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Published online 2017 Apr 11. doi:  10.1001/jama.2017.3086

Table 1.

Adverse Events Reported in Randomized Clinical Trials of Effectiveness of Spinal Manipulative Therapy for Acute Low Back Pain


SourceSample SizeMethod for Assessing Adverse EventsAdverse Events
Blomberg et al, 1993149Closed-end questionnaires at 1, 2, and 4 moHas a table of adverse effects by group; “The treatment hurts” was statistically significantly more likely in the group treated with SMT than continued medical care

Fritz et al, 2015220Open-end and closed-end questionnaire at 4 wk12.0% of patients reported a total of 20 adverse effects from treatment including increased pain, stiffness, spasm, shooting pain, and fatigue

Goertz et al, 201391Not specifiedNo serious adverse events (2 mild adverse events were reported in SMT group, both were pain that resolved in 24-48 h)

Hancock, 2007240Spontaneous reporting and open-ended questionsNo serious adverse reactions associated with SMT

Heymann et al, 2013100Not specifiedSafety analysis showed no unexpected untoward events in either group

Juni et al, 2009104Not specifiedTwo serious adverse events occurred in the experimental group (4%) and 2 in the control group (4%); in the experimental group there was 1 patient with acute pancreatitis and 1 patient with an acute loss of motor and sensory function due to a herniated disk after randomization, but before any SMT treatment was initiated; in the control group, there was 1 patient with symptomatic cholelithiasis and 1 patient with a femoroacetabular impingement syndrome

Morton et al, 199929Not specifiedNo adverse effects for either group
Waterworth et al, 1985108Not specifiedAdverse experiences with therapy were not specifically itemized, but their seriousness and drug relationship were recorded; patients receiving SMT experienced less adverse reactions to treatments on the second assessment (at 10-12 days of therapy) than patients receiving nonsteroidal anti-inflammatory drugs.

Abbreviation: SMT, spinal manipulative therapy.