Safe and Effective Health Care

Information for Patients

Chiropractic care is widely recognized as one of the safest, drug-free, surgery-free therapies available for the treatment of back and neck pain, headaches, and other musculo-skeletal conditions. Few other therapies can demonstrate a better safety record for the treatment of spinal pain syndromes. Of course, no health treatment is completely free of potential adverse effects. Even common over-the-counter medicines carry a risk. Fortunately, the vast majority of adverse effects associated with spinal adjustment are typically minor and short lived.

Questions and Answers

How safe is neck adjustment?

There is a rare risk of stroke, or stroke-like symptoms associated with adjustment of the neck. The most recent research published in 2001 in the Canadian Medical Association Journal puts the risk at one in 5.85 million adjustments(1).  Reports on the subject over the past 40 years present a range of estimates based on different research methodologies. However, all of the published studies to date agree that the risk is extremely low. Overall, a ratio of one to two cases per million neck adjustments represents a conservative and generally recognized estimate (2). That is less than your risk of getting struck by lightening or of dying while skiing or playing soccer (3). Most chiropractors do not have a single case of a patient experiencing serous adverse effects during their entire professional lives.

How does that compare to other risk factors?

There are many risk factors for stroke including blood clotting problems, hypertension, smoking, high cholesterol, use of birth control pills, heart problems and trauma such as sports injuries or blows to the head from accident. All carry a greater degree of risk than spinal adjustment.

Strokes or stroke like symptoms are also associated with many normal every day activities such as cradling a phone between your ear and shoulder during a prolonged conversation, having your head washed at a beauty parlor, dental procedures, painting a ceiling, and turning your head while driving. Strokes also occur spontaneously in some people for no apparent reason.

What are the risks for other therapies?

Spinal adjustment is significantly safer than other common therapies for back and neck pain and headache. Long-term use of non-steroidal anti-inflammatory drugs (aspirin, ibuprofen, Motrin) cause 1,000 serious complications and 100-200 deaths per million cases. Surgeries for neck and back pain cause 15,600 cases (4) of paralysis or stroke per million cases, and 6,900 deaths per million (5).

Is neck adjustment a forceful action?

No, It is not. Neck adjustment is done within the normal range of motion, This normal range is less than what is required to turn your head when backing up a car. Adjustment of a joint is a highly skilled procedure which requires relatively little pressure. This has been clearly demonstrated in studies to determine the degree od physical stress applied during an adjustment. It is skill, not strength that is needed to conduct a safe, effective adjustment. Chiropractic education in Canada is an intensive four year program following three years of university undergraduate studies. By the time they graduate, Canadian Chiropractors are among the most skilled in the world.

Why has there been media attention focused on neck adjustments?

Attention has been recently directed to neck adjustment by a group of neurologists called the Canadian Stroke Consortium. The Consortium has, on a number of occasions, publicized alarmist data from an incomplete survey based on a questionnaire. The consortium has never revealed what method it is using for confirming whether the cases of stroke it reports are in fact associated with neck adjustment. Until such time as the survey is published in a peer reviewed medical journal where the survey design and conclusions can be evaluated by medical peers, it should be viewed with skepticism and caution.

Does the medical profession regard neck adjustment as safe and appropriate treatment?

Yes. Most chiropractors have excellent relationships with physicians and cross refer patients on a routine basis. Depending on a patient’s problems, their care may be co managed by both a doctor of chiropractic and a medical doctor. Further evidence of the respect which chiropractic has within the medical community was the presence of Canadian chiropractors on the health care team for Canada’s athletes at the 2002 Winter Olympics, as well as previous Olympics and Pan Am games.

For more information on the chiropractic profession and Chiropractic care visit the Canadian Chiropractic Association website at, College of Chiropractors of Alberta at or the back pain channel at


  1. Arterial Dissections Following Cervical Manipulation: The Chirorpactic Experience, Haldeman S, Carey P, Townsend M, Papadopoulos C, Canadian medical Association Journal, Vol 165, No 7, 905-906, 2001
  2. The Appropriateness of Manipulation and Mobilization of the Cervical Spine: A Systematic Review of the Literature, Hurwitz EL, Aker PD, Adams AH Meeker WC, Shekelle PG, Spine, 21(15); 1746-1760
    Risk Factors and Precipitating neck movements Causing Vertebrobasilar Artery Dissection After Cervical Traumaand Spinal Manipulation, Haldeman S, KohlbeckFJ, McGregor M. Spine, 24(8)
    Conservative Management of Mechanical Neck Pain: A systematic Overview and Meta-Analysis, AkerPD, Gross AR, et al. The British Medical Journal, 313: 1291-96, 1996.
  3. The Reality and Acceptance of Risk, dinman JD, Journal of the American Medical Association, 244(1); 1226-1228. 1980.
  4. A Risk Assessment of Cervical Manipulation v. NSAIDS for the Treatment of Neck Pain, Dabbs V, Lauretti WJ, Journal of Manipulative and Physiological Therapeutics, 18;530-6, 1995.
  5. Ibid