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Safety of Osteopathic Treatment

24 May 2010 No Comment

I recently read a review of “the adverse events” associated with manual therapy. That is to say, the bad things that can happen when you get a hands on treatment. An adverse event included both ‘minor’ events like feeling sore after a treatment, as well as ‘major’ side effects like nerve injury, paralysis, and stroke. I have listed the definitions at the bottom of this page.

Here is a summary of the data they collected:

  • The risk for adverse events after manual therapy were about the same as for doing exercise,
  • The risk of an adverse event after manual therapy was greater than for going to a GP
  • Risks for ‘minor/moderate’ adverse events after manual therapy (specifically for manipulation) were lower than for taking medication
  • Risks for adverse events were the same as for ‘sham’ treatments (doesn’t that mean getting a treatment poses no risk – I’m pretty sure getting no treatment presents no risk at ll, right?)

The authors cited the following risks:

  • Risk of death from taking NSAID (Nurofen, Voltaren, Ibuprofen etc) is 100-400 times greater than the risk associated with manual therapy
  • Low Back Spinal Manipulation is 37,000-140,000 times safer than NSAID’s
  • Low Back Spinal Manipulation is 55,000-444,000 times safer than surgery for disc herniation
  • Cauda Equina Syndrome is 7,400-37,000 times more likely to result from surgery than from spinal manipulation.
  • Risk of a major adverse event from manual therapy is 0.003%.

After searching medical, allied medicine, and manual therapy electronic databases, the authors found “no reports of strokes or cervical artery dissections specifically from neck manipulation in any of the studies which qualified for the review”.

Source: Carnes, D, Et Al., Adverse Events and Manual Therapy: A Systematic Review, Manual Therapy (2010).

Definitions of Adverse Events:

‘Major’ adverse events are medium to long term, moderate to severe and unacceptable, they normally require further treatment and are serious and distressing;

‘Moderate’ adverse events are as ‘major’ adverse events but only moderate in severity; and

‘Mild’ and ‘not adverse’ adverse events are short term and mild, non-serious, the patient’s function remains intact, and they are transient/reversible; no treatment alterations are required because the consequences are short term and contained.

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