A common question: Are Chiropractic adjustments safe? If we look at the facts, a Chiropractic adjustment is one of the safest techniques available in the healthcare market. Any idea that it is not safe is rooted more in bias and/or misunderstandings than what actual data points say. If the chiropractic adjustment is safe, where does this notion come from that says otherwise?
Background
Back in the 19th and early 20th centuries, medicine had a monopoly on the healthcare system in America. Medicine believed that if they couldn’t care for a patient, no one else should be able to. If a patient sought help outside of the medical model, that person was doomed to fall prey to an “unscientific quack, cultist or charlatan.” And this is exactly what they called Chiropractors.
Since its humble beginnings in 1895, Chiropractic has garnered medical animosity. This was due to one prevailing fact: Chiropractic was competition. Early on, the majority of Chiropractic “miracle cases” were those patients deemed “lost causes” by medicine. Chiropractic quickly gained traction as a natural “alternative” to medicine. Medicine at this point was not willing to accept Chiropractic’s new approach to health intervention. Instead, they sought to dismantle the Chiropractic competition.
The first attempt to stifle Chiropractic was to unjustly jail Chiropractors for “practicing medicine without a license.” During the first 30 years as a profession, 12,000 practicing Chiropractors were prosecuted over 15,000 times for practicing medicine without a license. Early Chiropractors fought tooth and nail in the courts to argue that Chiropractic is a separate and distinct healthcare service.
After this failed attempt, the medical community rallied behind The American Medical Association (AMA). As early as 1947, the Journal of The American Medical Association (JAMA) began to make inflammatory claims that an adjustment was a “severe trauma” to the spine. These claims were not based on any scientific research though. And since Chiropractors were barred from the journal, these kinds of statements continued unchecked.
Then in 1963, the AMA created an official “Committee on Quackery.” This sought a “containment of the chiropractic profession” that would “result in the decline of chiropractic.” Joseph Sabatier, the chairman of the committee said that “rabid dogs and chiropractors fit into about the same category…. Chiropractors were nice but they killed people.” Finally in 1987, after many lawsuits, the U.S. District Courts confirmed that the AMA had violated the Sherman Antitrust Act. The U.S. Court asserted that “the AMA decided to contain and eliminate chiropractic as a profession” and that it was the AMA’s intent “to destroy a competitor.”
Even though Chiropractors won their day in court, years of medical misinformation created a false identity in the public's eye of Chiropractic. Facts might be on the side of Chiropractic, but belief systems don’t always line up with facts. Let me now go over some pertinent information about the Chiropractic adjustment.
How much force is used with an adjustment?
In 2016, a study published in the Journal of Manipulative and Physiological Therapeutics called “Forces of Commonly Used Chiropractic Techniques for Children: A Review of the Literature” looked to answer this question. This study measured the force of an adjustment on the pediatric population from newborns up to 18 years of age. The adjustment force was measured in Newtons. About 100 Newtons are about equivalent to 22.5 lbs of force. Obtained measurements follow as such:
Neonates and infants aged 0 to 2 months: 20 Newtons (4.5 pounds of force)
Infants and toddlers aged 3 months to 23 months: 28 Newtons (6.3 pounds of force)
Young children aged 2 years to 8 years: 60 Newtons (13.5 pounds of force)
Older children and young adults aged 8 to 18 years: 88 Newtons (19.75 pounds of force)
Can an adjustment break or fracture the spine?
In 2004, the journal Spine published an article called “Tensile Failure of C2 Pedicles and the Subsequent Direct Repair in a Porcine Model.” The study looked at the force needed to fracture the pedicles of a cervical bone. The pedicles are the bony bridge connecting the vertebra's front and back portions. They looked at the pedicles because they are considered the weakest section of the spine structure. Based on their research, they found it takes around 3,200 Newtons of force to fracture the cervical spine pedicles, that is about 720 pounds of force.
If we put this information into some perspective, no force of a Chiropractic adjustment could ever come close to a fracture, an untruth that sometimes circulates from Chiropractic objectors.
Can an adjustment cause a stroke?
There is no human, experimental evidence that Chiropractic adjustments or neck manipulations are causally related to strokes. We can say this with a high degree of certainty, not only within the Chiropractic profession but by the scientific community at large. Where did this idea come from that a stroke is possible from an adjustment?
Again, as early as 1947, certain organizations in the medical community have been making false insistence that an adjustment is a “severe trauma” to the neck. Believers of this narrative have been trying to fill in the gaps of this argument ever since. The most popular claim is that an adjustment causes cervical artery dissection.
Cervical artery dissection (CAD) is a condition where one of the blood vessel walls in the neck tears. This tear can cause blood clots in your arteries, affecting the blood supply to your brain. Cervical artery dissection is one of the most common causes of a stroke.
In 2016, The Cureus Journal of Medical Science published the article “Systematic Review and Meta-analysis of Chiropractic Care and Cervical Artery Dissection: No Evidence for Causation.” This article applied The Hill criteria to reach their conclusion. Sir Austin Bradford Hill was the famed epidemiologist and statistician who pioneered the randomized clinical trial. It was through his work that he made the connection between cigarette smoking and lung cancer. Hill’s criteria became the gold standard in public health research to establish epidemiologic evidence of a causal relationship between a presumed cause and an observed effect.
In this 2016 systematic review and meta-analysis, the researchers found “no convincing evidence to support a causal link between chiropractic manipulation [adjustment] and Cervical Artery Dissection [CAD].” Furthermore, they state that even though “the very weak data supporting an association between chiropractic neck manipulation and CAD” exists, an assumed relationship by many clinicians “seems to enjoy the status of medical dogma” in the “absence of adequate and reliable data.” This paper shows that not only does an adjustment not cause a stroke but the idea that it does is based more on a belief system than the facts.
Death by adjustment!?
In 2015, the Journal of Manipulative and Physiological Therapeutics published an article titled “Adverse Events Due to Chiropractic and Other Manual Therapies for Infants and Children: A Review of the Literature.” Reviewing 31 articles, they identified 12 articles with 15 severe adverse effects reported. Of those 15 cases, “3 deaths had been reported and were associated with various manual therapists; however, no deaths associated with chiropractic care were found in the literature to date.” Of the deaths reported, the cases involved 1 physical therapist, 1 unknown practitioner, and 1 craniosacral therapist.
Malpractice insurance
Another benchmark to look at in determining the safety of a Chiropractic adjustment is malpractice insurance. All healthcare professionals carry malpractice insurance. Malpractice is a type of professional liability insurance purchased by health care professionals. Coverage is designed to protect healthcare providers against patients who file suit against them. Suits involve a complaint that they were harmed by the doctor’s negligent or intentionally harmful treatment decisions.
Not all healthcare professionals pay the same premiums. Premiums are based on a few factors: risks associated with the intervention or procedure, the doctor's experience, prior claims and the state where you practice. The biggest factor involved in calculating premiums is risk; the dangers that surround a given intervention and the potential for injury sustained by the patient. If a Chiropractic adjustment is unsafe, Chiropractors should pay a relatively high premium to practice, right?
As a practicing Chiropractor in the state of Ohio, my malpractice premium is $1,600 per year. How does this compare to a medical doctor? Depending on the specialty, a medical doctor in the state of Ohio can pay anywhere from $10,000 (dermatologist) to $69,000 (OBGYN) a year on average.
Why do medical doctors pay more? Medical doctors perform interventions or procedures that are associated with more risk. So if we just look at malpractice insurance premiums, going to a dermatologist is riskier than going to a Chiropractor. The dermatologist does procedures that have a higher incidence of risk to the patient compared to the Chiropractor. They need to be insured more to pay out to the patient in the event of an adverse reaction or injury. Chiropractors have one of the lowest malpractice insurance premiums in the US because our health intervention, the adjustment, is one of the safest.
Facts might be on the side of Chiropractic, but belief systems don’t always line up with the facts. If you are still concerned about the safety of Chiropractic, all I ask is that you look at the facts and make a decision based on your perspective of the information provided. Not from medicine’s perspective. Not even from a Chiropractic perspective. But on the perspective that you want the best health choice for you and your family.
Jarek Esarco, DC, CACCP is a pediatric, family wellness and upper cervical specific Chiropractor. He is an active member of the International Chiropractic Pediatric Association (ICPA). Dr. Jarek has postgraduate certification in Pediatric Chiropractic through the ICPA. Dr. Jarek also has postgraduate certification in the HIO Specific Brain Stem technique through The TIC Institute. Dr. Jarek is happily married to his wife Regina. They live in Youngstown, Ohio with their daughter Ruby.
References
Todd, A. J., Carroll, M. T., & Mitchell, E. K. L. (2016). Forces of Commonly Used Chiropractic Techniques for Children: A Review of the Literature. Journal of manipulative and physiological therapeutics, 39(6), 401–410. https://doi.org/10.1016/j.jmpt.2016.05.006
Kaspar, S., Dickey, J. P., Perrier, J., & Bednar, D. A. (2004). Tensile failure of C2 pedicles and of subsequent direct repair in a porcine model. Spine, 29(7), E127–E133. https://doi.org/10.1097/01.brs.0000116983.50996.48
Church, E. W., Sieg, E. P., Zalatimo, O., Hussain, N. S., Glantz, M., & Harbaugh, R. E. (2016). Systematic Review and Meta-analysis of Chiropractic Care and Cervical Artery Dissection: No Evidence for Causation. Cureus, 8(2), e498. https://doi.org/10.7759/cureus.498
Todd, A. J., Carroll, M. T., Robinson, A., & Mitchell, E. K. L. (2015). Adverse Events Due to Chiropractic and Other Manual Therapies for Infants and Children: A Review of the Literature. Journal of manipulative and physiological therapeutics, 38(9), 699–712. https://doi.org/10.1016/j.jmpt.2014.09.008