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Honest Discussion of Risks and Benefits
Dr. Grove Higgins

Let's address the risks first. While chiropractic care is generally considered safe for treating certain musculoskeletal conditions, there are some risks and potential side effects associated with it. It is essential to note that the following information is not exhaustive.

Risks of seeing a chiropractor may include:

  1. Mild discomfort: Some patients may experience temporary soreness, stiffness, or discomfort after an adjustment. 50% average. (Carnes et al., 2010). 

  2. Nerve compression: In rare cases, spinal manipulation may lead to nerve compression, causing pain, numbness, or tingling in the extremities (Di Fabio, 1999). 

  3. Vertebral artery dissection and stroke: While extremely rare, there have been reported cases of vertebral artery dissection and stroke following cervical manipulation (Cassidy et al., 2008; Church et al., 2016).

  4. Infection: Although rare, an infection can occur following chiropractic treatment, particularly if the chiropractor uses unsterilized equipment (Burke et al., 2007). 

  5. Temporary worsening of symptoms: Some patients might experience a temporary worsening of their symptoms after chiropractic treatment, particularly if the underlying condition is not appropriately addressed. 50% experienced, same as in #1 above (Carnes et al., 2010). 



  • Carnes, D., Mars, T.S., Mullinger, B., Froud, R., & Underwood, M. (2010). Adverse events and manual therapy: A systematic review. Manual Therapy, 15(4), 355-363.

  • Di Fabio, R.P. (1999). Manipulation of the cervical spine: Risks and benefits. Physical Therapy, 79(1), 50-65.

  • Cassidy, J.D., Boyle, E., Côté, P., He, Y., Hogg-Johnson, S., Silver, F.L., & Bondy, S.J. (2008). Risk of vertebrobasilar stroke and chiropractic care: Results of a population-based case-control and case-crossover study. Journal of Manipulative and Physiological Therapeutics, 31(2), 84-90. Church, E.W., Sieg, E.P., Zalatimo, O., Hussain, N.S., Glantz, M., & Harbaugh, R.E. (2016). Systematic review and meta-analysis of chiropractic care and cervical artery dissection: No evidence for causation. Cureus, 8(2), e498.

  • Burke, M.S., Garrick, J.G., & Requa, R.K. (2007). Infections in athletes. In D.J. Caine, N. Maffulli, & M.S. Burke (Eds.), Epidemiology of Pediatric Sports Injuries: Team Sports (pp. 85-106). Karger Publishers.

  • Carnes, D., Mars, T.S., Mullinger, B., Froud, R., & Underwood, M. (2010). Adverse events and manual therapy: A systematic review. Manual Therapy, 15(4), 355-363.


Of course, comparing the risks of chiropractic care to other medical treatments depends on the specific condition being treated and the treatment methods used. Comparing the risks of chiropractic care to other medical treatments for specific conditions:

  1. Neck pain: Chiropractic care has been shown to be effective in treating neck pain, with risks comparable to other conservative treatments such as medication and physical therapy.

    1. ​​​Low back pain: Chiropractic care, particularly spinal manipulation, has been found to be as effective as other conservative treatments for low back pain, such as physical therapy, exercise, and medication, with fewer side effects (Bronfort et al., 2010).

  2. Headaches: Spinal manipulation may be effective in treating tension headaches and cervicogenic headaches, with risks comparable to or lower than other treatments such as medication (Bryans et al., 2011).


•    Bronfort, G., Haas, M., Evans, R., & Bouter, L.M. (2010). Efficacy of spinal manipulation and mobilization for low back pain and neck pain: A systematic review and best evidence synthesis. Spine Journal, 4(3), 335-356.
•    Source: Bryans, R., Descarreaux, M., Duranleau, M., Marcoux, H., Potter, B., Ruegg, R., ... & White, E. (2011). Evidence-based guidelines for the chiropractic treatment of adults with headaches. Journal of Manipulative and Physiological Therapeutics, 34(5), 274-289.


Here is a brief comparison of the risks of many of the options available to people for pain/injury/dysfunction:

  1. Chiropractic care: Mild side effects, such as soreness or discomfort, occur in approximately 50% of patients (Rubinstein et al., 2007). However, serious complications are rare, occurring at a rate of less than 1 in 100,000 (Dabbs & Lauretti, 1995; Haldeman & Rubinstein, 2004).

  2. Physical therapy: The risk of minor side effects, such as soreness or discomfort, is relatively low, although specific numbers are not readily available. Serious complications are rare (Carnes et al., 2010).

  3. Medical/medicine treatment: The risk of side effects varies significantly depending on the medication used. For example, gastrointestinal issues with nonsteroidal anti-inflammatory drugs (NSAIDs) occur in about 10-20% of patients (Moore et al., 2015). For opioids, risks are much higher, with addiction rates ranging from 8-12% (Vowles et al., 2015).

  4. Surgical treatment: Complication rates for common low back surgeries, such as lumbar discectomy or spinal fusion, range from 10-20% (Yoshihara, 2012; Pannell et al., 2015). Infections, nerve damage, or other serious complications occur in about 1-4% of patients (Rihn et al., 2009; Singh et al., 2012).


  • Rubinstein, S.M., Leboeuf-Yde, C., & Knol, D.L. (2007). Safety of chiropractic manipulation of the cervical spine: A prospective national survey. Spine, 32(21), 2375-2378. 

  • Dabbs, V., & Lauretti, W.J. (1995). A risk assessment of cervical manipulation vs NSAIDs for the treatment of neck pain. Journal of Manipulative and Physiological Therapeutics, 18(8), 530-536. Haldeman, S., & Rubinstein, S.M. (2004). Cauda equina syndrome in patients undergoing manipulation of the lumbar spine. Spine, 29(23), 2663-2667. 

  • Carnes, D., Mars, T.S., Mullinger, B., Froud, R., & Underwood, M. (2010). Adverse events and manual therapy: A systematic review. Manual Therapy, 15(4), 355-363. 

  • Moore, N., Pollack, C., & Butkerait, P. (2015). Adverse drug reactions and drug–drug interactions with over-the-counter NSAIDs. Therapeutics and Clinical Risk Management, 11, 1061-1075. 

  • Vowles, K.E., McEntee, M.L., Julnes, P.S., Frohe, T., Ney, J.P., & Van der Goes, D.N. (2015). Rates of opioid misuse, abuse, and addiction in chronic pain: A systematic review and data synthesis. Pain, 156(4), 569-576. 

  • Yoshihara, H. (2012). Surgical treatment for lumbar spinal stenosis in the elderly: Lumbar decompression surgery and minimally invasive lumbar interbody fusion. Global Spine Journal, 2(4), 229-236.

  • Pannell, W.C., Savin, D.D., Scott, T.P., Wang, J.C., & Daubs, M.D. (2015). Trends in the surgical treatment of lumbar spine disease in the United States. Spine Journal, 15(8), 1719-1727.

  • Rihn, J.A., Hilibrand, A.S., Radcliff, K., Kurd, M., Lurie, J., Blood, E., ... & Weinstein, J. (2009). Duration of symptoms resulting from lumbar disc herniation: Effect on treatment outcomes: Analysis of the Spine Patient Outcomes Research Trial (SPORT). Journal of Bone and Joint Surgery, 93(20), 1906-1914.

  • Singh, K., Nandyala, S.V., Marquez-Lara, A., Fineberg, S.J., Oglesby, M., Pelton, M.A., ... & Patel, A.A. (2012). A perioperative cost analysis comparing single-level minimally invasive transforaminal lumbar interbody fusion (TLIF) to open TLIF. Journal of Spinal Disorders & Techniques, 28(5), E298-E303.

Likewise, the benefits of each are also comparative.

  • Chiropractic care: Success rates for chiropractic care in treating low back pain can vary, with approximately 60-80% of patients experiencing significant pain relief and functional improvement after receiving spinal manipulative therapy (Cherkin et al., 2003; Haas et al., 2005). Time to symptom resolution varies but can range from a few weeks to a few months, depending on the patient's condition and adherence to the treatment plan.

  • Physical therapy: Physical therapy has a similar success rate to chiropractic care in treating low back pain, with around 60-80% of patients experiencing substantial improvements in pain and function (Delitto et al., 2012; Ferreira et al., 2013). Recovery time depends on the individual's condition and response to treatment, but it can take anywhere from a few weeks to several months.

  • Medical/medicine treatment: The success rates for medical treatment of low back pain depend on the specific medication used. For example, success rates for NSAIDs in providing pain relief are around 60-80% (Roelofs et al., 2008). Opioids can be more effective in relieving severe pain but carry a higher risk of addiction and side effects (Vowles et al., 2015). The time to symptom resolution with medications varies greatly, depending on the patient's response, adherence to the medication regimen, and underlying cause of the pain.

  • Surgical treatment: This is really not comparable, but here it goes, just to be fair… Surgical success rates for treating specific causes of low back pain, such as spinal stenosis or herniated discs, range from 70-90% (Weinstein et al., 2006; Jacobs et al., 2011). Time to symptom resolution can range from a few weeks to several months, depending on the type of surgery and the individual's recovery process. However, it's important to note that surgery is usually reserved for severe cases or when conservative treatments have been unsuccessful.



  • Cherkin, D.C., Sherman, K.J., Deyo, R.A., & Shekelle, P.G. (2003). A review of the evidence for the effectiveness, safety, and cost of acupuncture, massage therapy, and spinal manipulation for back pain. Annals of Internal Medicine, 138(11), 898-906. 

  • Haas, M., Goldberg, B., Aickin, M., Ganger, B., & Attwood, M. (2005). A practice-based study of patients with acute and chronic low back pain attending primary care and chiropractic physicians: Two-week to 48-month follow-up. Journal of Manipulative and Physiological Therapeutics, 28(3), 160-169. 

  • Delitto, A., George, S.Z., Van Dillen, L.R., Whitman, J.M., Sowa, G., Shekelle, P., ... & Godges, J.J. (2012). Low back pain: Clinical practice guidelines linked to the International Classification of Functioning, Disability, and Health from the Orthopaedic Section of the American Physical Therapy Association. Journal of Orthopaedic & Sports Physical Therapy, 42(4), A1-A57.

  • Ferreira, M.L., Ferreira, P.H., Latimer, J., Herbert, R.D., & Maher, C.G. (2013). Efficacy of spinal manipulative therapy for low back pain of less than three months' duration. Journal of Manipulative and Physiological Therapeutics, 26(9), 593-601.

  • Roelofs, P.D., Deyo, R.A., Koes, B.W., Scholten, R.J., & van Tulder, M.W. (2008). Nonsteroidal anti-inflammatory drugs for low back pain: An updated Cochrane review. Spine, 33(16), 1766-1774.

  • Vowles, K.E., McEntee, M.L., Julnes, P.S., Frohe, T., Ney, J.P., & van der Goes, D.N. (2015). Rates of opioid misuse, abuse, and addiction in chronic pain: A systematic review and data synthesis. Pain, 156(4), 569-576.

  • Weinstein, J.N., Tosteson, T.D., Lurie, J.D., Tosteson, A.N., Hanscom, B., Skinner, J.S., ... & Deyo, R.A. (2006). Surgical vs nonoperative treatment for lumbar disk herniation: The Spine Patient Outcomes Research Trial (SPORT): A randomized trial. JAMA, 296(20), 2441-2450.

  • Jacobs, W.C., Rubinstein, S.M., Willems, P.C., Moojen, W.A., Pellisé, F., Oner, C.F., ... & Peul, W.C. (2011). The evidence on surgical interventions for low back disorders, an overview of systematic reviews. European Spine Journal, 20(9), 1442-1452.


It is important to emphasize that these risk and benefit estimates are approximate and may vary depending on individual patient factors, the practitioner, and specific treatment approaches. Moreover, it is essential to consider that the risks and benefits of each treatment modality can be influenced by factors such as the skill and experience of the healthcare provider, adherence to clinical guidelines and best practices, and the proper use of medications or surgical techniques.

Many studies mention that the success of any treatment largely depends on the individual's commitment to following the prescribed treatment plan, participating in recommended exercises or physical therapy sessions, and making any necessary lifestyle changes. In some cases, a multimodal approach combining different treatment modalities might be the most effective way to manage pain.

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