How safe is chiropractic?

How safe is chiropractic or any other treatment for that matter?

There has been much rhetoric about how dangerous manipulation is, or could be, particularly of the cervical spine. What is important is the relative safety. Almost no treatment for any condition can be described as totally safe. Even drugs as common place as aspirin and anti-inflammatories cause a significant number of deaths every year, far in excess of a stroke after a chiropractic adjustment.

Chiropractic causes extremely few deaths. Statisticians have shown that you have about the same chance of dying from an adjustment as from being struck by lightening while playing golf; but it can happen.

It does happen, but it is very rare. 

Less than one in a million chance, and that makes the chiropractic adjustment one of the very safest treatments.

In comparison, the U.S. Department of Health and Human Resources stated that, on average, 17.14 percent of the 700 000 physicians in the United States causes one accidental death per year.

This page was last updated by Dr Barrie Lewis DC on 9th December, 2019.

How safe is chiropractic

How safe is chiropractic is a question that every potential patient should be asking, and of course of conventional care like drugs and surgery too. Whilst increased pain is not uncommon, catastrophic events are few and far between.

Actuarial reports

More important than all the rhetoric is the report of actuaries; the mathematicians who decide what insurance doctors should pay. Their calculations concerning the safety of chiropractic reveal that we should pay premiums of approximately $2000 per year. Some medical physicians pay over 100 000 dollars per year.

There are very few successful cases against chiropractors.

Is chiropractic totally safe? No, it is not, but it is a great deal safer than taking anti-inflammatories or going for surgery. They too, however, have their merits and your chiropractor may sometimes refer you for medical care.

How safe is Chiropractic? Pretty, damn safe. However, you can fairly frequently experience increased pain after the first few treatments. In fact there is some research suggesting that if you do not have some after pain you may also not get much benefit from manipulative care.

But that is another story; I am not in agreement of the no pain, no gain philosophy.

Dr Scott Haldeman, medical neurologist and chiropractor, states that there have been 23 known cases of vertebral artery dissection in 10 years after a chiropractic adjustment of the neck. However, he is of the opinion that these dissections were probably in progress before the treatment, rather than caused by the manipulation. During this time 135,000,000 cervical manipulations were given; a rate of less than 1 stroke after 6 million cervical adjustments.

In comparison, 16 000 Americans died in one year from gastric hemorrhage, directly from taking NSAIDs, not including those who died from heart and other complications of anti inflammatory drugs.


The only sensible conclusion is that chiropractic manipulation is a relatively, but not perfectly, safe procedure for the treatment of neck pain and headache. There are no perfectly safe procedures.


One in six million patients who have had a cervical manipulation will within three weeks have a stroke; are they connected? Some, yes, most no say the experts. Yet how safe is chiropractic is still an important question, more for the chiropractor than his patients; should this person be considered high risk?

Vertebral artery.

The BONE and JOINT decade 2000-2010 World Health Organisation Task Force

The Task Force, a multi-disciplinary research body, evaluated a 1000 studies on neck pain before coming up with a report addressing the question How safe is Chiropractic? for cervical spine conditions concluding with the the following statement:

We analyzed a total of 818 cases of Vertebro Basilar Artery (VBA) stroke admitted to Ontario hospitals over a 9-year period (more than 100 million patient-years of observation) in answer to the question, HOW SAFE IS CHIROPRACTIC? has concluded that:

"VBA stroke is a very rare event and that the risk of VBA stroke associated with a visit to a chiropractor’s office appears to be no different from the risk of VBA stroke following a visit to a family physician’s office."

A brush with stroke...

A brave chiropractor reveals all in his first-hand shattering experience with Chiropractic Coalface STROKE ... yet, because the wise chiropractor behaved so astutely, all was well that ends well.

An experience like this, or worse, will happen on average to about one in ten chiropractors once in his/her whole lifetime in practice.


Vaccination remains a thorn in the flesh of Alternative Healthcare, and I'm not aware of a strong statement confirming or denying the value of vaccination from mainline chiropractic. Fringe Chiropractic continues to condemn it.

I was born into a Chiropractic family. Both my parents were chiropractors, and I was not vaccinated as a baby. I, together with eight other children who were vaccinated, very nearly died of diphtheria at nine months old, saved only by a combination of good nursing and chiropractic adjustments. Did they help ...? I believe so, though there is no research ...

This month, in our small town in Holland, a healthy nine-year old boy died suddenly three days after a vaccination, resurrecting all the old fears. Thousands are now refusing to be vaccinated. In one week last three healthy children died within ten days of receiving a vaccination ...

I am not abreast of all the facts, though I suspect at the end of the day, the enormous benefit to the majority, preventing the scourges of polio, small pox ... and many other diseases, should not be disgarded because of the side effects, albeit very serious, on a tiny minority.

Like Chiropractic, do the enormous benefits of vaccination not vastly outweigh the occasional serious side-effects?

Having said that, I personally do not recommend vaccination against non-serious diseases. Only recently a patient suffered a dreadful bout of influenza that lasted over a month after a 'flu injection. Worse, the most serious case of shingles that I have ever seen began shortly after a shingles vaccination.

In the Spring of 2009, the Dutch minister of health announced that he has ordered enough vaccine to vaccinate every man, woman and child twice against Mexican Swine flu. I'm not convinced that I'll be queueing up for my jabs!

Update: Half way through the programme, it was suspended, no reasons given.

How safe is Chiropractic? I suspect that death from vaccination is probably about as prevalent as stroke from a Chiropractic adjustment. Does that invalidate either?

Update:  Because of several strokes recently, after cervical manipulation by physiotherapists who had been to a few weekend courses, the Minister of Health in Holland is threatening to ban all cervical manipulation.

But, yes, they do occur after Chiropractic manipulation too, only very rarely. Less than one in a million neck manipulations. It's all about proper training.

Would you allow a chiropractor to remove your appendix after attending a few weekend seminars on the subject?

The RATIONALE for the "Chiropractic Adjustment"

Probably the biggest single medical critque of Chiropractic is not "HOW SAFE IS CHIROPRACTIC?" but that there is no scientific basis for the 'adjustment'. They may have been the case once ... but now there is a huge amount of basic science research confirming that fixated joints become arthritic much faster, and bombard the spinal cord with noxious input.


Of far greater concern is the dizzy patient. An upper cervical subluxation can cause dizziness or vertigo - they're not quite the same - but a more likely cause is loose calcium crystals in the inner ear. For that (it's called BPPV) the treatment of choice is NOT manipulation but the Epley manoeuvres.

The test to differentially diagnose between an upper cervical cause and an inner ear cause is the Hallpike Dix test.

Chiropractic research indicates that upper cervical manipulation of the dizzy patient may often aggravate the condition. Hence the importance first to rule out an inner ear condition called Benign Positional Paroxysmal Vertigo as a cause of Vertigo Dizziness.

Rib pain treatment

Teddy needs a rib adjustment.

Even the most gentle and careful chiropractor will very occasionally crack a rib during rib pain treatment and not only in the elderly and osteoporotic. I admit to eight during 36 years in practice, two of which with hind sight should not have happened and could be described as negligent. All eight recovered completely with a few weeks, but with considerable gnashing of teeth! A bouquet of flowers went a long way. How safe is Chiropractic? Not perfectly safe.

None sued me. If every patient with cracked rib sued their chiropractor, there would be no more rib pain treatment and patients would have to suffer one of the most debilitating and painful conditions - a rib head subluxation, or sprung rib, is excruciating. Every breath ....

Interesting links

  1. Chiropractic Help
  2. Find a good Chiropractor
  3. How safe is chiropractic

Did you find this page useful? Then perhaps forward it to a suffering friend. Better still, Tweet or Face Book it.

Interesting challenges of the day

1. Mr S is a 76 year old man with neck pain of some 9 months duration. Luckily, most of the discomfort is upper cervical which is only rarely arthritic; his lower cervical spine is a degenerative mess that I have left alone. After seven treatments his pain and stiffness is 50 percent better, and he is happy in the circumstances. He can sleep through the night now and that makes a huge difference.

2. Mr P is 32 year old man with very severe lower back pain radiating to the big toe which is 30 percent numb. He had an episode three weeks ago, took anti-inflammatories and was soon better as is typical of the medial disc herniation. But before it healed, after a trivia it came roaring back, much worse. The characteristic crossed sign was evident; sitting in a chair, straightening the right leg provoked severe left back pain and tingling in the leg. He is doing well.

3. Severe lower back pain is scary; just ask Mrs P. Just watching her get out of the car I she was in trouble; she had a slipped disc at L4 making her lean towards the opposite side; luckily she had no pain in the leg. Despite family pressure that this was far too severe for a chiropractor, she persevered. Within five days she was standing upright, and after two weeks almost pain-free. 

Despite a hectic job, she wisely took my advice and stayed home for what I call exercising bed rest.

4. Mr S has had lower back, groin and back of thigh and calf pain for fourth months.

He has a pincer deformity in the hip causing the stabs in the groin, and a degenerative facet causing the sciatica. Both are responding well to chiropractic and he is well pleased; sixty-five percent better after three treatments.

5. Mr T is a wise man; he has taken a warning TIA seriously and has lost 15 pounds, and has at least as much again to lose. A change to a low starch diet and half hour daily stroll has made the difference; but the walking is making his foot and back miserable. The expensive orthotic is hopeless; luckily his hips and back are fine, but he needs a simple heel lift; he has a short leg.

6. I too have had serious lower back issues, luckily fixed by my own chiropractor; so I too have to do my exercises, take care when lifting supers full of honey, gardening and using the chainsaw. Regaining the function of your spine is just as important as the pain.

7. My own granddaughter, only 7 is hypermobile giving her pelvic, knee and ankle issues. X-rays show a mildly dysplastic hip. Years ago we would have called it growing pains. She too regularly needs chiropractic care and luckily responds well. Increased range of motion is more difficult than too stiff in my opinion. Our care is for kids too.

8. This 65-year old lady is a serious gardener; every day she is bending, lifting and digging for 2 to 3 hours a day. It regularly catches her in the sacroiliac joint, so she has a treatment once a month that sorts it out. She does her lower back exercises faithfully.

9. This 88-year old lady is an inspiration; every day she is busy in the community. With a nasty scoliosis she manages very well with a chiropractic adjustment every six weeks and exercises faithfully done. 

10. Mr X is a 71-year old retired man who wants to continue with maintenance care every six to eight weeks; he had suffered from two years of lower back pain when he first came a few months ago. He has no discomfort now after 8 chiropractic treatments, but is aware that danger lurks.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It is a non-complicated upper cervical facet syndrome, and she is doing well.

12. Mr D is a 38-year old year man with chronic shoulder pain after a rotator cuff tear playing cricket. It responded well to treatment, but he knows he must do his exercises every day; for two years he could not sleep on that shoulder.

13. Mr D, a 71-year old man, has a severe ache in the shoulder and midback since working above his head. Trapped nerve tests are negative but he has advanced degenerative joints of Luschka; after just two treatments he is 50 percent better. Can we reach 90?

And so the day goes; chiropractors should not be treating the elderly most medical sites state but that is so much bunkum.

Do you have a problem that is not getting better?

Are you looking for a different slant on your pain?

Do you want to pose a question?

Interesting questions from visitors

CLS writes:

Greetings, Dr B.

You helped me quite some time back with a soothing and professional response which turned out to be exactly correct. I now consult a local chiropractor. You write a superb newsletter, too.

Your own unresolved problem. Pose a question

Knowing that up to 70 percent of the time the correct diagnosis is made with no examination, no special tests, no xrays, but just from the history, there is a fair chance I can add some insight to your unresolved problem. But at least 30% of the time, I may be quite wrong. Give plenty of detail if you want a sensible reply.

You visited this chiropractic help site no doubt because you have a problem that is not resolving and want to know more about what a DC does.

The quickest and most interesting way is to read one of my eBooks of anecdotes. Described by a reader as gems, both funny and healthful from the life and work of a chiropractor, you will love them. Priced right at $2.99, though Kindle fiddles the amount without telling me.