Chiropractic Manipulations: Are They as Safe as You Think?
Chiropractic manipulation, also known as spinal manipulation or chiropractic adjustment, is a treatment method used by chiropractors and trained physiotherapists to address musculoskeletal issues, especially those related to the spine. The goal of chiropractic care is to improve spinal function, alleviate pain, and enhance the body’s natural ability to recover. While millions of people seek chiropractic care annually, questions about the safety of chiropractic manipulations remain a topic of ongoing debate. This blog aims to explore the safety of chiropractic manipulations by examining the techniques, potential risks, benefits, and scientific evidence supporting its use.
Understanding Chiropractic Manipulation
Chiropractic manipulation involves applying controlled force to specific joints, particularly in the spine, to restore proper alignment and mobility. Chiropractors use their hands or specialized instruments to perform these adjustments. The most common techniques include:
1. High-Velocity Low-Amplitude (HVLA) Thrust: This technique is what what most people think of as a manipulation. It involves a quick but small force applied to a joint, often resulting in an audible "crack" or "pop."
2. Low-Force Techniques: These methods use gentle pressure or slow movements to adjust the spine and joints.
3. Soft Tissue Manipulation: Chiropractors may also work on the muscles and ligaments surrounding the spine to relieve tension and improve mobility.
Benefits of Chiropractic Manipulations
The effects of chiropractic manipulations extend beyond the audible pops or cracks. When performed correctly, these adjustments can:
Restore Joint Function: Chiropractic manipulations help restore proper biomechanics and alleviate joint dysfunction (1).
Relieve Pain and Tension: Manipulations can reduce muscle tension, alleviate nerve compression, and promote the release of endorphins, leading to pain relief and improved mobility (2).
Enhance Nervous System Function: Proper spinal function ensures optimal communication between the brain and the rest of the body, enhancing overall nervous system function and promoting wellness (2).
Improve Range of Motion: Manipulations help restore joint flexibility and range of motion, allowing for smoother and more coordinated movements (3).
Conditions Benefited from Chiropractic Manipulation
Numerous studies and patient testimonials highlight the potential benefits of chiropractic care, particularly for conditions such as:
1. Lower Back Pain: Research has shown that chiropractic manipulation can be as effective as conventional medical treatments for lower back pain. It can reduce pain, improve function, and decrease the need for pain medications.
2. Neck Pain: Chiropractic adjustments can help alleviate neck pain and improve range of motion. Studies suggest that it can be more effective than some traditional treatments.
3. Headaches: Chiropractic care, especially spinal manipulation, has been found to reduce the frequency and intensity of tension headaches and migraines.
4. Sciatica: Chiropractic adjustments can provide relief for sciatic nerve pain by addressing the underlying spinal issues causing the condition.
5. Improved Mobility: Regular chiropractic care can enhance overall joint mobility and flexibility, contributing to better physical function and quality of life.
Dr. Rob Hor - Chiropractor Victoria, BC
Potential Risks and Side Effects
While many patients experience significant relief and improvements from chiropractic care, it is essential to understand that, like any medical treatment, it carries potential risks and side effects. These may include:
1. Short-Term Discomfort: Some patients may experience mild soreness or discomfort after an adjustment, similar to the feeling after a workout. This typically resolves within a day or two.
2. Vertebral Artery Dissection: Although extremely rare, there have been reports of vertebral artery dissection and stroke following cervical (neck) manipulation. The risk is estimated to be between 1 in 20,000 to 1 in 5.8 million manipulations (4). In reviewing the literature, many of these patients were likely already experiencing one of these rare medical events when they went to see the practitioner. This is why a careful medical screen is conducted with each new patient.
3. Nerve Compression: In rare cases, chiropractic adjustments may exacerbate nerve compression or cause new nerve-related symptoms.
4. Bone Fractures: Patients with osteoporosis or other bone-weakening conditions should approach chiropractic care with caution, as forceful adjustments may potentially cause fractures.
Factors Increasing Risk of Adverse Events After Manipulation
Certain patients may be at a higher risk for experiencing an adverse cerebrovascular event following neck manipulation. Risk factors include(5-8):
Vertebral artery abnormalities or insufficiency
Atherosclerotic or other vascular diseases
Hypertension
Connective tissue disorders
Receiving multiple manipulations in the last four weeks
Receiving a first CSM treatment
Visiting a primary care physician
Younger age
Prior cervical trauma or neck pain
It is for these reasons that your practitioner will go through a detailed interview of your medical history as well as perform several tests before considering manipulation. If your practitioner suspects any of the above conditions, they will not do a manipulation technique, opting for other treatment styles instead.
Guidelines and Best Practices
To ensure the safety and efficacy of chiropractic care, several guidelines and best practices have been established:
1. Thorough Assessment: Chiropractors should conduct a comprehensive assessment of the patient’s medical history, current condition, and any contraindications before performing adjustments.
2. Informed Consent: Patients should be fully informed about the potential risks and benefits of chiropractic care and provide consent before treatment.
3. Individualized Treatment Plans: Chiropractic care should be tailored to the individual needs and conditions of each patient, with adjustments performed only when necessary.
4. Collaboration with Other Healthcare Providers: Chiropractors should work collaboratively with other healthcare providers to ensure comprehensive and coordinated care, especially for patients with complex medical conditions.
Conclusion
Chiropractic manipulation is a widely used and generally safe treatment option for various musculoskeletal conditions, including lower back pain, neck pain, and headaches. While it carries some risks, serious adverse events are rare, and the potential benefits often outweigh these risks for most patients. As with any medical treatment, it is essential for patients to make informed decisions and work closely with qualified healthcare providers to ensure the best outcomes. By adhering to established guidelines and best practices, chiropractic care can be a valuable component of a holistic approach to health and wellness. If you’re experiencing any of the conditions mentioned above, we recommend that you visit our clinic at Victoria, BC and our chiropractor can help relieve the pain and provide a tailor fit treatment plan for you.
References:
1. Vining, R., Long, C., Minkalis, A., Gudavalli, M., Xia, T., Walter, J., Coulter, I., & Goertz, C. (2020). Effects of Chiropractic Care on Strength, Balance, and Endurance in Active-Duty U.S. Military Personnel with Low Back Pain: A Randomized Controlled Trial.. Journal of alternative and complementary medicine. https://doi.org/10.1089/acm.2020.0107.
2. Bialosky JE, Bishop MD, Robinson ME, Zeppieri G Jr, George SZ. Spinal manipulative therapy has an immediate effect on thermal pain sensitivity in people with low back pain: a randomized controlled trial. Phys Ther. 2009;89(12):1292-1303. doi:10.2522/ptj.20090058
3.Galindez-Ibarbengoetxea, X., Setuain, I., Andersen, L. L., Ramirez-Velez, R., González-Izal, M., Jauregi, A., & Izquierdo, M. (2017). Effects of cervical high-velocity low-amplitude techniques on range of motion, strength performance, and cardiovascular outcomes: a review. The Journal of Alternative and Complementary Medicine, 23(9), 667-675.
4. Hutting N, Kerry R, Coppieters MW, Scholten-Peeters GGM. Considerations to improve the safety of cervical spine manual therapy. Musculoskelet Sci Pract. 2018;33:41-45. doi:10.1016/j.msksp.2017.11.003
5. Cagnie, B., Barbaix, E., Vinck, E., D'Herde, K., & Cambier, D. (2005). A case of abnormal findings in the course of the vertebral artery associated with an ossified hyoid apparatus. A contraindication for manipulation of the cervical spine? Journal of Manipulative and Physiological Therapeutics, 28(5), 346-351.
6. Cagnie, B., Barbaix, E., Vinck, E., D'Herde, K., & Cambier, D. (2006). Atherosclerosis in the vertebral artery: An intrinsic risk factor in the use of spinal manipulation? Surgical and Radiologic Anatomy: SRA, 28(2), 129-134.
7. Biller, J., Sacco, R. L., Albuquerque, F. C., Demaerschalk, B. M., Fayad, P., Long, P. H., et al. (2014). Cervical arterial dissections and association with cervical manipulative therapy: A statement for healthcare professionals from the american heart association/american stroke association. Stroke, 45(10), 3155-3174.
8. Todd A.J., Carroll M.T., Robinson A., & Mitchell, E. K. L. (2015). Adverse events due to chiropractic and other manual therapies for infants and children: A review of the literature. Journal of Manipulative and Physiological Therapeutics, 38(9), 699-712.
