Is Chiropractic Safe? Can a Chiropractor Paralyze You?

One of the biggest fears I hear from new patients is: “I’m terrified to see a chiropractor because I’ve heard they can paralyze you or cause a stroke.”

So, is chiropractic actually safe?

Yes. When performed appropriately on a properly screened patient, spinal manipulation has a strong overall safety record. Serious complications have been reported, but they appear to be very rare. Most side effects, when they occur, are temporary things like soreness, stiffness, or a mild headache.[1-3]

What About the Horror Stories?

The complication that gets the most attention is cervical artery dissection, which is a tear within the wall of an artery in the neck that can potentially lead to a stroke.

This is where an important principle comes into play:

Correlation does not necessarily mean causation.

A large population-based study by Cassidy and colleagues looked at vertebrobasilar strokes and visits to chiropractors and primary care physicians. Interestingly, people who eventually suffered this type of stroke were more likely to have recently visited either a chiropractor OR a medical doctor for complaints such as neck pain and headaches.[4]

Why would that happen?

Because neck pain and headache can actually be early symptoms of an artery that is already dissecting.[4,5]

In other words, a patient may wake up with unusual neck pain or a headache and think they simply have a neck problem. They seek treatment, and later the dissection progresses into a stroke. Because they happened to visit a chiropractor shortly before the stroke, it is easy to assume the adjustment caused it.

But the same association was found when these patients visited their primary care doctor.[4]

The Cassidy study concluded that there was no evidence of excess vertebrobasilar stroke risk associated with chiropractic care compared with primary care.[4]

That does not mean cervical manipulation can never be associated with an injury. The American Heart Association acknowledges a statistical association between cervical manipulation and cervical artery dissection but also states that it remains unclear whether some of these patients already had a developing dissection when they sought treatment.[5]

How Common Are Serious Chiropractic Injuries?

Thankfully, they appear to be extremely uncommon.

A prospective study following 19,722 chiropractic patients, 28,807 treatment visits, and more than 50,000 cervical manipulations found zero serious adverse events.[2]

A 2024 systematic review and meta-analysis of randomized clinical trials involving cervical manipulation also found that the reported adverse events were mild, with no moderate or serious adverse events reported in the included trials. The authors appropriately noted that extremely rare complications are difficult to measure in randomized trials because you would need enormous numbers of patients to detect them.[3]

Another review of 154 randomized trials involving 7,518 patients receiving spinal manipulation reported no serious adverse events, although researchers noted that adverse-event reporting across studies still needs to improve.[6]

So when you hear that chiropractic adjustments routinely cause paralysis or strokes, that simply is not what the research shows.

Mild Side Effects Are Much More Common

It is important to separate a serious complication from a normal temporary reaction to treatment.

Some people experience:

• Muscle soreness
• Temporary stiffness
• Mild headache
• Temporary increase in discomfort

These symptoms generally resolve on their own.[1]

That is very different from paralysis, spinal cord injury, or stroke.

The Evaluation Before the Adjustment Matters

This is also why I believe a chiropractic visit should involve much more than simply walking into an office and immediately getting your neck adjusted.

At Square One Health, we first perform a thorough history and examination to determine what may actually be causing your neck pain. When clinically appropriate, we also take X-rays to evaluate the structure of the spine, alignment, degeneration, previous injuries, or other findings that could affect treatment.

Most importantly, we do not assume that every patient should be adjusted.

If your examination suggests that something is outside the scope of conservative chiropractic care—or that further testing such as advanced imaging or medical evaluation is needed—we refer you to the appropriate provider.

Sometimes the most important thing a chiropractor can do is recognize when not to adjust someone.

Have Neck Pain but Nervous About Chiropractic?

If you have been dealing with neck pain but have avoided seeing a chiropractor because you are worried about safety, you do not have to start with an adjustment.

Start with an evaluation.

At Square One Health, our goal is first to determine why you are hurting and whether chiropractic care is appropriate for you. We perform a detailed examination, obtain X-rays when indicated, review your findings with you, and refer out when something requires additional medical evaluation.

You should understand what is happening in your body before anyone starts treating it.

If you have neck pain and want to find out what may be causing it, schedule an evaluation at Square One Health. We will examine you first, explain what we find, and then determine the safest and most appropriate next step.

References

1. Paige NM, Miake-Lye IM, Booth MS, et al. Association of spinal manipulative therapy with clinical benefit and harm for acute low back pain: systematic review and meta-analysis. JAMA. 2017;317(14):1451-1460. doi:10.1001/jama.2017.3086.
2. Thiel HW, Bolton JE, Docherty S, Portlock JC. Safety of chiropractic manipulation of the cervical spine: a prospective national survey. Spine. 2007;32(21):2375-2378.
3. Pankrath N, Nilsson J, Ballenberger N. Adverse events after cervical spinal manipulation: a systematic review and meta-analysis of randomized clinical trials. Pain Physician. 2024.
4. Cassidy JD, Boyle E, Côté P, et al. Risk of vertebrobasilar stroke and chiropractic care: results of a population-based case-control and case-crossover study. Spine. 2008;33(4 Suppl):S176-S183.
5. Biller J, Sacco RL, Albuquerque FC, et al. Cervical arterial dissections and association with cervical manipulative therapy: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45(10):3155-3174.
6. Gorrell LM, Brown BT, Engel R, Lystad RP. Reporting of adverse events associated with spinal manipulation in randomised clinical trials: an updated systematic review. BMJ Open. 2023;13:e067526.