For most people, going to the chiropractor is safe. Spinal adjustments carry a low risk of serious harm, though mild, temporary side effects like soreness and stiffness are common. Roughly 30% to 61% of patients report some kind of minor aftereffect following an adjustment, but serious complications are rare. The real answer depends on your specific health situation and the type of adjustment being performed.
What Mild Side Effects to Expect
The most honest thing to say about chiropractic visits is that you’ll probably feel something afterward, and it’s usually minor. A systematic review in the Journal of the Royal Society of Medicine found that 61% of patients reported at least one side effect, most of which resolved on their own. The most common ones were headache (20%), stiffness (20%), local discomfort (15%), pain radiating to another area (12%), and fatigue (12%).
About 21% of those post-treatment effects were described as “severe” by patients, and 27% said the effects temporarily got in the way of daily activities. That sounds high, but context matters: a second study tracking 280 patients found a 30% side-effect rate with zero serious complications. The pattern across the research is consistent. Soreness and stiffness are the norm, not the exception, and they typically clear within a day or two.
The Risk of Serious Complications
The most-discussed serious risk is vertebral artery dissection, a tear in one of the arteries running through the neck. This can lead to stroke. Estimates place the risk at roughly 1 in 20,000 spinal manipulations, though the exact number is uncertain because these events are difficult to track and may be underreported. Over time, more than 200 patients have been identified in case reports as having been seriously harmed by spinal manipulation.
That 1-in-20,000 figure applies specifically to neck adjustments, which involve rotating or thrusting the cervical spine. Adjustments to the mid-back or lower back don’t carry the same stroke risk. If you’re concerned, it’s reasonable to ask your chiropractor whether your treatment plan involves cervical manipulation and what alternatives exist.
How It Compares to Other Treatments
One useful way to think about chiropractic safety is to compare it against what you’d otherwise do for the same problem. A risk assessment comparing cervical manipulation to nonsteroidal anti-inflammatory drugs (NSAIDs like ibuprofen or naproxen) for neck pain found that long-term NSAID use poses a significantly greater risk of serious complications and death. The researchers estimated the difference was as much as several hundred times greater risk from NSAIDs, largely because of gastrointestinal bleeding and cardiovascular side effects that accumulate with regular use.
That comparison isn’t perfect, since people take NSAIDs for many reasons and at varying doses. But it does put chiropractic risk in perspective. For musculoskeletal pain, spinal manipulation is on the lower end of the risk spectrum when compared to medications, injections, or surgery.
When Chiropractic Care Is Not Safe
There are specific conditions that make spinal manipulation genuinely dangerous. The Mayo Clinic lists several situations where you should not get a chiropractic adjustment:
- Severe osteoporosis: bones that are already fragile can fracture under the force of an adjustment
- Cancer in your spine: tumors weaken vertebrae and surrounding tissue
- Numbness, tingling, or loss of strength in an arm or leg: these may signal nerve compression or spinal cord involvement that manipulation could worsen
- Increased risk of stroke: including known vascular issues or a history of blood clots
- Structural abnormalities in the upper neck: certain bone formation issues make the area unstable
Inflammatory arthritis, certain connective tissue disorders, and people on blood-thinning medications also fall into higher-risk categories. A competent chiropractor should screen for these before touching your spine.
What a Safe Visit Looks Like
Before any adjustment, your chiropractor should be looking for what clinicians call “red flags,” signs that your back or neck pain might be caused by something more serious than a muscle or joint issue. An international framework identifies four major concerns to rule out: compression of the nerves at the base of the spine, spinal fracture, cancer, and spinal infection.
Specific warning signs they should ask about include unexplained weight loss, night pain that wakes you up, fever, difficulty with bladder or bowel control, progressive weakness in your legs, and pain that’s getting steadily worse rather than coming and going. If any of these apply to you, mention them. A responsible practitioner will pause treatment and refer you for imaging or to another provider.
You should also receive informed consent before treatment begins. This means your chiropractor explains what they plan to do, why, what the common side effects are (like temporary soreness), what the rare but significant risks are (including the possibility of stroke with neck manipulation), and what your alternatives are. Those alternatives might include physical therapy, massage, exercise programs, or simply doing nothing. If a chiropractor skips this conversation and goes straight to cracking, that’s a red flag about the practice itself.
Training and Licensing Requirements
Chiropractors complete a Doctor of Chiropractic degree, which involves a minimum of 4,200 hours of classroom, lab, and clinical training spread over four academic years. Every state requires licensure, and candidates must pass all four parts of the National Board of Chiropractic Examiners exam plus a physiotherapy exam. This level of training is specifically focused on the musculoskeletal system and spinal manipulation, so a licensed chiropractor has extensive hands-on experience before they ever treat a patient independently.
That said, training quality and clinical philosophy vary. Some chiropractors stick closely to evidence-based treatment for back and neck pain. Others make broader claims about treating conditions like asthma, allergies, or digestive problems through spinal adjustments, which lack strong scientific support. Choosing a practitioner who focuses on musculoskeletal complaints and communicates clearly about risks is your best filter.
Safety for Children and Older Adults
Pediatric chiropractic care is a topic where the evidence is thin. A review in Clinical Pediatrics found that serious adverse events in infants and children are rare, and no deaths had been reported in the literature reviewed. Most techniques used on children are gentler and lower-force than adult adjustments. However, significant adverse events have been documented in pediatric patients, including brain hemorrhage, stroke, and paraplegia. There is also concern about delayed diagnosis when parents bring children to chiropractors for conditions that need medical treatment instead.
For infants specifically, there is insufficient safety data on spinal manipulation for conditions like colic, which is one of the more common reasons parents seek chiropractic care for babies. The lack of data doesn’t necessarily mean it’s dangerous, but it does mean the safety profile isn’t well established.
Older adults face elevated risk primarily because of bone density. Age-related osteoporosis makes vertebrae and ribs more susceptible to fracture during manipulation. If you’re over 65 or have been told you have low bone density, make sure your chiropractor knows before any treatment. Modified, lower-force techniques can often be used, but the conversation needs to happen first.