Is Chiropractic Safe?

This is a controversial question, though I’m not sure why. The short answer is, yes, it is safe. The easiest way to tell is to look at malpractice insurance premiums (the ones I show here are from a US government review). Insurance companies don’t mess with risk. They charge an arm and a leg if they think you are a risk. The average premiums for different professions will tell you who has risk of problems, and who does not. Let me show you some numbers (Connecticut General Assembly Legislative Review, 2003):

Approximate Malpractice Insurance Premiums

OB/Gyn $120,000

General Surgeon $75,000

Internal Medicine $20,000

Family Practice $15,000

Chiropractors $2000-4000

Obviously the insurance industry doesn’t think chiropractors are a big risk for malpractice claims.

Now here’s where it gets controversial. And people may say, wait a minute studies have shown more than that. It’s true there have been rare serious problems seen after chiropractic treatments. The problem is that they are so rare that research has not been able to prove a causal link to chiropractic, or to rule it out. These problems are so rare that it is nearly impossible to prove one way or the other.  In fact the most recent and complete study showed that the risk of stroke is no greater after visiting a chiropractor than after visiting a medical doctor (Haldane et al 2008).   The worst risk is a stroke, and the risk is estimated (due to lack of concrete evidence) to be somewhere between 1 in a million to 1 in 3.3 million (Haldane 1999, Rand report 1996, Terrett 2001) (* or see abstract at the end of this article) . Compare that with the risks in common medical neck treatments:

Risk Likelihood Source
Stroke after chiropractic adjustment 1 in 1,000,000 (Haldane, 1999)
Serious neurological injury after neck spinal surgery 1 in 64.1 (Rand report, 1996)
Death after neck spinal surgery 1 in 144 (Terrett, 2001)
Hospitalization after anti-inflammatory use leading to gastric ulcers 1 in 25 (Terrett, 2001)


The most recent study on strokes (Haldane el al 2008) emphasizes people come to chiropractor’s and doctor’s offices with neck pain because a stroke is already developing and the treatment has no bearing on the occurance of the stroke. Again, they found the same likelihood of suffering a stroke after seeing a chiropractor as after seeing an MD.

OK, so what are the more common risks? The possible risks of chiropractic treatment include, bruising, muscle and ligament strain/sprain, undefined soreness, headache and bone fracture. Now let’s put them in perspective. Bone fracture, like strokes, is one of those rare things, and again will probably only happen when someone is predisposed. A person with osteoporosis or bone tumors, or suspected to possibly have osteoporosis or bone tumors, should not be adjusted with a full force method. This is why I usually leave this side effect out of the list when talking about proper chiropractic treatment. These other risks are still quite small and depend on the chiropractor’s technique and aggressiveness as well as the patient’s ability to relax and let the chiropractor do his work. Understand, stretching and working tender tissues can be uncomfortable, but the tenderness should be transitory.

The last thing that I will say is that you should always bring negative effects to the attention of your chiropractor. Even if they are not caused by the doctor himself he should be aware of them, so that if they are serious he can take care of them or get you to an ER if needed. Some of the serious things to report are:  intense pain, dizziness, vertigo, slurring of speech, vision changes, weakness, tingling, or numbness. They may be nothing, but you should let your doctor determine that.


Connecticut General Assembly Legislative Review. Medical Malpractice Insurance Rates. December, 2003. Hartfort, Connecticut.

Haldeman, Scott, DC, MD, PhD. Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. Spine 2008: 33 (4S).

Haldeman, S., Kohlbeck, FJ and McGregor, M. Risk Factors and Precipitating Neck Movements Causing Vertebrobasilar Artery Dissection After Cervical Trauma and Spinal Manipulation. Spine 1999: 24 (8): 785-794.

Rand Report: Coulter, ID, et al. (1996) The Appropriateness of Manipulation and Mobilization of the Cervical Spine. RAND, Santa Monica, California. Document No. MR-781-CR

Terrett, AGJ. Current Concepts in Vertebrobasilar Complications Following Spinal Manipulation. NCMIC Group Inc., Des Moines, Iowa. 2001.


* Here is a recent analysis of the risk of stroke after chiropractic neck manipulation.

Scott Haldeman, MD, DC reviewed malpractice claims records for a 10-year period between 1988 and 1997. In reviewing the outcomes following the application of 134.5 million cervical manipulations (commonly referred to as the chiropractic adjustment), the records indicated that there were 23 reported cases of stroke or vertebral artery dissection (VAD).  Of this group, 10 of the patients had the complicating factors of high blood pressure, use of oral contraceptives, or a history of smoking, all of which are associated with vascular disease.   The actual incidence of stroke or VAD following cervical manipulation was found to be one per 5.85 million cervical adjustments. That means that the average chiropractor could work for 1430 years (or practice 48 full chiropractic careers!) before they might be involved with this type of litigation.

Haldeman. Arterial Dissections Following Cervical Manipulation: The Chiropractic Experience. Canadian Medical Association Journal (2001). Oct 2; 165 (7):  905–906