Technique Update: Few Serious Adverse Effects From Manual Treatments

by Dr. David Graber, ANJC Council on Technique & Clinical Excellence Chairman

A scoping review of the literature of the risks of manual therapy which included 250 studies was published last month in the online journal Chiropractic & Manual Therapies. Looking at the occurrence of both benign and serious complications, the review found the following:

• Benign adverse events are common following manual treatment to the spine, affecting 23-83 percent of adult patients. These are mild and transient (usually resolve within 24 hours) and commonly include musculoskeletal pain, stiffness and headache.
• Dizziness, tiredness, feeling faint/lightheaded or tingling in the arms might also be experienced following neck treatment.
• Serious adverse events appear to be rare and are usually documented as case-reports, case series or retrospective surveys, making it difficult to quantify their occurrence or to establish causality.
• Serious adverse events could result from pre-existing pathologies in both adults and children, therefore assessment for signs or symptoms of these is important before any cervical manual treatment.
• It is essential that careful screening for known neck artery stroke risk factors, or signs or symptoms that there is a problem, is performed prior to manual treatment of the neck.
• Patients presenting with moderate to high levels of neck disability may have an approximately three times greater likelihood of experiencing transient neurological symptoms (dizziness, nausea, visual disturbance, tinnitus, extremity weakness or confusion) following manual cervical treatment compared with patients with mild levels of neck disability.
• Cervical manipulation may carry a greater risk compared with cervical mobilization or thoracic manipulation in patients with neck pain. Non-specific effects or natural progression may also contribute to reporting of benign adverse events.
• In neck pain patients, benign adverse events may result in poorer short-term outcomes, but do not seem to influence longer-term outcome.
• There does not seem to be any greater risk of traumatic injury for elderly patients visiting a chiropractor compared with visiting a medical practitioner for neuro-musculoskeletal problems.

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