New Published Study Reinforces the Safety of Spinal Manipulation

Feb 7, 2023 | Industry News

Published last month in the journal Nature, a retrospective analysis examining nearly one million chiropractic treatment sessions has concluded that severe adverse events (AE’s) occur in fewer than one in 100,000 spinal manipulative treatments (SMT).

Patients with SMT-related adverse events were identified over a 5-year period using data from 30 clinics in Hong Kong. Some of their findings were:

  • A total of 960,140 SMT sessions for 54,846 patients were reviewed, only 39 AEs were identified.
  • The incidence of grade 3 (severe) or greater AEs was less than 1 per 100,000 SMT sessions.
  • There were no cases of stroke, transient ischemic attack, vertebral or carotid artery dissection, cauda equina syndrome, or spinal fracture.
  • No AEs were identified that were life-threatening or resulted in death.
  • Rib fractures were the only severe AEs found. Both cases of rib fracture occurred in females over 60 with a history of osteoporosis, following SMT performed to the thoracic spine with the patient prone.

Reference: Chu, E.CP., Trager, R.J., Lee, L.YK. et al. A retrospective analysis of the incidence of severe adverse events among recipients of chiropractic spinal manipulative therapy. Sci Rep 13, 1254 (2023).

Open access available at