ChiropracticProf. ErnstStroke

Professor Ernst cautions against upper spinal manipulation

Professor Edzard Ernst from the Universities of Exeter & Plymouth in the UK is an outspoken critic of CAM.

In an interview, he says, “If any drug were linked to such rates of harm [as is spinal manipulation], I somehow doubt that it would still be on the market.”

First, the details.

  • For this review, all reports (regardless of language) of adverse effects published between January 2001 and June 2006 included.

And, the results.

  • 44 articles were identified, mostly case reports (32).
  • More than 200 patients were suspected to have had a serious adverse effect.
  • Vertebral artery dissection (a form of stroke) was the most common serious adverse effect reported.
  • Relatively mild adverse effects occur in 30% to 61% of patients.
  • The evidence suggests a causal relationship between spinal manipulation and the adverse effect, which are infrequently reported.

The bottom line?
This is one of the topics that almost guarantees comments from readers. It was debated here, here, and here. Often a comparison is made to nonsteroidal anti-inflammatory drugs.

Here are Professor Ernst’s thoughts.
“It is, of course, important to present any risk?benefit assessment fairly and in the context of similar evaluations of alternative therapeutic options. One such option is drug therapy. The drugs in question — nonsteroidal anti-inflammatory drugs (NSAIDs) — cause considerable problems, for example gastrointestinal and cardiovascular complications. Thus, spinal manipulation could be preferable to drug therapy.”

“But there are problems with this line of argument: the efficacy of NSAIDs is undoubted but that of spinal manipulation is not, and moreover, the adverse effects of NSAIDs are subject to post-marketing surveillance while those of spinal manipulation are not. Thus, we are certain about the risks and benefits of the former and uncertain about those of the latter. Finally, it should be mentioned that other therapeutic options (eg, exercise therapy or massage) have not been associated with significant risks at all.”


Hi, I’m JR

John Russo, Jr., PharmD, is president of The MedCom Resource, Inc. Previously, he was senior vice president of medical communications at, a complementary and alternative medicine website.