Consent for Care

Changes to the law now require all practitioners to inform patients of any potential risks no matter how small.

There is no such thing as a form of medical treatment which is guaranteed 100% safe in every case. Even the painkillers you buy in the supermarket for a headache may cause severe side effects in some patients. That said, however, Osteopathy has one of the best safety records of any medically-related profession. Osteopaths are trained to differentially diagnose and therefore recognise any condition that might make treatment inadvisable, and will refer patients for appropriate medical attention in such cases. Just as a Doctor regards safety as the most important factor in selecting appropriate medication for a particular patient, so an Osteopath will also select the most appropriate style of treatment with safety as the prime consideration.

Listed below are some supposed significant risks with comparisons to some common medical risks to put the issue into perspective.

Manipulative Care   Medical / Other  
Lumbar Disc Injury 1 / 62,000 Death from Car Accident 1 / 20,000
Cervical Nerve Injury 1 / 39,000 Death from neck surgery 1 / 145
Lumbar Nerve Injury 1 / 188,000 Death from Anti-inflammatories 1 / 1000
Loss of Consciousness & Spinal Cord Injury 1 / 382,000 Stomach Bleeding from Anti-inflammatories (after 1 month) 1 / 250
Stroke from upper cervical manipulation

1 / 120,000 - 1 / 1.6 million

Being struck by lightening 1 / 300,000

Possible Adverse Outcomes:

In a minority of cases treatment may not be succesful and you may be in the same position you are in now. Sometimes your condition may become worse before it gets better (especially if it's a long term issue) and 1 in 3 patients (often new patients or one's who haven't been seen for a long time) report temporary soreness, tenderness  or bruising. Some patients report fatigue, headache, dizzyness or nausea following treatment. Also, whilst rare, some patients have reported rib, shoulder, chest or knee pain following spinal manipulation. 

There may be a slight risk of sprain/strain injury to a ligament or disk in the neck or lower back. These are extremely rare, but can cause nerve pain with radiation of pain into the arms, trunk or legs. Bowel or bladder function can be affected and erectile dysfunction has been reported very rarely.

In the case of manipulation of the neck it has been suggested that there may be a risk of injury to arteries (see chiropractic article below). These are very, very rare events. It has been calculated that stroke or stroke-like symptoms may occur in 0.0008% of upper cervical manipulations and is probably more likely to happen having your hair washed at the hairdressers or bumping your car in a car park.

Although screening questions have been asked and screening tests performed, there is no way of guaranteeing that you do not suffer one of these extremely rare events.

Connecticut Chiropractors’ Informed Consent Standard Upheld  June 11, 2010

In a comprehensive and detailed ruling published today, the Connecticut State Board of Chiropractic Examiners confirmed that Connecticut’s chiropractic physicians are taking the proper steps to inform and protect their patients. Through its ruling, the Board reaffirmed that the informed consent process practiced by the state’s Doctors of Chiropractic is the standard of care for the profession.

Today’s decision caps a process that began more than a year ago when the Connecticut Chiropractic Association asked the Board to issue a declaratory ruling on whether the current standard of informed consent is sufficient or whether, as opponents demanded, that it specifically include the possibility of a stroke or cervical artery dissection as a possible side effect of cervical manipulation/adjustment.

The Board’s decision follows four days of testimony in January in which an extensive range of evidence was presented. In making its determination and declaratory ruling, the Board cited the most comprehensive scientific study to date on the subject, research by J. David Cassidy, DC, PhD, DrMedSc and colleagues. The Cassidy study is considered the definitive research on the subject. The abstract and complete paper can be found at PubMed Central,

In issuing its final judgment on the matter, the Board wrote: “After a careful and thorough review of all the testimony and documentary evidence admitted at the hearing, the Board concludes that there is sufficient evidence to establish that a stroke or a cervical arterial dissection is NOT a risk or side effect of a joint mobilization, manipulation or adjustment of the cervical spine.”

Risk of Carotid Stroke after Chiropractic Care: A Population-Based Case-Crossover Study.

Study Refutes Link Between Strokes, Chiropractic Care

Risk of Traumatic Injury Associated with Chiropractic Spinal Manipulation in Medicare Part B Beneficiaries Aged 66 - 99

Safety of spinal manipulation in the treatment of lumbar disk herniations: a systematic review and risk assessment.

Effect of Atlas Vertebrae Realignment in Subjects with Migraine: An Observational Pilot Study.