Chiropractic - Safety
Safety
Chiropractic care in general is safe when employed skillfully and appropriately. Its primary therapeutic procedure, spinal manipulation, involves directed thrust to move a joint past its physiological range of motion without exceeding the anatomical limit. Manipulation is regarded as relatively safe, but as with all therapeutic interventions, complications can arise, and it has known adverse effects, risks and contraindications.[1] Absolute contraindications to spinal manipulation are conditions that should not be manipulated; these contraindications include rheumatoid arthritis and conditions known to result in unstable joints. Relative contraindications are conditions where increased risk is acceptable in some situations and where low-force and soft-tissue techniques are treatments of choice; these contraindications include osteoporosis.[1] Although most contraindications apply only to manipulation of the affected region, some neurological signs indicate referral to emergency medical services; these include sudden and severe headache or neck pain unlike that previously experienced.[2]
Spinal manipulation is associated with frequent, mild and temporary adverse effects,[2][3] including new or worsening pain or stiffness in the affected region.[4] They have been estimated to occur in 34% to 55% of patients, with 80% of them disappearing within 24 hours.[2] Rarely, spinal manipulation, particularly on the upper spine, can also result in complications that can lead to permanent disability or death; these can occur in adults[3] and children.[5] The incidence of these complications is unknown, due to rarity, high levels of underreporting, and difficulty of linking manipulation to adverse effects such as stroke, a particular concern.[3] Several case reports show temporal associations between interventions and potentially serious complications.[6] Vertebrobasilar artery stroke is statistically associated with chiropractic services in persons under 45 years of age, but it is similarly associated with general practitioner services, suggesting that these associations are likely explained by preexisting conditions.[6] Weak to moderately strong evidence supports causation (as opposed to statistical association) between cervical manipulative therapy (whether chiropractic or not) and vertebrobasilar artery stroke.[7]
- ↑ 1.0 1.1
- ↑ 2.0 2.1 2.2 Anderson-Peacock E, Blouin JS, Bryans R; et al. (2005). "Chiropractic clinical practice guideline: evidence-based treatment of adult neck pain not due to whiplash" (PDF). J Can Chiropr Assoc. 49 (3): 158–209.
• Anderson-Peacock E, Bryans B, Descarreaux M; et al. (2008). "A clinical practice guideline update from The CCA•CFCREAB-CPG" (PDF). J Can Chiropr Assoc. 52 (1): 7–8. - ↑ 3.0 3.1 3.2 Ernst E (2007). "Adverse effects of spinal manipulation: a systematic review". J R Soc Med. 100 (7): 330–8. PMID 17606755.
- ↑ Thiel HW, Bolton JE, Docherty S, Portlock JC (2007). "Safety of chiropractic manipulation of the cervical spine: a prospective national survey". Spine. 32 (21): 2375–8. PMID 17906581.
- ↑ Vohra S, Johnston BC, Cramer K, Humphreys K (2007). "Adverse events associated with pediatric spinal manipulation: a systematic review". Pediatrics. 119 (1): e275–83. doi:10.1542/peds.2006-1392. PMID 17178922.
- ↑ 6.0 6.1 Hurwitz EL, Carragee EJ, van der Velde G; et al. (2008). "Treatment of neck pain: noninvasive interventions: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders". Spine. 33 (4 Suppl): S123–52. doi:10.1097/BRS.0b013e3181644b1d. PMID 18204386.
- ↑ Miley ML, Wellik KE, Wingerchuk DM, Demaerschalk BM (2008). "Does cervical manipulative therapy cause vertebral artery dissection and stroke?". Neurologist. 14 (1): 66–73. doi:10.1097/NRL.0b013e318164e53d. PMID 18195663.