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J R Soc Med. 2007 October; 100(10): 446.
PMCID: PMC1997256

Adverse effects of spinal manipulation

I have with interest read Professor Ernst's article entitled ‘Adverse effects of spinal manipulation: a systematic review’ in the July issue of this Journal (JRSM 2007;100:330-338).

Professor Ernst goes through the published side effects of spinal manipulation, which is fine and which has been done at least in 20 other papers already. However, when discussing side effects, an essential part is to consider how often the treatment in question is administered; unfortunately, Professor Ernst seems to have forgotten this essential part.

In Denmark, where I reside, chiropractic patients are reimbursed by the Health Service, and we therefore have reasonably accurate data. The last data I am aware of show that just chiropractors (add to this physiotherapists and manual medicine practitioners) treat some 350,000 patients per year—out of a population of only 5 million. Including physiotherapists and other practitioners of chiropractic, probably 10% of the total population are treated every year.

Compared to this Professor Ernst's figures for side effects are minimal and without any impact—remember that 1 in 10,000 patients die of simple general anaesthesia. I find Professor Ernst's conclusion wildly overstated: the paper is embarrassing seen with international eyes.


Competing interests None declared.


1. Ernst E. Adverse effects of spinal manipulation: a systematic review. J Roy Soc Med 2007;100: 330-8 [PMC free article] [PubMed]

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