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Is there really a risk to having Osteopathic treatment?

The short answer is that Osteopathy is really quite safe, but it isn’t completely risk free, even if the risks are incredibly small, with the most common adverse events being post treatment soreness & a slight increase in symptoms for 24 to 48 hours after treatment, feeling hungry & perhaps even feeling more sleepy, but for the vast majority of people, that’s pretty much it.

But I’m a bit worried about the worst case scenario – please put my mind at rest.

It’s ok, I get it, you’ve seen the video of the Chiropractor who is apparently trying to ‘remove someone’s head’ with a neck adjustment & are a tad concerned that we might do it too, it’s understandable.

Please don’t worry, because here at Baks Osteopathy Maidstone, we will only ever use techniques that are deemed safe for you, with each case assessed individually to determine what technique is most appropriate. Choices are always given to you in advance, ensuring you always remain in control of your treatment process.

Evidence for the risks of Osteopathic treatment

The current evidence base for risk relating to spinal manipulation includes studies from a number of different professional disciplines (e.g. chiropractic, physiotherapy, medicine as well as osteopathy); they may have different interpretations of manipulation & perform manipulations in slightly different ways but the information from these studies is still relevant to osteopathic practice (9,10,11,12)

What are the known common reactions & risks of Osteopathic treatment?

Reactions to any treatment can be described as positive, negative, physiological or psychological.

Approximately half of all manual therapy patients experience some mild to moderate short-lived reaction to treatment.  These can include, for example, a temporary increase in pain, aching after treatment, or post-treatment fatigue.

In a study of osteopathy patients, 10-20% patients reported an increase in pain or symptoms, however, 42% of those went on to make clinically significant improvements compared to base line (9). Most muscle soreness, aching & headache post treatment resolved within 24 hours.

Many patients who attend for osteopathic treatment take non-steroidal anti-inflammatory drugs (NSAIDs) to help with their symptoms.  Approximately 1 in 10 people who take NSAIDs on a daily basis experience persistent headaches. It’s a fair hypothesis to suggest that the data that says manual therapy could potentially be the cause of headaches (in just 10-20% of patients), is not actually a fact – more a side effect of the patient simultaneously taking NSAIDs.

Who is most likely to experience these common reactions?

Mild to moderate treatment reactions are more frequently reported by females after their first appointment1.

Treatment reactions can result from a range of manual therapy techniques & an increase in intensity of symptoms does not appear to be related to high velocity thrust (HVT) techniques (4).  They appear to be more common after a patient’s first treatment & in patients presenting with multiple sites of pain (4).

What about other, more serious treatment reactions?

Symptoms that last for more than a few days that do not require medical treatment, such as increased pain or troublesome numbness or tingling are considered to be moderate treatment reactions. These types of reactions are uncommon & are estimated to occur in 1% of patients.

For your information, here is a comparison between the use of common drugs for pain relief, such as Ibuprofen for example & having manual therapy including thrust techniques. Note: thrust techniques are only used at Baks if it is appropriate for you and with your explicit consent.

Estimated risk of serious adverse event over 1 year for: Risk
Non-steroidal anti-inflammatory drugs (such as NSAIDs for osteoarthritis)1 in every 4000 people
Course of manipulative treatment
1 in every 400,000 people
The risk of having an adverse event with manual therapy (HVT) is less than taking medication (NSAIDs, diclofenac and amitriptyline)1 
Available To Read From NCOR


1. Carnes D, Mars T, Mullinger B, Underwood M. Adverse events in manual therapy: a systematic review. 2009. Available at:

4. Vogel S, Mars T, Keeping S, Barton T, Marlin N, Froud R, Eldridge S, Underwood M, Pincus T. Clinical Risk Osteopathy and Management Scientific Report: The CROaM Study. 2013.  Available at

9. Licciardone, J., S. Stoll, et al. (2003). “Osteopathic manipulative treatment for chronic low back pain: A randomized controlled trial.” Spine 28(13): 1355-62.

10. UK BEAM Trial team (2004). “United Kingdom back pain exercise & manipulation (UK BEAM) randomised trial: effectiveness of physical treatments for back pain in primary care.” Bmj 329(7479): 1377.

11. Licciardone, J., A. Brimhall, et al. (2005). “Osteopathic manipulative treatment for low back pain: A systematic review & meta-analysis of randomsied controlled trials.” BioMedCentral Musculoskeletal Disorders 6: 43.

12. Gross, A., J. Miller, et al. (2010). “Manipulation or mobilisation for neck pain: a Cochrane Review.” Man Ther 15(4): 315-33.

This article is available to read direct from the NCOR website.

If any of these risks of Osteopathic treatment concern you and you wish to discuss anything further before coming to see us, then please call and speak to Phil the Osteopath

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