Chiropractic is recognized as one of the safest, drug-free, non- invasive treatments available for headache, neck, and back pain. During the last 25 years there have been five formal government inquiries into chiropractic, all of which have found the profession to be both safe and effective.1 Based on the results of more than 85 studies into the safety and efficacy of chiropractic treatment, no other profession, including medicine, can demonstrate greater effectiveness or a better safety record for the treatment of spinal pain syndromes.

The risk of stroke from manipulation of the upper neck is small. Current published reports put the risk at between one or two out of one million treatments with the risk of serious consequences being even less likely.2

In fact, strokes may occur from normal everyday activities such as cradling a phone between your ear and shoulder during a prolonged conversation.3Strokes have also been associated with simple activities such as having one’s hair washed at a beauty parlour, dental procedures, painting a ceiling, and turning one’s head while driving.4 Occurrences like this cannot be predicted.

Other likely treatments for head, neck and back pain carry a notably higher risk. For example:

  • The risk of gastrointestinal bleeding, caused by common pain relievers, such as ASA, is 400 times greater than the risk of damage from neck manipulation.5
  • Serious neurological complications from cervical spine surgery are more than 15,000 per million, and the mortality rate is almost 7,000 per million.6

Informed Consent

The chiropractor makes a diagnosis by taking a thorough health history and performing a physical examination. After determining any contraindications to treatment, an appropriate plan of care is developed.

Prior to starting treatment, chiropractors are required to obtain informed consent from their patients. A consumer’s choice of health care should always be based on informed consent. Health consumers must receive adequate and accurate information to assist them in evaluating their health care choices, and in balancing the relative risks of treatment options with the benefits.

Ongoing research

In 2008 the journal Spine published an article called Risk of Vertebrobasilar Stroke and Chiropractic Care: Results of a Population-based Case-control and Case-crossover Study7 which studied which practitioner, a medical doctor or a chiropractor, a person had seen prior to having a vertebrobasilar stroke. The result was that there was virtually no difference, in fact, people were slightly more likely to see an MD in the week prior. The increased risks of vertebrobasilar artery stroke associated with chiropractic and physician visits is likely explained by patients with vertebrobasilar dissection-related neck pain and headache consulting both chiropractors and primary care physicians before their VBA stroke. The authors of the study concluded that:

  • Vertebrobasilar artery stroke is a rare event in the population.
  • There is an association between vertebrobasilar artery stroke and chiropractic visits in those under 45 years of age.
  • There is also an association between vertebrobasilar artery stroke and use of primary care physician visits in all age groups.
  • We found no evidence of excess risk of VBA stroke associated chiropractic care.

The authors of the 2012 study Vertebral artery strains during high-speed, low amplitude cervical spinal manipulation8 state… “Spinal manipulative therapy (SMT) has been recognized as an effective treatment modality for many back, neck and musculoskeletal problems. One of the major issues of the use of SMT is its safety, especially with regards to neck manipulation and the risk of stroke. The vast majority of these accidents involve the vertebro-basilar system, specifically the vertebral artery (VA) between C2/C1. However, the mechanics of this region of the VA during SMT are unexplored. Here, we present first ever data on the mechanics of this region during cervical SMT performed by clinicians. VA strains obtained during SMT are significantly smaller than those obtained during diagnostic and range of motion testing, and are much smaller than failure strains. We conclude from this work that cervical SMT performed by trained clinicians does not appear to place undue strain on VA, and thus does not seem to be a factor in vertebro-basilar injuries.”

The chiropractic profession continues to conduct research that will ensure that care is provided as effectively and safely as possible.

  1. Chiropractic in the United States: Training, Practice and Research, U.S. Department of Health and Human Services, AHCPR Research Report, Dec.1997.
    Chiropractic in New Zealand, Report of the Commission of Inquiry, Hasselberg PD, Government Printer, Wellington, 1979.
    Medicare Benefits Review Committee, Thompson CJ, Commonwealth Government Printer, Australia, 1986
    Legitimization for Vissa Kiropraktorer, Commission on Alternative Medicine, SOU, 1987.
    The Effectiveness and Cost-Effectiveness of Chiropractic Management of Low-Back Pain, Manga P, Angus D, et al. Commissioned by the OCA and funded by the Ontario Ministry of Health. Pran Manga & Associates, University of Ottawa, 1993.
  2. The Appropriateness of Manipulation and Mobilization of the Cervical Spine: A Systematic Review of Literature, Hurwitz EL, Aker PD, Adams AH, Meeker WC, Shekelle PG, Spine, 21(15); 1753-1755, 1996.
    Risk Factors and Precipitating Neck Movements Causing Vertebrobasilar Artery Dissection After Cervical Trauma and Spinal Manipulation, Haldeman S, Kohlbeck FJ, McGregor M, Spine, 24(8); 785-794, 1999.
  3. Carotid Artery Dissection due to Elongated Styloid Process, Zuber M, Meder JF, Mos JI, Neurology, Nov. 1999.
  4. Beauty Parlour Stroke Syndrome: Report of Five Cases, Weintraub MI, Journal of the American Medical Association, 269:2085-86, 1993.
    Abrupt Change in Head Position and Cerebral Infarction, Sherman DG, Hart RG, Easton JD, Stroke, 12:2-6, 1981.
    Vertebral Artery Occlusion Following Hyperextension and Rotation of the Head, Okawara S, Nibbelink D, 5:640-42, 1974.
    Cervical Manipulation and Stroke, Stroke, 8:594-97, 1977.
  5. A Risk Assessment of Cervical Manipulation v. NSAIDS for the Treatment of Neck Pain, Dabbs V, Lauretti WJ, Journal of Manipulative and Physiological Therapeutics, 18.530-36, 1995.
  6. Ibid.
  7. Risk of Vertebrobasilar Stroke and Chiropractic Care: Results of a Population-based Case-control and Case-crossover Study
    Cassidy JD, Boyle E, Côté P, He Y, Hogg-Johnson S, Silver FL, Bondy SJ
    SPINE (Phila Pa 1976) 2008 (Feb 15); 33 (4 Suppl): S176–183
  8. Vertebral artery strains during high-speed, low amplitude cervical spinal manipulation
    W. Herzog, T.R. Leonard, B. Symons, C. Tang, S. Wuest
    Journal of Electromyography and Kinesiology 22 (2012) 740–746