Clinical Update: The Latest on the Safety of Chiropractic Care

By Dr. David I. Graber

Several studies have come out recently that support the safety of the care delivered by chiropractors. They cover some ground, so let’s review the key points in each.

1. Chiropractors are excellent at determining which patients are not appropriate for spinal manipulation. Published in the prestigious journal Spine, a study by the RAND Corporation found that only 1% of chronic low back pain patients and 3% of chronic neck pain patients deemed inappropriate for spinal manipulation (SM) received it.  Appropriateness of SM was determined by a criteria developed by multidisciplinary panel of DCs and other health specialties.

(Coulter, Ian D. PhDa; Herman, Patricia M. ND, PhDa,b; Kommareddi, Mallika PhDa,b; Hurwitz, Eric L. DC, PhDb; Shekelle, Paul G. MD, PhDa Measuring the Appropriateness of Spinal Manipulation for Chronic Low Back and Chronic Neck Pain in Chiropractic Patients, SPINE: February 15, 2021 – Volume Publish Ahead of Print – Issue – doi: 10.1097/BRS.0000000000004009)

2. Low rate of malpractice claims for chiropractors.  Utilizing a legal database to evaluate the relationship between chiropractic spinal manipulation and medical malpractice between 1988 and 2018: While only 48 cases were found, the outcomes showed several findings. 93.8% featured allegations involving spinal manipulation. The defense (practitioner) was victorious in 70.8% of cases. Overaggressive manipulation was the most frequent allegation (33.3%). A majority of cases alleged neurological injury of the spine as the reason for litigation (66.7%). C5-C6 & C6-7 disc herniations were the most frequently alleged injuries (57%). 

(Hartnett DA, Milner JD, Kleinhenz DT, Kuris EO, Daniels AH. Malpractice Litigation Involving Chiropractic Spinal Manipulation. World Neurosurg. 2021 Feb 22:S1878-8750(21)00260-6. doi: 10.1016/j.wneu.2021.02.067. Epub ahead of print. PMID: 33631389)

3. Communication to patients reduces the perception of adverse effects. A survey on patients’ perceptions of adverse effects (AE) after spinal manipulation found that 55% believed they had an AE. The most common AE symptoms were pain/soreness, headache, and stiffness. Symptoms that affected patient’s functionality were most often perceived as an AE. However, communication regarding post-treatment symptoms by the clinician was found to change the patients’ perception of their experience as adverse. 

(Martha Funabashi & Lisa C. Carlesso (2021) Symptoms patients receiving manual therapy experienced and perceived as adverse: a secondary analysis of a survey of patients’ perceptions of what constitutes an adverse response, Journal of Manual & Manipulative Therapy, 29:1, 51-58, DOI: 10.1080/10669817.2020.1761139)

4.  “The safety of spinal manipulation, especially when compared with medical treatments,

encourages its use for conservative treatment of lumbar disc herniation.”  This was a conclusion of the latest study on SM for lumbar radiculopathy. 
(Ghasabmahaleh SH, Rezasoltani Z, Dadarkhah A, Hamidipanah S, Mofrad RK, Najafi S. Spinal Manipulation for Subacute and Chronic Lumbar Radiculopathy: A Randomized Controlled Trial. Am J Med. 2021 Jan;134(1):135-141. doi: 10.1016/j.amjmed.2020.08.005. Epub 2020 Sep 13. PMID: 32931763)

5. There is no evidence to show an increase in serious risks associated with chiropractic treatment of neck or back pain in Medicare beneficiaries. In a paper discussing evidence that supports the resolution of inequities for Medicare beneficiaries who receive chiropractic care, Dr. Leach reiterated the conclusions from several previous studies on the safety of SM and chiropractic care. He argues that full coverage for chiropractic services in Medicare, as outlined the house bill HR 3654, would be both beneficial to patients’ health and cost-saving for the system. 

(Leach RA. Full-Coverage Chiropractic in Medicare: A Proposal to Eliminate Inequities, Improve Outcomes, and Reduce Health Disparities Without Increasing Overall Program Costs. J Chiropr Humanit. 2020 Dec 7;27:29-36. doi: 10.1016/j.echu.2020.10.002. PMID: 33324134; PMCID: PMC7729103)

From: ANJC Back Channel E-Newsletter, March10, 2021

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