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Table 2.

Results From Cohort Studies and Randomized Clinical Trials Focused on Adverse Events of Spinal Manipulative Therapy
SourceSample SizeMethod for Assessing Adverse EventsInterventionsFindings
Prospective Cohort Studies
Barrett et al, 200068 Patients; 11 chiropractorsQuestionnaires given to 12 consecutive new patientsAll received SMT53% reported an adverse event, mostly increased or radiating pain

Cagnie et al, 2004465 Patients; 51 manipulating cliniciansQuestionnaires given to 15 consecutive new patientsAll received SMT283 patients (61%) reported at least 1 reaction; headache, stiffness, aggravation of complaints, and radiating discomfort accounted for two-thirds of reactions

Leboeuf-Yde et al, 1997625 Patients; 66 chiropractorsQuestionnaires given to 10 consecutive patientsAll received SMTTreatment reactions were common, but benign and short lasting

Rubinstein et al, 2008529 Patients with neck pain; 79 chiropractorsQuestionnaires completed at regularly scheduled visitsAll received SMTAll patients were treated for neck pain; 56% of patients reported at least 1 adverse event; more than 70% of reported adverse events were musculoskeletal or pain

Senstad et al, 19971050 Patients; 102 chiropractorsChiropractor asked 12 consecutive patients a set of standardized questionsAll received SMTAt least 1 reaction was reported by 580 patients (55%), 53% reported reactions were local discomfort

Randomized Clinical Trials

Maiers et al, 2014194 Elderly patients with neck painStandardized solicitation by clinicians, unsolicited reporting of patients, and qualitative interviews with patientsSMT, home exercise, or supervised rehabilitation exercise130 patients (67%) reported at least 1 adverse event; SMT patients reported about twice as many adverse events as patients randomized to home exercise (74 for SMT vs 40 for home exercise)

Paanalahti et al, 2014767 PatientsQuestionnaires at each return visitSMT, manual therapy without SMT, and manual therapy without stretchingAbout 50% of patients reported an adverse event; the most common adverse event was soreness in muscles, followed by increased pain, stiffness, and tiredness; there were no differences between patients receiving SMT, manual therapy without SMT, or manual therapy without stretching

Walker et al, 2013198 Patients; 12 chiropractorsQuestionnaires completed within 48 h of treatmentUsual chiropractic care (96% received SMT) or a sham42% of usual care patients and 33% of sham care patients reported an adverse event; the most common adverse events were increased pain, muscle stiffness, headache, and radiating discomfort
Abbreviation: SMT, spinal manipulative therapy.