Prize-winning paper from the World Federation of Chiropractic 7th Biennial Congress| Volume 27, ISSUE 1, P16-25, January 2004

Download started.


Adverse reactions to chiropractic treatment and their effects on satisfaction and clinical outcomes among patients enrolled in the UCLA Neck Pain Study



      Minor side effects associated with chiropractic are common. However, little is known about their predictors or the effects of reactions on satisfaction and clinical outcomes.


      The objectives of this study are to compare the relative effects of cervical spine manipulation and mobilization on adverse reactions and to estimate the effects of adverse reactions on satisfaction and clinical outcomes among patients with neck pain.


      Neck pain patients were randomized to receive cervical spine manipulation or mobilization. At 2 weeks, subjects were queried about possible treatment-related adverse reactions and followed for 6 months with assessments for pain and disability at 2, 6, 13, and 26 weeks. Numerical rating scales and the Neck Disability Index were used to measure pain and disability. Perceived improvement and satisfaction with care were assessed at 4 weeks.


      Of 960 eligible patients, 336 enrolled and 280 responded to the adverse event questionnaire. Thirty percent of respondents reported at least 1 adverse symptom, most commonly increased pain and headache. Patients randomized to manipulation were more likely than those randomized to mobilization to report an adverse reaction (adjusted odds ratio = 1.44, 95% confidence interval = 0.85, 2.43). Subjects reporting adverse reactions were less satisfied with care and less likely to have clinically meaningful improvements in pain and disability.


      Adverse reactions are more likely to be reported following cervical spine manipulation than mobilization. Chiropractors may reduce iatrogenesis and increase satisfaction and perhaps clinical outcomes by mobilizing rather than manipulating their neck pain patients.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Manipulative & Physiological Therapeutics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Hurwitz E.L.
        • Aker P.D.
        • Adams A.H.
        • Meeker W.C.
        • Shekelle P.G.
        Manipulation and mobilization of the cervical spine.
        Spine. 1996; 21: 1746-1760
        • Assendelft W.J.
        • Bouter L.M.
        • Knipschild P.G.
        Complications of spinal manipulation.
        J Fam Pract. 1996; 42: 475-480
        • Haldeman S.
        • Carey P.
        • Townsend M.
        • Papadopoulos C.
        Arterial dissections following cervical manipulation.
        Can Med Assoc J. 2001; 165: 905-906
        • Senstad O.
        • Leboeuf-Yde C.
        • Borchgrevink C.F.
        Side-effects of chiropractic spinal manipulation.
        Scand J Prim Health Care. 1996; 14: 50-53
        • Senstad O.
        • Leboeuf-Yde C.
        • Borchgrevink C.F.
        Frequency and characteristics of side effects of spinal manipulative therapy.
        Spine. 1997; 22: 435-441
        • Leboeuf-Yde C.
        • Hennius B.
        • Rudberg E.
        • Leufvenmark P.
        • Thunman M.
        Side effects of chiropractic treatment.
        J Manipulative Physiol Ther. 1997; 20: 511-515
        • Barrett A.J.
        • Breen A.C.
        Adverse effects of spinal manipulation.
        J R Soc Med. 2000; 93: 258-259
      1. Cherkin DC, Mootz RD. Chiropractic in the United States: training, practice and research. Rockville (MD): Agency for Health Care Policy and Research, Public Health Service, US Dept of Health and Human Services; December 1997. p. 74-6. AHCPR Publication No. 98-N002

        • Christensen M.G.
        • Kerkoff D.
        • Kollasch M.W.
        Job analysis of chiropractic 2000. National Board of Chiropractic Examiners, Greeley (CO)2000: 129
      2. Haldeman S, Chapman-Smith D, Petersen DM. Guidelines for chiropractic quality assurance and practice parameters. Proceedings of the Mercy Center Consensus Conference; 1992 Jan 25-30; Burlingame, Calif. Gaithersburg (MD): Aspen; 1993

        • Vernon H.T.
        • Mior S.A.
        The Neck Disability Index.
        J Manipulative Physiol Ther. 1991; 14: 409-415
        • Vernon H.
        The Neck Disability Index.
        J Musculoskelet Pain. 1996; 4: 95-104
        • Fairbank J.C.T.
        • Couper J.
        • Davies J.B.
        • O'Brien J.P.
        The Oswestry low back pain disability index.
        Physiotherapy. 1980; 66: 271-273
        • Ware J.E.
        • Sherbourne C.D.
        The MOS 36-Item Short-Form Health Survey (SF-36).
        Med Care. 1992; 30: 473-483
        • McHorney C.A.
        • Ware J.E.
        Construction and validation of an alternate form general mental health scale for the Medical Outcomes Study Short-Form Health Survey.
        Med Care. 1995; 33: 15-28
        • Cherkin D.
        • Deyo R.A.
        • Berg A.O.
        Evaluation of a physician education intervention to improve primary care for low-back pain. II.
        Spine. 1991; 16: 1173-1178
        • Hoving J.L.
        • Koes B.W.
        • de Vet H.C.
        • van der Windt D.A.
        • Assendelft W.J.
        • van Mameren H.
        • et al.
        Manual therapy, physical therapy, or continued care by a general practitioner for patients with neck pain.
        Ann Intern Med. 2002; 136: 713-722
        • Hurwitz E.L.
        • Morgenstern H.
        • Harber P.
        • Kominski G.F.
        • Yu F.
        • Adams A.H.
        A randomized trial of chiropractic manipulation and mobilization for patients with neck pain.
        Am J Public Health. 2002; 92: 1634-1641
        • Powell F.C.
        • Hanigan W.C.
        • Olivero W.C.
        A risk/benefit analysis of spinal manipulation therapy for relief of lumbar or cervical pain.
        Neurosurgery. 1993; 33: 73-79
        • Haldeman S.
        • Rubinstein S.M.
        The precipitation or aggravation of musculoskeletal pain in patients receiving spinal manipulative therapy.
        J Manipulative Physiol Ther. 1993; 16: 47-50
        • Haldeman S.
        • Kohlbeck F.J.
        • McGregor M.
        Risk factors and precipitating neck movements causing vertebrobasilar artery dissection after cervical trauma and spinal manipulation.
        Spine. 1999; 24: 785-794
        • Haldeman S.
        • Kohlbeck F.J.
        • McGregor M.
        Unpredictability of cerebrovascular ischemia associated with cervical spine manipulation therapy.
        Spine. 2002; 27: 49-55
        • Haldeman S.
        • Kohlbeck F.J.
        • McGregor M.
        Stroke, cerebral artery dissection, and cervical spine manipulation therapy.
        J Neurol. 2002; 249: 1098-1104
        • Senstad O.
        • Leboeuf-Yde C.
        • Borchgrevink C.
        Predictors of side effects to spinal manipulative therapy.
        J Manipulative Physiol Ther. 1996; 19: 441-445