Someone gets adjusted on Monday. They have a stroke on Friday.
Was it the adjustment?
This timing question reveals everything wrong with how we talk about chiropractic safety. The numbers you hear range wildly from one in 20,000 to one in 1.3 million. That’s not just statistical noise.
It’s a fundamental problem of causation versus coincidence.
The Causation Problem Nobody Mentions
Research shows that patients with pre-existing arterial dissection are about three times more likely to see a chiropractor or primary care physician before their stroke than controls.
They’re seeking care because something is already wrong.
The headache that drives someone to seek treatment might be the first symptom of a dissection that’s already happening. The adjustment didn’t cause the problem. The problem caused them to seek the adjustment.
This matters because it changes everything about how we assess risk.
Where Real Risk Actually Lives
All significant risk from chiropractic adjustments comes from rotation of the spine. In the neck, rotation can dissect a vital artery to the brain. In the lower back, it can herniate a disc.
These events are genuinely rare. But rare doesn’t mean impossible.
I screen for specific red flags before any treatment. Someone who’s had a previous stroke faces higher risk of another one. Young women on birth control medication have elevated stroke risk generally.
These aren’t theoretical concerns. They’re clinical decision points.
Elderly patients with osteoporosis present a different challenge entirely. Their bones are fragile, especially in elderly women. But fragile doesn’t automatically mean untreatable.
The data supports modification over elimination. Among960,140 spinal manipulation sessions, only two serious adverse events occurred in women over 60 with osteoporosis. That’s 0.21 per 100,000 sessions.
The key is matching technique to patient. A sledgehammer approach works for some patients. A light jackhammer approach works for others.
The technology I use eliminates rotational risk entirely by keeping the patient stationary while a computerized probe moves the spine over several seconds. But not every practitioner uses this approach.
What to Look for in Any Practitioner
Start with Google. Search the chiropractor’s name and look at reviews. Check if they’ve had any regulatory issues with their governing college.
This takes five minutes and filters out obvious problems.
But the real evaluation happens in the office during your first visit. A full health history and consultation should come before any treatment. This isn’t a paperwork theater.
It’s the screening process that identifies whether you’re a candidate for care or need referral elsewhere.
I’ve turned patients away when their history revealed red flags. Someone with an extreme headache and fever who experiences severe pain when flexing their head forward might have bacterial meningitis. That’s not a chiropractic case.
A practitioner who rushes to treatment without thorough history is skipping the most important safety step.
What Normal Actually Feels Like
The spectrum of post-treatment responses is wider than most patients expect.
Some people feel relief after their first treatment. Most people feel nothing particularly noteworthy. A few experience soreness because we’re moving joints and vertebrae that haven’t moved properly in a long time.
All of these responses are normal.
But certain symptoms demand immediate attention. Vomiting or dizziness along with pain requires a phone call right away.Warning signs from vascular complications can appear hours or even weeks after treatment.
Neck pain, visual impairment, nausea, dizziness, or numbness that develops after treatment needs evaluation.
The distinction matters because normal soreness resolves on its own. Vascular complications escalate.
The Safety Factor You Control
Patients often ask what they can do to minimize risk. The answer is simpler than most expect.
Be straightforward and upfront with your complete health history.
Don’t leave anything out. I need to know about previous strokes, current medications, bone density issues, and any other health conditions. The more complete the picture, the better I can assess whether treatment is appropriate.
Patients frequently omit information they don’t think matters. Women often leave out cosmetic surgeries and enhancements when discussing prior surgeries. But every piece of medical history contributes to the risk assessment.
Your practitioner can’t identify red flags they don’t know exist.
Safety in chiropractic care works like safety in any medical intervention. It requires proper screening, appropriate technique selection, clear communication about expectations, and ongoing monitoring for complications.
The risks are real but manageable when both practitioner and patient fulfil their roles. The data shows serious complications are rare when proper protocols are followed.
But rare only stays rare when we take screening seriously, modify approaches when needed, and maintain honest communication throughout care.
That’s not a guarantee. It’s a partnership.