A!
When an adjustment is performed there will often be an audible ‘pop’. The actual pop is called a cavitation and it’s the release of gas that makes the popping sound. But certainly there is no bone crunching that occurs and no risk to the joints or bones.
So if there is no risk to the joints or bones, what are the risks?
Most of the literature you will read on this subject relates to manipulation/adjustment to the cervical spine (neck). And even more precisely a rotational manipulation of the neck.
Vigorous rotation of the neck can “kink” this artery along its course. This may cause dissection of the artery, or the trauma may lead to formation of a blood clot. Either of these episodes may cause ischemia to the brainstem (stroke).
The concern relates to the vertebral arteries of the neck as they course through the transverse foramen (holes) within the vertebrae, making their way into the skull. See the diagram above.
It should be noted that manipulation is not the only mechanism for this type of injury. Similar vascular accidents have been reported during activities such as yoga, swimming, prolonged overhead work and with contact sports such as football, ice hockey and rugby.
So what is the risk of suffering a stroke from cervical (neck) adjustment?
A complete review of the scientific literature was performed in this study.
Every published study they found that estimated the incidence of stroke from cervical manipulation agreed that the risk is 1 to 3 incidents per million treatments.
1 to 3 incidents per MILLION treatments!
To put this into perspective, cervical manipulation should be compared to other prominent treatment protocols for neck pain such as non-steroidal anti-inflammatory drugs (NSAIDS) and surgery. The literature is clear, the use of NSAIDS for neck pain carries a hundred-times-greater risk of serious injury or death.
- Ibuprofen – Nurofen, Advil and Bugesic
- Diclofenac – Voltaren, Dinac and Fenac
- Naproxen – Naprosyn, Naprogesic and Aleve
- Celecoxib – Celebrex.
The chance of you been hospitalized from the use of NSAIDS is 1 in 3190 and the chance of you dying from their use is 1 in 21, 267.
Chances of death (Lifetime Odds)
|Motor vehicle accident
||1 in 113
|Assault by firearm
||1 in 358
|Falling off a ladder or scaffolding
||1 in 9552
|Dying in a plane crash
||1 in 9, 737
|Bitten or struck by a dog
||1 in 114, 622
||1 in 117, 994
|Being struck by lightening
||1 in 174, 426
Source: National Center for Health Statistics; National Safety Council.
As you can see from the literature, the risk associated with cervical manipulation is very small, especially when compared to other forms of treatment and other lifestyle factors.
So what’s next?
Are spinal manipulations effective?
Before we get started in evaluating the evidence it should be noted that all of our Body Genius ‘pain and dysfunction’ practitioners have the skill set to manipulate the spine.
With that said, they also have a very long list of supporting skills and techniques that can be utilized to achieve the desired outcome. Secondly, BG practitioners follow the Body Genius Method described earlier in this article, and it’s this Method that has proven so highly successful with clients. As part of that process our practitioners may choose to use manipulation as a treatment tool.
The goal of manipulation, like all other treatments is to improve functional movement around a joint(s) or improvement in another objective measure such as improvements in muscle power. This demonstrates to the practitioner that the manipulation is sending the right signals to the brain and having the desired affect.
Repeated manipulations without positive changes in functional movement patterns is not apart of the Body Genius methodology.
So both you and the practitioner can see (measure) that the manipulations are effective. If manipulation is not effective then another treatment ‘tool’ can be used to affect the desired outcome in movement.
The Meade study found that chiropractic treatment was more effective than hospital outpatient management for patients with chronic or severe back pain.1
The Florida Worker’s Compensation study reported that chiropractic care is more cost-effective than standard medical care in the management of work-related back injuries and that “a claimant with a back-related injury, when initially treated by a chiropractor versus a medical doctor, is less likely to become temporarily disabled, or if disabled, remains disabled for a shorter period of time; and claimants treated by medical doctors were hospitalized at a much higher rate than claimants treated by chiropractors.”2
The RAND study concluded that spinal manipulations are beneficial to some patients with acute lower back pain and is an appropriate treatment for certain low-back conditions.3
The Utah study was published in the Journal of Occupational Medicine and found that patients of chiropractic care returned to work sooner after an injury, reporting an average of two lost work days compared with 20 under standard medical care. Furthermore, the study revealed that chiropractic care was 10 times less expensive than standard medical care in compensation payouts.4
The 1991 Koes’ clinical trial compared manipulative (chiropractic) and physiotherapy with standard medical care for the treatment of persistent back and neck complaints. After 12 months, the manipulative therapy groups showed greater improvement in the primary complaint as well as in physical function, with fewer visits.5
The Manga report, funded by the Ontario Ministry of Health researched ways to reduce the incidence of work-related injuries, and to address cost-effective ways to rehabilitate disabled and injured workers. The report overwhelmingly supported the efficacy, safety, scientific validity, and cost-effectiveness of chiropractic for low-back pain. Additionally, it found out that higher patient satisfaction levels were associated with chiropractic care than with medical treatment alternatives.6
1 – Meade, T.W., Dyer, S., Browne, W., Townsend, J., Faran, A.O. (1990 & 1995) Randomised Comparison of Chiropractic and Hospital Outpatient Management for Low Back pain, British Medical Journal
2 – Jarvis, K.B., Phillips, R.B., Morris, E.K. (1991) “Cost per Case Comparison of Back Injury Claims versus Medical Management with Identical Diagnostice Codes”. Journal of Occupational medicine, Vol 33 (8), pp. 847-852
3 – Shekelle, P.G., Adams, A.H., Chaissin, M.R., Hurwitz, E.I., Phillips, R.B., Brook, R.H. (1991) “The Appropriateness of Spinal Manipulation for Low Back Pain. Project Overview and Literature Review”, Rand, Santa Monica, California
4 – Cost per Case Comparison of Back Injury Claims of Chiropractic versus medical Management for Conditions with Identical Diagnostic Codes. Jarvis KB, et al. Journal of Occupational Medicine – 1991;33:847-52.
5 – Eric L. Hurwitz, DC, PhD, Hal Morgenstern, PhD, Philip Harber, MD, MPH, Gerald F. Kominski, PhD, Fei Yu, PhD, and Alan H. Adams, DC, MS (2002). A Randomized Trial of Chiropractic Manipulation and Mobilization for Patients With Neck Pain: Clinical Outcomes From the UCLA Neck-Pain Study. Am J Public Health. 2002 October; 92(10): 1634–1641.
6 – The Effectiveness and Cost Effectiveness of Chiropractic Management of Low-Back Pain (The Manga Report). Pran Manga and Associates (1993) – University of Ottawa, Canada.