Safety: Musculoskeletal

Curator: Charlotte Leboeuf-Yde DC MPH PhD

Contributors: Bruce Walker DC MPH DrPH

PUBMED was searched using MeSH headings: ("adverse effects" [Subheading]) AND "Musculoskeletal Manipulations"[Mesh] and incidence

PUBMED was then searched using non-MeSH terms: combinations of: adverse effects and adverse events and lumabr spine and thoracic spine and cervical spine and chiropractic and spinal manipulation


The literature on the incidence of new and worsened musculoskeletal symptoms after spinal manipulation /chiropractic treatment consists of four types of articles:

1. Case-reports of clinically observed events either reported singly or collected in the form of a literature review.

2.  Practice-based prospective outcome studies, in which “ordinary” patients, treated by “ordinary” chiropractors describe what they experience after treatment.

3. Clinical studies in which chiropractic treatment is compared to other treatments.

4. Clinical trials in which chiropractic treatment is compared to sham treatment  or no treatment in terms of such symptoms.


A number of abstracts have been collected in relation to these four topics and are presented below. The vocabulary differs throughout the literature. Some authors refer to “reactions”, others to “side-effects” whereas others use the more harsh term “adverse events/reactions”. There are also a number of articles on the predictors of these reactions and on the clinical importance that these reactions may have on the future clinical course. However, these have not been specifically included in this list but will be dealt with in a future publication.