Incidences of Injury in Chiropractic and Mitigation Strategies for Benign Adverse Events after Spinal Manipulation

Incidences of Injury in Chiropractic and Mitigation Strategies for Benign Adverse Events after Spinal Manipulation

By: Dr. Ayhem Sabry B.S., D.C.

            It is hypothesized that fewer than 1 in 100,000 spinal manipulation techniques (SMT) result in adverse events (AE) grade 3 or higher on a scale of 1 to 5, with 1 being mild and 5 being death. The study was conducted as a retrospective analysis of that examined the data of 960,140 SMT treatments provided to 54,846 patients in 30 clinics in Hong Kong. The study reviewed patients' medical records, surveys, and complaint logs from January 2017 to August 2022. Data collection included SMS surveys, phone calls, and electronic medical records. The severity of the adverse events (AE). The patients received manual thrust SMT techniques, and their pain severity was recorded (Chu, E. C.-P. et al., 2023).

           According to Chu, E.C.-P et al. (2023), severe adverse events (AE) related to chiropractic spinal manipulation techniques (SMT) are extremely rare. No fatalities were reported in this study, and no AEs were life-threatening. Patients with past medical conditions such as osteoporosis, older age, previous dental issues, and spinal degeneration had a higher risk of severe adverse reactions. The standard techniques leading to AE were SMT to the cervical spine, followed by the lumbar spine and thoracic spine manipulations (Chu, E. C.-P., et al., 2023).

            Most of the AEs were mild or moderate; 82% were grade 2 or moderate, and 13% were grade 1 or mild. Mild AEs included symptoms related to the patient's chief complaints, as well as chest pain and jaw pain, among other symptoms. Incidences of severe AEs of grade 3 or higher were very low, with 0.21 per 100,000 SMT treatments. Two incidences were reported in women over the age of 60 with osteoporosis, and both were found to have a rib fracture. No life-threatening events were identified (Chu, E. C.-P., et al., 2023).

            Many AEs after a spinal manipulation are benign and commonly transient. Approximately 50% of SMT patients experience benign AEs such as soreness, stiffness, or headaches. These mild AEs can affect patient satisfaction and their perception of the quality of care (Funabashi, M., et al., 2020). 

            A survey was conducted at two chiropractic teaching institutions, the focus of which was on the beliefs of the occurrences of benign AEs and potential mitigation strategies. Clinicians were surveyed, and the survey showed that 97% of clinicians believed that benign AEs occurred, and 82% acknowledged that their patients did experience AEs. Most clinicians advised their patients to use ice, soft tissue treatment, or education to help themselves (Funabashi M. et al., 2020).

            Patients reported that the most common AEs were pain, soreness, headache, and stiffness, with 55% of patients experiencing these symptoms. Patients reported that stretching was the most common and effective strategy to reduce the AE symptoms, followed by education and massage. Patients reported that their chiropractors were not implementing these mitigations to alleviate AEs, but chiropractors reported that they did. There seems to be a disconnect between what chiropractors do and what patients perceive (Funabashi M. et al., 2020).

References:

Funabashi, M., Pohlman, K. A., Goldsworthy, R., Lee, A., Tibbles, A., Mior, S., & Kawchuk, G.   (2020). Beliefs, perceptions, and practices of chiropractors and patients about mitigation strategies for benign adverse events after spinal manipulation therapy. Chiropractic & Manual Therapies, 28(46).

Chu, E. C.-P., Trager, R. J., Lee, L. Y.-K., & Niazi, I. K. (2023). A retrospective analysis of the incidence of severe adverse events among recipients of chiropractic spinal manipulative therapy. Scientific Reports, 13, 1254.