SynthesisSystematic reviews2017
The risk associated with spinal manipulation: an overview of reviews.
Synthesis in Systematic reviews, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 30 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
30 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Adverse events following cervical spine self-manipulation: A systematic review.PM & R : the journal of injury, function, and rehabilitation · 2026Pooled it
- Efficacy and safety of musculoskeletal manipulations in elderly population with musculoskeletal disorders: a systematic review.BMJ open · 2025Pooled it
- The Biomechanical Analysis of Magnitude and Direction of Force by Different Techniques of Thoracic Spinal Manipulation.BioMed research international · 2020Trial
- 'It might help, but it won't fix me': a qualitative study of individuals' beliefs about manual therapy for low back pain.Chiropractic & manual therapies · 2026Article
- A description of serious adverse events following spinal manipulative therapy for adults with history of spine surgery: a single institution retrospective chart review.The Journal of manual & manipulative therapy · 2025Article
- [Atlas block and alar ligament lesion-Underestimated or overrated?]Schmerz (Berlin, Germany) · 2024Review
- Spinal manipulation and adverse event reporting in the pregnant patient limits estimation of relative risk: a narrative review.The Journal of manual & manipulative therapy · 2023Review
- Ten years of online incident reporting and learning using CPiRLS: implications for improved patient safety.Chiropractic & manual therapies · 2023Article
- Demographic and psychometric predictors associated with engagement in risk-associated alternative healthcare behaviours.PloS one · 2023Article
- Knowledge, beliefs, and attitudes of spinal manipulation: a cross-sectional survey of Italian physiotherapists.Chiropractic & manual therapies · 2022Article
- A taxonomy of risk-associated alternative health practices: A Delphi study.Health & social care in the community · 2022Article
- Safety of Chuna Manipulation Therapy in 289,953 Patients with Musculoskeletal Disorders: A Retrospective Study.Healthcare (Basel, Switzerland) · 2022Article
- Definition and classification for adverse events following spinal and peripheral joint manipulation and mobilization: A scoping review.PloS one · 2022Article
- What are the effects of diagnostic imaging on clinical outcomes in patients with low back pain presenting for chiropractic care: a matched observational study.Chiropractic & manual therapies · 2021Observational
- Thrust joint manipulation: just do it!The Journal of manual & manipulative therapy · 2021Article
- Interexaminer Agreement and Reliability of an Internationally Endorsed Screening Framework for Cervical Vascular Risks Following Manual Therapy and Exercise: The Go4Safe Project.Physical therapy · 2021Article
- Article
- Spinal epidural hematoma after spinal manipulation therapy: Report of three cases and a literature review.World journal of clinical cases · 2021Article
- The Flat Earth Theory: is Evidence-Based Physiotherapy a Sphere?The Journal of manual & manipulative therapy · 2021Article
- Effects of Osteopathic T9-T10 Vertebral Manipulation in Tonsillitis: A Randomized Clinical Trial.Healthcare (Basel, Switzerland) · 2021Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundSpinal manipulative therapy (SMT) is a widely used manual treatment, but many reviews exist with conflicting conclusions about the safety of SMT. We performed an overview of reviews to elucidate and quantify the risk of serious adverse events (SAEs) associated with SMT.
methodsWe searched five electronic databases from inception to December 8, 2015. We included reviews on any type of studies, patients, and SMT technique. Our primary outcome was SAEs. Quality of the included reviews was assessed using a measurement tool to assess systematic reviews (AMSTAR). Since there were insufficient data for calculating incidence rates of SAEs, we used an alternative approach; the conclusions regarding safety of SMT were extracted for each review, and the communicated opinion were judged by two reviewers independently as safe, harmful, or neutral/unclear. Risk ratios (RRs) of a review communicating that SMT is safe and meeting the requirements for each AMSTAR item, were calculated.
resultsWe identified 283 eligible reviews, but only 118 provided data for synthesis. The most frequently described adverse events (AEs) were stroke, headache, and vertebral artery dissection. Fifty-four reviews (46%) expressed that SMT is safe, 15 (13%) expressed that SMT is harmful, and 49 reviews (42%) were neutral or unclear. Thirteen reviews reported incidence estimates for SAEs, roughly ranging from 1 in 20,000 to 1 in 250,000,000 manipulations. Low methodological quality was present, with a median of 4 of 11 AMSTAR items met (interquartile range, 3 to 6). Reviews meeting the requirements for each of the AMSTAR items (i.e. good internal validity) had a higher chance of expressing that SMT is safe.
conclusionsIt is currently not possible to provide an overall conclusion about the safety of SMT; however, the types of SAEs reported can indeed be significant, sustaining that some risk is present. High quality research and consistent reporting of AEs and SAEs are needed. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42015030068 .
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.