Risks of Chiropractic

(Originally posted on bcotoronto.com on Nov 17th, 2011)
The Informed Consent process applies to all healthcare including chiropractic. In most health related blogs a pretty biased picture is painted where the author will praise the benefits of their own therapies and present the risks of others. So in the interest of Informed Consent I am going to take this week and next to discuss the risks of chiropractic as unbiasedly as possible.

There are three major risks with chiropractic manipulation; disc herniations, broken bones, and stroke.

Four weeks ago we discussed what disc herniations or “bulging discs” are so I will not go into great detail here. When the squishy discs between each pair of vertebra herniate they can put pressure on the spinal cord or the nerves leaving the spine and cause tingling sensations, pain, and/or muscle weakness. The most common movement that causes herniation of an intervertebral disc is rotation to one side (either) and forward flexion of the spine. This is also the most common movement used by chiropractors to adjust the low back and the neck. The missing component of this equation is that most herniations occur when load is being applied such as lifting something.

Through this logic alone chiropractic has been accused of causing disc herniations for many decades. There was research a long time ago supporting this claim and stating that when the spine of cadavers was moved in the same way as a chiropractic adjustment the discs herniated. Deconstruction of the methodology of this study demonstrated the conclusion was incorrect because to study the discs the researchers had removed the motion limiting portions of the spine and moved the remaining bones beyond the range physically possible in an intact spine.

It is undeniable that some people do experience the symptoms of a herniated intervertebral disc after an adjustment but it is more likely that this is an aggravation of an asymptomatic (doctor speak for “The problem is there but is currently not causing any symptoms”) herniation. In fact, over half of the general population has asymptomatic disc herniations1.

It is very common to fear breaking bones with chiropractic adjustments. Many people claim it is the cracking sound that cause this thought but this risk is very rare. Bones are there to take a beating so that our internal organs don’t have to. The greatest risk of a fracture is in patients with severe osteoporosis (a decrease in bone quality) or other conditions that alter bone density. The most common break is in the ribs of these patients and this can be avoided with a minor change in technique if the condition is known beforehand. Broken bones with chiropractic adjustments in the average population are extremely uncommon.

The last and most publicly known risk of chiropractic manipulations is stroke with a cervical adjustment. This is such an in-depth and important topic that we will devote and entire post just to it next week.

Thanks for reading,
Dr. Ben

P.S. – Another part of the informed consent process is allowing patients to ask questions and provide them with all the answers they want. So please comment below or e-mail me if you have any questions.

1. Jensen et al. Magnetic resonance imaging of the lumbar spine in people without back pain. New England Journal of Medicine 1994 14;331(2):69-73.


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