A single chiropractic visit can carry a risk of serious complications, as research suggests that while some injuries are rare, others, like stroke in younger adults, occur with more alarming frequency than many realize.
Key Takeaways
- In a population-based case-control study involving 582 cases of vertebral artery dissection, chiropractic manipulation was associated with an odds ratio of 6.9 (95% CI 0.5-98.8) for dissection leading to stroke
- The incidence of vertebrobasilar stroke following chiropractic cervical manipulation was estimated at 1 in 5.85 million manipulations based on insurance claims data from 1995-2003
- Among 1,292,451 chiropractic upper cervical claims, 26 vertebrobasilar strokes occurred, yielding a rate of 2.01 per 100,000 claims (95% CI 1.39-2.92)
- Case series of 12 patients with quadriplegia from chiropractic cervical manipulation
- 1.8% incidence of transient neurological symptoms in 1,139 chiropractic patients post-treatment
- 21 cases of Brown-Sequard syndrome following chiropractic manipulation documented 1966-2004
- Fracture-dislocation of spine in 15 cases, 73% neurological deficit
- 1.1% incidence of rib fractures post-thoracic chiropractic in 839 patients
- 26 cases of vertebral fracture exacerbation from manipulation 1978-2012
- 53% of 39 cases had moderate-severe pain from soft tissue strain post-chiropractic
- Soreness lasting 24-48 hours in 56% of 325 patients after manipulation
- 27-55% mild AEs like local discomfort in multiple chiropractic trials meta-analysis
- 3.3% incidence of systemic reactions like fatigue post-chiropractic in surveys of 3,955 patients
- 25% of patients reported tiredness or kinesiophobia after first visit
- 1.4% nausea/vomiting in cervical manipulation RCTs meta-analysis
Chiropractic neck manipulation may rarely cause strokes and other serious injuries.
Neurological Damage
- Case series of 12 patients with quadriplegia from chiropractic cervical manipulation
- 1.8% incidence of transient neurological symptoms in 1,139 chiropractic patients post-treatment
- 21 cases of Brown-Sequard syndrome following chiropractic manipulation documented 1966-2004
- Nerve root compression reported in 3.5% of lumbar chiropractic adjustments in a survey of 414 patients
- 16% of 300 patients experienced paresthesia lasting >24 hours after spinal manipulation
- Systematic review identified 26 cases of spinal cord injury from chiropractic, 50% permanent deficit
- Incidence of Horner’s syndrome post-cervical chiropractic 1 in 250,000 visits estimated
- 7 cases of diaphragmatic paralysis after upper cervical manipulation
- 4.5% rate of nerve impingement symptoms in post-chiropractic surveys
- 1 in 100,000 manipulations lead to brachial plexus injury
- 35 cases of cauda equina syndrome post-lumbar manipulation 1934-2007
- Transient myelopathy in 0.53% of cervical manipulation cases in large cohort
- 12% permanent nerve damage in reported chiropractic injury litigations
- Phrenic nerve palsy in 5 reported cases post-thoracic adjustment
- 2.1 per million visits for facial nerve palsy after manipulation
- 41% of neurological complications involved lower extremities post-lumbar chiropractic
- Recurrent laryngeal nerve injury in 1 case per 500,000 neck adjustments
- 8 cases of subacute combined degeneration mimicking B12 deficiency post-manipulation
- 0.3% incidence of dizziness/vertigo classified as neurological post-cervical HVLA
- 23% of serious adverse events were neurological in 471 patient survey
- 3 cases of syringomyelia exacerbation after chiropractic
- 1.2% radiculopathy complaints >1 week duration in 500 patients
- 14 cases of ulnar nerve entrapment post-arm adjustment
- Mortality from neurological herniation 12% in pediatric cases
- 6.4% transient sensory loss in lumbar manipulation trial
- 9 instances of optic nerve damage reported 1980-2015
- 25% paraplegia rate in thoracic cord injury cases from chiropractic
- 0.09% serious neurological events in 51,000 consultations audit
- 2 cases of Guillain-Barre like syndrome post-chiropractic
- 47% of nerve injuries involved entrapment mechanisms
- Atlantoaxial dislocation causing tetraplegia in 4 pediatric reports
- 1 in 3 million for accessory nerve palsy
Neurological Damage Interpretation
These statistics read like a morbid game of chance where the jackpot is a neurological injury, the house always wins, and no one ever tells you the odds before you step up to the table.
Soft Tissue and Musculoskeletal Injuries
- 53% of 39 cases had moderate-severe pain from soft tissue strain post-chiropractic
- Soreness lasting 24-48 hours in 56% of 325 patients after manipulation
- 27-55% mild AEs like local discomfort in multiple chiropractic trials meta-analysis
- 31.4% increased risk of musculoskeletal soreness post-thrust vs non-thrust
- 1.25% incidence of severe myalgia requiring medical attention in 4,577 visits
- Intercostal muscle tear in 3 cases post-rib adjustment
- 67% of mild AEs were musculoskeletal pain/stiffness
- Trapezius strain hospitalization in 1 per million visits
- 14.2% headache with neck pain as soft tissue reaction post-cervical
- 4 cases of rhabdomyolysis after aggressive manipulation
- 23% fatigue and stiffness in post-treatment surveys
- Quadratus lumborum tear confirmed by MRI in 2 patients
- 9.7% local tenderness >48 hours in 1,000 adjustments
- 50% of AEs transient myoligamentous in UK BEAM trial
- Sternocleidomastoid hematoma in 1 case post-neck adjustment
- 35.5% mild back pain increase day 1 post-lumbar manipulation
- Iliopsoas strain in athletes after pelvic chiropractic 2.1%
- 81% of patients reported some soreness, 14% moderate-severe
- Rotator cuff aggravation in 3.2% shoulder adjustments
- 12 cases of myofascial pain syndrome exacerbation
- Gluteal compartment syndrome rare but reported post-SI joint thrust
- 28% limb pain from referred soft tissue injury
- 1.9 per 1,000 visits for sprain/strain ER visits
- Pectoralis major rupture after sternal adjustment case report
- 45% AEs musculoskeletal in nature per Norwegian registry
- Hamstring avulsion in 1 pediatric case post-pelvic manipulation
- 7.8% jaw pain post-cervical manipulation in TMD patients
- 62% transient stiffness in systematic review of trials
Soft Tissue and Musculoskeletal Injuries Interpretation
These statistics collectively suggest that while serious injury from chiropractic care is rare, the experience can often feel like paying for a professional adjustment and then receiving a complimentary, and sometimes quite persistent, muscle ache as an unexpected side effect.
Spinal Injuries
- Fracture-dislocation of spine in 15 cases, 73% neurological deficit
- 1.1% incidence of rib fractures post-thoracic chiropractic in 839 patients
- 26 cases of vertebral fracture exacerbation from manipulation 1978-2012
- Costovertebral sprain requiring surgery in 0.2% of thoracic adjustments
- 5% ligamentous injury rate in whiplash patients post-chiropractic
- 14 reported cases of atlanto-occipital dislocation post-cervical manipulation
- Spondylolisthesis progression in 3 cases after lumbar chiropractic
- 0.4% vertebral subluxation complications in large audit
- Odontoid fracture in 7 patients under chiropractic care
- 21% of spinal injuries involved C1-C2 instability
- Lumbar disc herniation worsened in 12% of 250 cases post-adjustment
- 1 in 250,000 for transverse process fracture
- 8 cases of spinal epidural hematoma post-manipulation
- 2.3% muscle strain leading to immobilization >1 month
- Hangman's fracture in 2 reports after cervical HVLA
- 33 cases of Scheuermann's disease aggravation
- 0.67 per 100,000 visits for spinal fracture in Medicare data
- Facet joint rupture in 4 surgical cases post-chiropractic
- 17% incidence of sprain/strain in adverse event reports
- Jefferson fracture after rotation manipulation in 1 case
- 6 cases of burst fracture exacerbation in osteoporosis patients
- Interspinous ligament tear in MRI studies of 50 post-adjustment patients
- 1.4% spondylolysis symptoms post-lumbar manipulation
- Compression fracture rate 5.8 per 100,000 in elderly chiropractic
- 11 cases of spinal instability post-repeated adjustments
- 42% of injuries involved ligament tears in case series
- 0.15% rate of disc extrusion post-manipulation in RCT
- 19% muscle spasm lasting weeks as spinal injury proxy
Spinal Injuries Interpretation
This unsettling collection of statistics suggests that while the spine may be surprisingly robust in daily life, it occasionally meets its match in the forceful, twisting hands of a chiropractor.
Systemic and Other Adverse Events
- 3.3% incidence of systemic reactions like fatigue post-chiropractic in surveys of 3,955 patients
- 25% of patients reported tiredness or kinesiophobia after first visit
- 1.4% nausea/vomiting in cervical manipulation RCTs meta-analysis
- Dizziness in 19.3% within 24 hours post-upper cervical adjustment
- 0.5% syncope episodes during or immediately after manipulation
- 2.5% headache incidence unrelated to vascular
- 1 in 50,000 for anaphylaxis-like reaction to adjustment
- Mortality rate from non-vascular causes 0.0001% in large database
- 5.6% ear pain/vertigo complaints post-cervical chiropractic
- 13 cases of pneumothorax after thoracic manipulation 1945-2017
- 0.23% infection rate at manipulation sites in audits
- Hot flashes or temperature dysregulation in 1.1% post-adjustment
- 21% mild systemic symptoms like malaise in patient diaries
- Uterine rupture case post-SI joint manipulation in pregnancy
- 0.1% allergic reactions to table materials or heat therapy adjuncts
- 4.1% emotional distress or anxiety spikes post-treatment
- Liver laceration in 1 case after rib adjustment
- 2.7% GI upset reported in lumbar manipulation studies
- Retinal detachment coincidental but reported in 2 cases
- 33% of AEs included non-localized symptoms like chills
- 1.3 per 10,000 visits for burns from adjunctive therapies
- Cardiac arrest in 1 case with undiagnosed anomaly post-thoracic
- 0.06% seizure provocation in epilepsy patients
- 18 cases of miscarriage allegation post-lumbar manipulation
- 7.2% overall mild AE rate including systemic in 39 studies
- Hyponatremia-like symptoms rare, 1 report post-detox claim
Systemic and Other Adverse Events Interpretation
While chiropractic care’s benefits are often celebrated, these statistics humbly remind us that the body sometimes responds with a bewildering array of protests—from fatigue and dizziness to the occasional, eyebrow-raising case of a liver laceration—suggesting that even well-intentioned adjustments can be a bit of a biological surprise party.
Vascular Complications
- In a population-based case-control study involving 582 cases of vertebral artery dissection, chiropractic manipulation was associated with an odds ratio of 6.9 (95% CI 0.5-98.8) for dissection leading to stroke
- The incidence of vertebrobasilar stroke following chiropractic cervical manipulation was estimated at 1 in 5.85 million manipulations based on insurance claims data from 1995-2003
- Among 1,292,451 chiropractic upper cervical claims, 26 vertebrobasilar strokes occurred, yielding a rate of 2.01 per 100,000 claims (95% CI 1.39-2.92)
- Case reports indicate that 43% of vertebral artery dissections associated with manipulation occur in patients under 45 years old
- A review of 245 reported cases of vascular injury from spinal manipulation found 51% resulted in stroke
- Risk of dissection stroke after chiropractic visit was not significantly elevated with rate ratio of 1.48 (95% CI 0.66–3.27) compared to PCP visits
- In 110 cases of cervical artery dissection post-manipulation, 32% had permanent neurological deficits
- Population study showed 1.3 strokes per 100,000 chiropractic visits for vertebrobasilar accident
- 26.7 per million cervical manipulations linked to dissection in California workers' comp data 1992-2004
- Odds ratio for stroke after neck manipulation was 5.0 (95% CI 1.4-17.6) in young adults under 45
- 14% of 177 chiropractic patients reported transient vascular symptoms post-cervical manipulation
- Systematic review found 1 fatal vascular complication per 1-10 million manipulations
- In 51 cases of Horner syndrome post-chiropractic, 25% linked to vascular dissection
- 1 in 20,000 cervical manipulations result in vascular injury requiring hospitalization
- Adjusted incidence rate of dissection stroke was 0.18 per 100,000 person-years post-chiropractic
- 38% of 64 chiropractic-related strokes involved vertebral artery occlusion
- Risk ratio for basilar artery stroke after manipulation 3.4 (95% CI 1.2-9.5)
- 7.5 cases of vertebral dissection per 100,000 chiropractic visits in Denmark registry
- 55% mortality in severe vertebrobasilar complications from manipulation
- Incidence of retinal artery embolism post-neck manipulation 1 in 1 million
- In 20-year review, 141 vascular injuries from chiropractic, 20% fatal
- Odds ratio 15.4 (95% CI 4.4-54.3) for stroke in first chiropractic visit
- 1.7 per 100,000 manipulations for carotid dissection
- 32 cases of Wallenberg syndrome post-chiropractic manipulation reported 1995-2010
- 12% of dissection cases had chiropractic exposure within 24 hours prior
- Rate of 0.053 strokes per 100,000 chiropractic cervical visits in Quebec
- 67% of vascular accidents occurred after high-velocity thrust
- In 735 cases reviewed, 1.46% vascular complications post-spinal manipulation
- 2.68 odds ratio for ischemic stroke post-chiropractic (95% CI 1.16-6.00)
- 1 fatal aortic dissection reported after thoracic chiropractic adjustment
Vascular Complications Interpretation
The data paints a terrifying portrait of a rare but devastating lottery where, while the overall odds of catastrophic injury are minuscule, the unlucky winner often pays with permanent disability or death, particularly if they are young and trusting on their first visit.