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Abstract and Figures

Pain-related massage, important in traditional Eastern medicine, is increasingly used in the Western world. So the widening acceptance demands continual safety assessment. This review is an evaluation of the frequency and severity of adverse events (AEs) reported mainly for pain-related massage between 2003 and 2013. Relevant all-languages reports in 6 databases were identified and assessed by two coauthors. During the 11-year period, 40 reports of 138 AEs were associated with massage. Author, year of publication, country of occurrence, participant related (age, sex) or number of patients affected, the details of manual therapy, and clinician type were extracted. Disc herniation, soft tissue trauma, neurologic compromise, spinal cord injury, dissection of the vertebral arteries, and others were the main complications of massage. Spinal manipulation in massage has repeatedly been associated with serious AEs especially. Clearly, massage therapies are not totally devoid of risks. But the incidence of such events is low.
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Review Article
Adverse Events of Massage Therapy in Pain-Related
Conditions: A Systematic Review
Ping Yin,1Ningyang Gao,2Junyi Wu,1Gerhard Litscher,3and Shifen Xu1
1Acupuncture Department, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai 200071, China
2Traumatology Department, Shuguang Hospital Aliated to Shanghai University of Traditional Chinese Medicine,
Shanghai 201203, China
3Research Unit for Complementary and Integrative Laser Medicine, Research Unit of Biomedical Engineering in
Anesthesia and Intensive Care Medicine, and TCM Research Center Graz, Medical University of Graz, 8036 Graz, Austria
Correspondence should be addressed to Shifen Xu; xu teacher@.com
Received  July ; Accepted  July ; Published  August 
Academic Editor: Huang-Ping Yu
Copyright ©  Ping Yin et al. is is an open access article distributed under the Creative Commons Attribution License, which
permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Pain-related massage, important in traditional Eastern medicine, is increasingly used in the Western world. So the widening
acceptance demands continual safety assessment. is review is an evaluation of the frequency and severity of adverse events (AEs)
reported mainly for pain-related massage between  and . Relevant all-languages reports in  databases were identied
and assessed by two coauthors. During the -year period,  reports of  AEs were associated with massage. Author, year of
publication, country of occurrence, participant related (age, sex) or number of patients aected, the details of manual therapy,
and clinician type were extracted. Disc herniation, so tissue trauma, neurologic compromise, spinal cord injury, dissection of
the vertebral arteries, and others were the main complications of massage. Spinal manipulation in massage has repeatedly been
associated with serious AEs especially. Clearly, massage therapies are not totally devoid of risks. But the incidence of such events is
low.
1. Introduction
Massage, as any systematic form of touch or manipulation
performed on the so tissues of the body to provide com-
fort and promote health [], has become popular in the
United States and the rest of the world in recent decades.
It has also been recommended by the Chartered Society of
Physiotherapy for the management of various pain-related
conditions, especially those of musculoskeletal origin [],
such as neck pain, low back pain, headache, and migraine
[]. is is supported by numerous systematic reviews of
a large number of randomized controlled trials (RCTs) [
]. Between  and , the -year prevalence of use of
massage by the US adult population increased from 5%(.
million) to 8.3% (. million), and massage belongs to one
of the most popular complementary and alternative medicine
(CAM) therapies in the USA []. e increased use brings
attention to the safety and quality of the modality.
Anumberoflargesurveysonthesafetyofmassagehave
been conducted. Most reported incidents have been fairly
minor, and incidence rates were low. For example, from
surveys and review articles, the risk of a serious irreversible
complication (e.g., stroke) for cervical manipulations has
been reported to vary from one adverse event in  to
one in ,, manipulations, and another review of the
articles on complications of spinal manipulation, which iden-
tied  complications, yielded estimates of vertebrobasilar
accidents from one in   patients to one per ,,
cervical manipulations and cauda equina syndrome to be less
than one per ,, treatments []. e authors of
these studies concluded that serious AEs seem to be rare and
massage is generally a safe intervention. So this systematic
review seeks to evaluate all published data (between  and
) about adverse eects of massage therapy. We specically
hope to help the clinician feel comfortable and informed in
conversations with their patients regarding the appropriate,
Hindawi Publishing Corporation
Evidence-Based Complementary and Alternative Medicine
Volume 2014, Article ID 480956, 11 pages
http://dx.doi.org/10.1155/2014/480956
Evidence-Based Complementary and Alternative Medicine
2246 reports in English
identified through database
searching
1036 reports in Chinese
identified through database
searching
3282 reports screened
3156 reports excluded: irrelevant
studies and duplicates
126 reports (full text
assessed for eligibility)
86 full texts excluded: unrelated to
AEs, no details reported
40 reports (138 cases)
included
F : Flow chart of the screening process.
safe, and eective use of massage, not only in pain-related
conditions.
2. Materials and Methods
2.1. Search Strategy. We searched  databases in an attempt
to locate all existing case reports (irrespective of language of
publication) with original data on AEs following any type
of massage therapy published between January  and
June  in electronic form. PubMed including MEDLINE,
EMBASE, e Cochrane Library (via Wiley), CNKI, CQVIP,
and Wanfang digital databases were searched. Search terms
were “massage, manual therapy, tuina, and chiropractic.
ese terms were combined with “safe, safety, adverse event,
adverse reaction, side eects, complications, and risk.
2.2. Inclusion and Exclusion Criteria. Only original case
reports of complications or AEs of massage, manual therapy,
and tuina published from January  to June  were
included in this review. All those clinical study designs
shouldbepublishedinpeer-reviewedjournals,andlike
conference proceedings, cross-sectional and other descriptive
designs and narrative reviews were excluded. Two coauthors
independently screened the titles and abstracts of all papers
found from the initial search. Disagreements between the two
authors were resolved through discussion.
We excluded multiple inclusions and analyses of the same
AEs as well as irrelevant studies. An irrelevant study was
dened as a non-case report, such as a review, commentary,
or clinical trial. Treatments not typically carried out by a mas-
sage therapist were also excluded, such as cardiac massage,
prostatic massage, or carotid sinus massage. Adverse events
related to massage oils, for example, allergies to aromatherapy
oils or to the use of ice in conjunction with massage, were also
excluded. All articles were evaluated and validated by one of
the authors according to inclusion criteria.
2.3. Data Extraction. Electronic database searches identied
a total of  articles for consideration. Aer screening, 
potentially relevant articles were identied for full review,
and  studies met inclusion criteria nally. ere were 
articles that were excluded for being unrelated to AEs or for
having no details reported (Figure ).Afulllistofexcluded
articles is available from the corresponding author. When
provided, we extracted author, year of publication, country
of occurrence, participant related information (age, sex) or
number of patients aected, the details of manual therapy,
andcliniciantypethatmighthavecontributedtotheAE,
the reported AE, and its outcome. e data were extracted
by two independent coauthors (P. Y. and NY. G.) and double
checked to ensure matching and disagreements were resolved
by consensus. Since there are no widely accepted criteria for
judging the quality of AEs reports and the current studies’
objective of describing case details, we did not assess the risk
of bias on the included studies.
3. Results
e search strategy located  articles reporting a total of 
case reports (in which the patients’ age and/or sex were given)
(Table ), and a total of  reports containing  AEs in case
series associated with massage were identied (Tab le  ). Most
cases were reported from Asia especially in China (𝑛=24,
60%oftotal)andEurope(,30%), with few cases from the
USA (, 7.5%) and Australia (, 2.5%), and more than half
of the reported patients were female. ere are  signs or
symptoms of AEs in total, and the most common problems
included disc herniation ( cases, 16.3%), so tissue trauma
Evidence-Based Complementary and Alternative Medicine
T : Cases of AEs associated with massage therapy.
Author (year) Country Language Age, sex Details of manual
therapy Clinician type Adverse event (nature and
location) Follow-up
Jay et al. () []USA English , F Chiropractic
manipulations Chiropractor
Bilateral dissection of
vertebral arteries followed
by bilateral
occipital-parietal
hemorrhagic infarction and
visual impairment
Complete resolution ( d.)
Beck et al. () []Germany English , F Axial tension and
rotation Chiropractor Intracranial hypotension Complete resolution
conrmed by MRI
Nadgir et al. () []USA English , M Neck manipulation Chiropractor
Neck cramping (bilateral
internal carotid and
vertebral artery dissection)
Minimal residual
hemianesthesia and
dysesthesia
Oehler et al. () []Germany German , F Chiropractic neck
manipulation Unknown Bilateral dissections of
vertebral arteries Resolution
Yokota et al. () []Japan Japanese , M Chiropractic neck
manipulation
Unregistered
practitioner
Dissection of le vertebral
artery followed by Dejerine
syndrome
Unknown
Licht et al. () []Denmark English , M Cervical
manipulation
General
practitioner
Large infarction in the le
cerebellar hemisphere
(presumably due to arterial
dissection)
Complete recovery ( mo.)
Xiong () []China Chinese , M Reduction
manipulation Not mentioned Cerebral infarction Irritating cough and limb
numbness ( y.)
MaandXu()[]China Chinese , F Rotation Not mentioned Peripheral ner ve
entrapment syndrome Recovered
Yu et al. () []China Chinese , M Manipulative
reduction Not mentioned Spinal cord injury Recovered ( mo.)
Yu et al. () []China Chinese , M Manipulative
reduction Not mentioned Spinal cord injury Symptom remission ( d.)
Zhang et al. () []China Chinese , M Rotation Not mentioned
Extrusion of lumbar
intervertebral discs (lower
limb pain, incontinence,
and saddle sensation
disorders)
Pain relief aer surgery, but
residual saddle area
numbness
Zhang et al. () []China Chinese , M Rotation Not mentioned
Extrusion of lumbar
intervertebral discs (lower
limb pain, walking and
sexual dysfunction)
Muscle recovery aer
surgery, but still sexual
dysfunction ( y.)
Evidence-Based Complementary and Alternative Medicine
T : C o nt i n u e d .
Author (year) Country Language Age, sex Details of manual
therapy Clinician type Adverse event (nature and
location) Follow-up
Izquierdo-Casas et al. ()
[]Spain Spanish , F Chiropractic Not mentioned
Dissection of vertebral
artery followed by
tetraparesis
Locked-in syndrome
Morandi et al. () []France English , F Lumbar vertebral
manipulation Physician Caudal spinal cord
ischemia Permanent neuroloss
Saxler and Barden ()
[]Germany German , F
Cervical
chiropractic
manipulation
(C/), facet joint
inltration
Not mentioned
Epidural hematoma
extending from cervical to
sacral spine
Complete resolution
Tom´
eetal.()[]Spain Spanish Not noted Chiropractic
manipulation Not mentioned Multiple cervical disc
herniation Not mentioned
Hansis et al. () []Germany German , M Chiropractic
manipulation Unknown L fracture osteoporosis Surgery
Hansis et al. () []Germany German , M Unknown Unknown Disk protrusion Surgery
Wang et al. () []Australia English , F Lumbosacral
manipulation Unknown Extradural hemorrhagic
synovial cyst, leg pain
Complete recovery aer
L–L laminectomy and
cyst removal
Wang et al. () []Australia English , F Lumbosacral
manipulation Unknown
Hemorrhagic synovial cyst
with resultant lumbar canal
stenosis and exacerbation
of severe pain in buttock
and le leg pain
L-L laminectomy and
cystremovalwithexcellent
outcome
L. Zhang and G. H. Zhang
() []China Chinese , F Rotation Not mentioned Atlantoaxial dislocation Recovered aer surgery
( wk.)
Chen et al. () []Taiwan E ng l i s h  , M Chiropractic and
massage therapy Not mentioned
Neck pain, relieved by
chiropractor, hematoma of
ligamentum avum at the
level of C-C with
hemiparesis
Complete recovery aer
laminectomy ( y.)
Suh et al. () []Korea English , F Axial tension and
rotation Chiropractor Intracranial hypotension Complete resolution aer
epidural blood patch
Schmitz et al. () []Germany English , F Cervical
manipulation
General medical
practitioner
Displaced odontoid
fracture in the presence of
an aneurismal bone cyst
Complete recovery aer
surgery
Chen et al. () []China Chinese , F Rotation Self-treatment
by her husband
Cervical myelopathy (neck
pain, dizziness, and
numbness of limbs)
Recovered ( d.)
Evidence-Based Complementary and Alternative Medicine
T : C o nt i n u e d .
Author (year) Country Language Age, sex Details of manual
therapy Clinician type Adverse event (nature and
location) Follow-up
Jing and Yang () []China Chinese , M Rotation Not mentioned Fracture and bulge of
intervertebral discs
Nearly full recovery aer
surgery
Solheim et al. () []Norway English , M
Lumbar
manipulation
therapy
Chiropractor
Partial cauda equina
syndrome due to spinal
epidural hematoma in the
L region
Surgical evacuation of
hematoma via L and L
laminectomies,
improvement with motor
decits, but the bladder
dysfunction remained
Guo et al. () []China Chinese , F
Lumbar
manipulation
therapy
Not mentioned Ribfracture(theseventh
rib) Not mentioned
Guo et al. () []China Chinese , M Cervical
manipulation Not mentioned Lacerations of so tissues Recovered ( mo.)
Guo et al. () []China Chinese , M
Lumbar
manipulation
therapy
Not mentioned Fracture (L transverse
process fractures) Not mentioned
Guo et al. () []China Chinese , F
Lumbar
manipulation
therapy
Not mentioned Fracture (L transverse
process fractures) Not mentioned
Guo et al. () []China Chinese , F Cervical
manipulation Not mentioned Syncope Not mentioned
Guo et al. () []China Chinese , M Rotation Not mentioned Fracture (proximal humeral
fracture) Not mentioned
Yi et al. () []China Chinese , F Cervical
manipulation Not mentioned Hypochondriacal neurosis Not mentioned
Yi et al. () []China Chinese , F
Cervical spine
manipulative
reduction
Not mentioned Hypochondriacal neurosis Recovered
Jiang () []China Chinese , M Rotation
Massage
therapist
(private clinics)
Brown-Sequard syndrome
due to spinal epidural
hematoma
Near full recovery aer
surgery ( w k.)
Huang et al. () []Taiwan En g l i s h , M
Manipulation
directed at the
lumbopelvic-thigh
region and massage
Physiotherapist Ruptureofsotissuetumor
at anterior proximal thigh
Surgical tumor resection,
and neither recurrence nor
metastasis was observed 
months aer surgery
Zhu () []China Chinese , F Joint mobilization Not mentioned Hemarthrosis of knee joint Improved the joint activity
( mo.)
Jin et al. () []China Chinese , not noted Rotation Massage
therapist Dead Dead
Evidence-Based Complementary and Alternative Medicine
T : C o nt i n u e d .
Author (year) Country Language Age, sex Details of manual
therapy Clinician type Adverse event (nature and
location) Follow-up
Tamburrelli et al. () []Italy Eng lish , M Spinal manipulation Doctor of
chiropractic
Cauda equina syndrome,
L-S extrusion
L laminotomy and L-S
discectomy,
improved, but with
persistent bowel
dysfunction, impotence,
lower extremity; pain,
paresthesias, and mild
sensory decit
Bi () []China Chinese , M Cervical
manipulation Not mentioned Dorsolateral medullary
syndrome Improved ( d.)
Zhang et al. () []China Chinese , F Rotation Massage doctor Atlantoaxial dislocation Near full recovery aer
surgery ( mo.)
Li et al. () []China Chinese , F Neck massage Not mentioned Vertebral arterial dissecting
aneurysm
Horner syndrome
disappeared and without
dysphagia ( mo.)
Evidence-Based Complementary and Alternative Medicine
T : Case series of AEs associated with massage therapy.
Author (year) Country Language Cases Details of manual
therapy Clinician type Adverse event (nature
and location) Follow-up
Yo u n g a n d C h e n
() []Tai w a n E n g l i sh Cervical
manipulation Chiropractor
Vertebral artery
occlusion ( case);
stenosis ( case);
slow blood ow ( case)
associated with normal
ndings ( cases)
Recovered ( mo.)
Mei et al. () []China Chinese 
Rotatory
reduction
manipulation
Not mentioned
Nausea and profuse
sweating ( cases);
headache and vertigo (
cases); upper extremity
numbness ( cases);
cervical limitation of
activity ( cases); lower
limbs motor disturbance
( cases)
 cases recovered,
 cases improved
Oppenheim et al.
() []USA English  Spinal
manipulation Chiropractor
Spinal cord injuries (
cases); cauda equina
syndrome ( cases);
radiculopathy ( cases);
pathological fracture (
cases)
 patients need
surgery, but half of
them made an excellent
recovery subsequently,
and one-third had a
good recovery
Wang ( ) [ ]China Chinese
Rotatory
reduction
manipulation
Not mentioned Lumbar intervertebral
disc extrusion
Fully recovered (
cases);
foot prolapse ( cases);
hypoesthesia ( case)
Wang et al. ()
[]China Chinese Neck massage Not mentioned Cervical disc herniation Recovered
Guo and Lu ()
[]China Chinese 
Rotation (
cases), tendon-
regulating
method ( cases)
Not mentioned
Simple so tissue injury
( cases);
cervical structural
damage ( cases)
Not mentioned
Qu et al. () []China Chinese Pressing
manipulation Not mentioned
Aggravated lumbar
intervertebral disc
extrusion
Recovered (– d.)
( cases, 11.1%), neurologic compromise ( cases, 8.5%),
spinal cord injury ( cases, 8.5%), dissection of the vertebral
arteries ( cases, 6.5%), bone fracture ( cases, 5.9%),
hematoma or hemorrhagic cyst ( cases, 3.9%), syncope (
cases, 3.9%), cauda equina syndrome ( cases, 2.6%), pain
( cases, 1.3%), dislocation ( cases, 1.3%), and others. e
symptoms are frequently life-threatening, though in most
cases the patient made a full recovery. In the majority of cases,
the problems were related to spinal manipulations, including
rotational movements, which seem to be the probable cause
of the AEs.
4. Discussion
OurprimaryobjectiveinreviewingthecasereportsofAEs
associated with massage has been to identify individual cases
and outbreaks of AEs then to analyze their possible causes, in
order to minimize the massage AEs in future and enhance
the practice safety within the profession. Of the  cases
involving the AEs following massage in  references (Tables
and ), spinal manipulation has repeatedly been reported
with serious AEs especially. Collectively, these data suggest
that massage is associated with frequent, mild, and transient
AEs, but sometimes it may also be indeed associated with
serious complications which can lead to permanent disability
or even death. Although important details of most cases are
poorly reported or frequently missing, these results have clear
clinical and research related implications comparatively.
e true risk of injury due to spinal manipulation is
still not known. Yet causal inferences may be not completely
reasonable. Vascular accidents may happen spontaneously
orcouldbecausedbyfactorsotherthanmassage.ereal
serious incidence of AEs has been estimated to be ranging
from  strokes in , manipulations to . case series in
 million manipulations, and a rate of . deaths in  mil-
lion manipulations has been reported []. e insurance
industry claims []datasupportariskofstrokeasper
million manipulations. 99% of all chiropractors practicing in
Denmark completed a survey; they estimated that one case of
cerebrovascular accident occurred for every . million cervi-
cal treatment sessions. e occurrence increased to  in every
, treatment sessions for upper cervical manipulations,
Evidence-Based Complementary and Alternative Medicine
and they noted that techniques using rotational thrusts were
overrepresented in the frequency of injury.
A temporal relationship is insucient to establish causal-
ity, and recall bias can further obscure the truth. Moreover,
denominators are rarely available. Smaller randomized con-
trolled trials (RCTs) are unlikely to detect rare AEs, and better
reporting of AEs is required, obviously. erefore Senstad
et al. [] reported the data from  prospective inves-
tigations of  adults who received chiropractic spinal
manipulation indicated that 30%to55%reportedaminor
adverse event. e most common were local discomfort
(% to %), radiating discomfort (10%to23%), headache
(10%to12%), tiredness (%), or nausea; dizziness, hot
skin, or “other” reactions are uncommonly reported (<%
of reactions). And of the reported reactions, reactions were
mild or moderate in 85%to90%ofpatients.64%ofreactions
appeared within  hours of treatment, and 74%to83%had
disappeared within  hours. Interestingly, reactions are most
commonly reported by women and (for both genders) at the
beginning of the treatment series. Patients with long-lasting
problems are more likely to report treatment reactions, and
patients with no prior experience of chiropractic care do not
report more reactions than patients previously treated by chi-
ropractors. en Cagnie et al. [] recruited  new patients
treated with spinal manipulation by  physiotherapists
(Belgian). All patients were asked to complete a questionnaire
about AEs subsequently. 61%ofthepatientsreportedatleast
one AE, most of which were mild and transient, like headache
(20%), stiness (%), local discomfort (15%), radiating
discomfort (12%), and fatigue (12%). 61%oftheproblems
had started within  hours aer manipulation; 64%had
resolved within  hours. No complicationswith long-lasting
consequences were reported. Hurwitz et al. []reported
the AEs documented in a -patient RCT which compared
spinal manipulation with spinal mobilization as treatments
for neck pain. 30% reported at least one AE. Patients receiving
spinal manipulation were more likely to experience AEs than
mobilization. e most frequently noted AEs were increase
of pain, headache, tiredness, and radiating pain. 80%of
theAEsbeganwithinhoursaertreatmentandwere
mild or of medium severity. No serious complications were
noted. e three prospective case series above corroborate
the results from several earlier studies []showingthatmild
tomoderateAEsoccurinalargeproportionofpatients
receivingspinalmanipulation,buttheseAEsaretransient
and nonserious. And recently,  patients were random-
ized to one of three treatment arms in a new study [],
to investigate dierences in occurrence of adverse events
between three dierent combinations of manual treatment
techniques used by manual therapists (i.e., chiropractors,
naprapaths, osteopaths, physicians, and physiotherapists) for
patients seeking care for back and/or neck pain. And adverse
events were measured with a questionnaire aer each return
visit and categorized into ve levels. As a result, the most
common adverse events were soreness in muscles, increased
pain, and stiness. e most frequent level of adverse event in
this study was short minor lasting less than  hours and was
rated less than or equal to three on the numeric rating scale
regarding severity. No serious adverse events were reported.
Clearly, we should dierentiate between various ap-
proaches. e above cases suggest that massage by nonpro-
fessional and forceful techniques is oen associated with
AEs. In  cases the practitioners are massage therapists
(5.8% of total) and  are chiropractors (23.9%), while
in the other cases (70.3%)theyareunregisteredoreven
healthcare professionals only. So it might be unfair to assess
the AEs of spinal manipulation as practiced by well-trained
chiropractors alongside that associated with the untrained.
Obviously from above, a variety of dierent care providers
like physiotherapists, massage therapists, physicians, and
osteopaths may perform a manipulation as part of their
practice, but it should be most frequently performed by
chiropractors []. Certainly skill and experience are impor-
tant, and it is relevant to dierentiate between dierent
professions. But on the other hand, skill is a quality not easily
controlled and some therapists are more skilled than others.
Moreover,thisreviewisaimedatevaluatingtheAEsofan
intervention (massage) and not that of a profession (massage
therapist/chiropractic). at is why in this review we show
the implicated practitioners are not only chiropractors but
also physicians, physiotherapists, “bonesetters,” and general
medical practitioners.
is systematic review has several limitations. Even
though the search strategy was deemed thorough, some rele-
vant published articles might have been missed. It is possible
that not all cases were identied in our searches. Although
this paper has resulted in a few papers to review, it still had its
strengths including the thorough search of the literature to
help reduce bias in the review. We searched multiple relevant
electronic databases and used two coauthors to determine
articles for inclusion in the review and to evaluate the liter-
ature. But because of the inherent nature of case reports and
other anecdotal reports, it is impossible to make inferences
regarding cause and eect. erefore, it is not known whether
the serious AEs in cases identied in this review were caused
by massage and whether the association between therapy
and event was accidental or not. So the safety in massage
is still far from being achieved. Further investigations are
urgent to assess denite conclusions regarding this issue. In
the meantime, it should be necessary to establish a system of
risk alert for guaranteed sur veillance on this type of CAM and
safe practice guidelines are required and could continue to be
enforced.
5. Conclusions
In conclusion, although serious AEs associated with massage
in general and pain-related massage in particular are few,
massage therapies are not totally devoid of risks. Spinal
manipulation in massage has repeatedly been associated with
serious AEs especially. But the incidence of such events is
probably low. Adequate regulation could further minimize
the risks. So we recommend that not only adequate training in
biomedical knowledge for practitioners, such as anatomy and
microbiology, but also safe practice guidelines are required
andshouldcontinuetobeenforcedinordertominimize
massage AEs.
Evidence-Based Complementary and Alternative Medicine
Conflict of Interests
e authors declare that there is no conict of interests
regarding the publication of this paper.
Authors’ Contribution
Ping Yin and Ningyang Gao made equal contributions to this
paper.
Acknowledgments
e work in Austria was supported by the Federal Ministries
of Science, Research and Economy and of Health (project
title: “Evidence-based high-tech acupuncture and integrative
laser medicine for prevention and early intervention of
chronic diseases”).
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[] W. C. Meeker and S. Haldeman, “Chiropractic: a profession at
the crossroads of mainstream and alternative medicine,Annals
of Internal Medicine,vol.,no.,pp.,.
... The massage is described as any type of manipulation or touch which was performed on the soft tissue of the body in order increase in comfort and relieve from pain [2]. Most of the time massage was successful without any adverse events. ...
... The post massage complications are more common in females compared to males. Further Complications art more commonly reported in Asian populations especially among Chinese [2]. Followed by Europeans and few in Australia and USA. ...
... The list of most common complication after Neck massage[2]. ...
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Background The neck massage is one of the modes of treatment offered for the cervical pain. Most of the time it will cause successful reduction or improvement of the cervical pain. But sometimes it can lead to various complications, which ranges from minimal neck soreness in the massage area to significant mortality like death. Case report A 70-year-old male patient came with the complaints of difficulty in raising the bilateral upper limb with mild weakness of bilateral lower limb for the past 3 days. He had an history of neck massage before 3 days for his longstanding cervical pain. He was not a known diabetic or hypertensive. He doesn't have any significant past medical or surgical history. Conclusion Massage, which is one the supportive therapy for the pain, although most of the time it will serve the purpose. But sometimes it can lead to dreadful complication in certain hands. Longus colli edema, which is mostly seen in case of calcific tendinosis, can also be seen in the case of post massage complication. Proper technique and gentle approach can avert many neurovascular complications after massage.
... Massage therapy promotes local circulation in tissues and relieves muscle spasms and soft-tissue adhesions. Mild complications associated with massage therapy, namely focal discomfort or pain, fatigue, headache, dizziness, and nausea, have been reported in the literature (12). Moreover, several cases have reported severe complications of massage, namely, spinal cord injury, hepatic hematoma, and embolism of the retinal and cerebral arteries (12)(13)(14)(15). ...
... Mild complications associated with massage therapy, namely focal discomfort or pain, fatigue, headache, dizziness, and nausea, have been reported in the literature (12). Moreover, several cases have reported severe complications of massage, namely, spinal cord injury, hepatic hematoma, and embolism of the retinal and cerebral arteries (12)(13)(14)(15). ...
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Median nerve damage caused by trauma is rare, especially after the massage therapy. There have been no reports of median neuropathy in the distal forearm following massage therapy. A 61-year-old man developed paresthesia and numbness in the right hand after two sessions of massage therapy. Electrophysiologic studies, ultrasound, and magnetic resonance imaging were used to localize and confirm the median nerve lesion in the distal forearm. Ultrasound-guided perineural steroid injection and oral pregabalin were administered. At the 1-month follow-up, more than 80% of the sensory symptoms had resolved, and the results of the sensory nerve conduction study and ultrasound showed improvement. Although massage-induced mononeuropathy is uncommon, massage therapy should be performed carefully to avoid complications.
... Most of massage therapy related adverse events were mild. Serious adverse events were reported such as soft tissue trauma, neurologic compromise, cervical cord injury, and myopathy [29,30]. ...
... For restless leg syndrome, vascular compression arising from massage therapy is postulated to lead to release of endothelial mediators which modulate symptoms of restless leg syndrome [93]. Given that the use of massage therapy entails minimal adverse effects, this makes it an attractive alternative option to be adopted for CKD patients to promote their overall well-being [94]. ...
Article
Background and purpose: Among chronic kidney disease (CKD) patients, manipulative and body-based methods (MBM) have demonstrated efficacy in improving symptoms such as fatigue. This review aims to summarize the efficacy and safety of MBM among CKD patients. Methods A systematic review was performed in PubMed, Embase, Scopus, CINAHL, CENTRAL and PsycInfo. Randomised controlled trials (RCTs) which evaluated the use of MBM among adult CKD patients were included. The grading of recommendations, assessment, development, and evaluation (GRADE) approach was used to determine the risk of bias and certainty of evidence. The efficacy of each MBM was determined by reduction in symptom severity scores. All adverse reactions were documented. Results Of 8529 articles screened, 55 RCTs were included. Acupressure (n = 23), massage therapy (n = 17), reflexology (n = 6) and acupuncture (n = 5) were the most studied MBMs. Acupressure and reflexology were shown to reduce sleep disturbance and fatigue by 6.2–50.0% and 9.1–37.7% respectively. For uremic pruritus, acupressure and acupuncture reduced symptoms by 34.5–77.7% and 56.5–60.2% respectively. Common adverse reactions associated with acupressure included intradialytic hypotension (20.4%) and dizziness (11.1%) while that of acupuncture included elbow soreness (7.5%) and bleeding (7.5%). No adverse effects were reported for massage therapy, moxibustion, reflexology and yoga therapy. Conclusion Acupressure, reflexology and massage therapies were the most well-studied MBMs which have demonstrated efficacy in alleviating sleep disturbance, fatigue and uremic pruritus symptoms in CKD patients.
... As indicated by Table 1, a literature search, revealed only one paper that comments on the clinical standards and contraindications/cautions within the broader context of foam rolling [13]. The authors of that study considered the therapeutic massage literature [18][19][20][21][22][23][24] to produce an initial list of potential contraindications and cautions as empirical evidence is scarce. While said paper is commenting on the contraindications and cautions of roller massage practices, the list of contraindications and cautions can serve as a valuable starting point for more focused investigations. ...
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Background: Foam rolling is a type of self-massage using tools such as foam or roller sticks. However, to date, there is no consensus on contraindications and cautions of foam rolling. A methodological approach to narrow that research gap is to obtain reliable opinions of expert groups. The aim of the study was to develop experts' consensus on contraindications and cautions of foam rolling by means of a Delphi process. Methods: An international three-round Delphi study was conducted. Academic experts, defined as having (co-) authored at least one PubMed-listed paper on foam rolling, were invited to participate. Rounds 1 and 2 involved generation and rating of a list of possible contraindications and cautions of foam rolling. In round 3, participants indicated their agreement on contraindications and cautions for a final set of conditions. Consensus was evaluated using a priori defined criteria. Consensus on contraindications and cautions was considered as reached if more than 70% of participating experts labeled the respective item as contraindication and contraindication or caution, respectively, in round 3. Results: In the final Delphi process round, responses were received from 37 participants. Panel participants were predominantly sports scientists (n = 21), physiotherapists (n = 6), and medical professionals (n = 5). Consensus on contraindications was reached for open wounds (73% agreement) and bone fractures (84%). Consensus on cautions was achieved for local tissue inflammation (97%), deep vein thrombosis (97%), osteomyelitis (94%), and myositis ossificans (92%). The highest impact/severity of an adverse event caused by contraindication/cautions was estimated for bone fractures, deep vein thrombosis, and osteomyelitis. Discussion: The mechanical forces applied through foam rolling can be considered as potential threats leading to adverse events in the context of the identified contraindications and cautions. Further evaluations by medical professionals as well as the collection of clinical data are needed to assess the risks of foam rolling and to generate guidance for different applications and professional backgrounds.
... Although massage therapy is not a safe therapeutic option for all conditions such as spinal manipulation, it has not shown any particular side effects in treatment of KOA patients [79]. There are just few studies that discussed the long-term effect of manual therapy on knee osteoarthritis. ...
Article
Background: One of the most destructive forms of arthritis is knee osteoarthritis (KOA) that leads to disability because of pain in elderly individuals and also increases utilization of health care among them. Through improving local circulation and joint flexibility, and relaxation of muscles, massage therapy is capable of relieving painful musculoskeletal conditions. Therefore, it may be beneficial for treatment of KOA. Moreover, the successfulness of exercise therapy in treatment of KOA broadly is proved and required to be reviewed more. Through a comprehensive review, the present study is aimed to investigate the role of massage therapy on knee osteoarthritis. Method: A literature search was carried out using the five most well-known databases of Europe PubMed, PubMed, EMBASE, MEDLINE, and Google Scholar from 2010 to 2020. All the articles were searched in English with the main subject of massage therapy on knee osteoarthritis. During the search from all 284 searched, articles 189 deleted due to the subject similarity and finally, 82 article were chosen to be included in the research inclusion criteria. Results: Manual therapy is an effective treatment option in the management of KOA patients. It could be used alone or in combination with other available types of therapies. Conclusion: The present study provides a general set of information about manual therapy and its effectiveness in the management of KOA patients.
... It should be noted that the patient's companion, after examining the patient's abdomen in terms of a mass and other contraindications to massage, would start the massage if there was no problem. Massage cause too little and rare problem, such as trauma, neurologic compromise, pain, dissection of arteries, and the like [35], that it is explained to patients, and they reported any unpleasant feeling. e massage started from the beginning of the ascending colon, in a clockwise direction, and continued towards the horizontal colon and finally to the end of the descending colon. ...
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Objective: The aim of this study was to determine the effect of abdominal massage with and without Salvia officinalis on nausea and vomiting in patients with cancer undergoing chemotherapy. Methods: In this randomized clinical trial, 60 patients undergoing chemotherapy were placed in one of two intervention groups or in a control group. Abdominal massage with and without Salvia officinalis was performed for 15 minutes twice a day for 3 consecutive days by the patient's companion. The rate of nausea and vomiting was measured with a Visual Analog Scale. Results: Findings showed that immediately after the intervention, the mean score of nausea in abdominal massage with Salvia officinalis group was lower than that of the control group. The mean score of nausea was not different between abdominal massage and control groups. One week after the intervention, the mean score of nausea was not different among the three groups. In addition, the frequency of vomiting was not different among the three groups. Conclusion: Abdominal massage with/without Salvia officinalis as a complementary medicine has not considerable effect on reducing nausea and vomiting in patient with cancer undergoing chemotherapy. More studies are needed to achieve better and more accurate results.
... (19,41,43) However, each massage therapy intervention, in addition to its positive effects, brings about some complications and side effects including muscle pain, fatigue, and damage to muscle tissue and peripheral nerves. (44,45,46) Nevertheless, since Oketani massage is based on massaging all breast muscles-the base, as well as the areola-it affects blood and lymph flows, and can also reduce milk stasis in the breast without any unwanted side effects. It can even reduce the pain of breast congestion and increase the breastfeeding success by stimulating the oxytocin/milk ejection reflex. ...
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Background: The negative effects of cesarean section on breastfeeding are a major global concern. Purpose: This study aimed to determine the effect of Oketani breast massage on the maternal need for support during breastfeeding, breastfeeding success, and breastfeeding self-efficacy. Setting: Three hospitals affiliated to Shahid Beheshti University of Medical Sciences in Tehran, Iran, from April to July 2019. Study design: The participants in this experimental study were 113 pregnant women who were candidates for cesarean section. The mothers were selected using convenience sampling and randomly assigned. In addition to routine care, the mothers in the intervention group received Oketani breast massages twice. However, the mothers in the control group received routine care. The data were collected using the Infant Breastfeeding Assessment Tool (IBFAT), LATCH Assessment Score, and the Breastfeeding Self-Efficacy Scale (BSES). The data were analyzed with SPSS 20 software via the independent samples t test, the Mann-Whitney U test, and the chi-square test. Results: The results of the study suggested that the breastfeeding success rate, which was evaluated with IBFAT in both the first two breastfeeding stages and the last pre-discharge breastfeeding, was significantly higher for the mothers in the intervention group (p < .001). In addition, the mother's need for support, which was evaluated with LATCH in the first two breastfeeding stages (p = .044) and the last pre-discharge breastfeeding (p < .001) in the intervention group, was less. The total number of breastfeeding sessions from birth to discharge was higher in the intervention group (p = .002). Furthermore, the mothers in the intervention group breastfed their infants in a significantly shorter time interval (p = .002). Breastfeeding self-efficacy, according to the BSES, was significantly higher in the mothers of the intervention group (p < .001). Conclusion: Oketani massage can be used as a care intervention by nurses to improve breastfeeding in mothers who undergo cesarean sections.
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Introduction: Spinal and peripheral joint manipulation and mobilization are interventions used by many healthcare providers to manage musculoskeletal conditions. Although there are many reports of adverse events (or undesirable outcomes) following such interventions, there is no common definition for an adverse event or clarity on any severity classification. This impedes advances of patient safety initiatives and practice. This scoping review mapped the evidence of adverse event definitions and classification systems following spinal and peripheral joint manipulation and mobilization for musculoskeletal conditions in adults. Methods: An electronic search of the following databases was performed from inception to February 2021: Medline, Embase, CINHAL, Scopus, AMED, ICL, PEDro, Cochrane Library, Open Grey and Open Theses and Dissertations. Studies including adults (18 to 65 years old) with a musculoskeletal condition receiving spinal or peripheral joint manipulation or mobilization and providing an adverse event definition and/or classification were included. All study designs of peer-reviewed publications were considered. Data from included studies were charted using a standardized data extraction form and synthesized using narrative analysis. Results : From 8248 identified studies, 98 were included in the final synthesis. A direct definition for an adverse event and/or classification system was provided in 69 studies, while 29 provided an indirect definition and/or classification system. The most common descriptors to define an adverse event were causality, symptom severity, onset and duration. Twenty-three studies that provided a classification system described only the end anchors (e.g., mild/minor and/or serious) of the classification while 26 described multiple categories (e.g., moderate, severe). Conclusion: A vast array of terms, definition and classification systems were identified. There is no one common definition or classification for adverse events following spinal and peripheral joint manipulation and mobilization. Findings support the urgent need for consensus on the terms, definition and classification system for adverse events related to these interventions.
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The evidence of benefits and safety of complementary and alternative medicine for kidney diseases are still dubious to both practitioners and general public. Chinese herbal medicines are the main CAM in treating chronic kidney disease as an adjunctive therapy to conventional medicine. Several meta-analyses of randomised controlled trials assessing the efficacy of CHM reported that Astragalus and Cordyceps seem to have a beneficial effect on the kidneys. Acupuncture, yoga and aromatherapy may alleviate symptoms in patients with ESRD, such as pain, anxiety and pruritus. This evidence should be interpreted with caution due to several limitations of the RCTs of CAM, i.e., small sample sizes, unclear randomisation and blinding. Acute kidney injury is the common nephropathy caused by herbal and dietary supplements, e.g. aristolochic acid. Dietary supplements may induce uncontrolled hyperkalemia and hyperphosphatemia in patients with advanced CKD. Unregistered herbal products from India and China may be adulterated by conventional medicines and heavy metals, which could cause AKI.
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The safety of the manual treatment techniques such as spinal manipulation has been discussed and there is a need for more information about potential adverse events after manual therapy. The aim of this randomized controlled trial was to investigate differences in occurrence of adverse events between three different combinations of manual treatment techniques used by manual therapists (i.e. chiropractors, naprapaths, osteopaths, physicians and physiotherapists) for patients seeking care for back and/or neck pain. In addition women and men were compared regarding the occurrence of adverse events. Participants were recruited among patients, ages 18-65, seeking care at the educational clinic of the Scandinavian College of Naprapathic Manual Medicine in Stockholm. The patients (n = 767) were randomized to one of three treatment arms 1) manual therapy (i.e. spinal manipulation, spinal mobilization, stretching and massage) (n = 249), 2) manual therapy excluding spinal manipulation (n = 258) and 3) manual therapy excluding stretching (n = 260). Treatments were provided by students in the seventh semester of total eight. Adverse events were measured with a questionnaire after each return visit and categorized in to five levels; 1) short minor, 2) long minor, 3) short moderate, 4) long moderate and 5) serious adverse events, based on the duration and/or severity of the event. Generalized estimating equations were used to examine the association between adverse event and treatments arms. The most common adverse events were soreness in muscles, increased pain and stiffness. No differences were found between the treatment arms concerning the occurrence of adverse event. Fifty-one percent of patients, who received at least three treatments, experienced at least one adverse event after one or more visits. Women more often had short moderate adverse events (OR = 2.19 (95% CI: 1.52-3.15)), and long moderate adverse events (OR = 2.49 (95% CI: 1.77-3.52)) compared to men. Adverse events after manual therapy are common and transient. Excluding spinal manipulation or stretching do not affect the occurrence of adverse events. The most common adverse event is soreness in the muscles. Women reports more adverse events than men.Trial registration: This trial was registered in a public registry (Current Controlled Trials) (ISRCTN92249294).
Article
Recommendation 1: Clinicians should conduct a focused history and physical examination to help place patients with low back pain into 1 of 3 broad categories: nonspecific low back pain, back pain potentially associated with radiculopathy or spinal stenosis, or back pain potentially associated with another specific spinal cause. The history should include assessment of psychosocial risk factors, which predict risk for chronic disabling back pain (strong recommendation, moderate-quality evidence). Recommendation 2: Clinicians should not routinely obtain imaging or other diagnostic tests in patients with nonspecific low back pain (strong recommendation, moderate-quality evidence). Recommendation 3: Clinicians should perform diagnostic imaging and testing for patients with low back pain when severe or progressive neurologic deficits are present or when serious underlying conditions are suspected on the basis of history and physical examination (strong recommendation, moderate-quality evidence). Recommendation 4: Clinicians should evaluate patients with persistent low back pain and signs or symptoms of radiculopathy or spinal stenosis with magnetic resonance imaging (preferred) or computed tomography only if they are potential candidates for surgery or epidural steroid injection (for suspected radiculopathy) (strong recommendation, moderate-quality evidence). Recommendation 5: Clinicians should provide patients with evidence-based information on low back pain with regard to their expected course, advise patients to remain active, and provide information about effective self-care options (strong recommendation, moderate-quality evidence). Recommendation 6: For patients with low back pain, clinicians should consider the use of medications with proven benefits in conjunction with back care information and self-care. Clinicians should assess severity of baseline pain and functional deficits, potential benefits, risks, and relative lack of long-term efficacy and safety data before initiating therapy (strong recommendation, moderate-quality evidence). For most patients, first-line medication options are acetaminophen or nonsteroidal anti-inflammatory drugs. Recommendation 7: For patients who do not improve with self-care options, clinicians should consider the addition of nonpharmacologic therapy with proven benefits-for acute low back pain, spinal manipulation; for chronic or subacute low back pain, intensive interdisciplinary rehabilitation, exercise therapy, acupuncture, massage therapy, spinal manipulation, yoga, cognitive-behavioral therapy, or progressive relaxation (weak recommendation, moderate-quality evidence).
Article
Objective To estimate the effect of adding exercise classes, spinal manipulation delivered in NHS or private premises, or manipulation followed by exercise to "best care" in general practice for patients consulting with back pain. Design Pragmatic randomised trial with factorial design. Setting 181 general practices in Medical Research Council General Practice Research Framework; 63 community settings around 14 centres across the United Kingdom. Participants 1334 patients consulting their general practices about low back pain. Main outcome measures Scores on the Roland Morris disability questionnaire at three and 12 months, adjusted for centre and baseline scores. Results All groups improved over time. Exercise improved mean disability questionnaire scores at three months by 1.4 (95% confidence interval 0.6 to 2.1) more than "best care." For manipulation the additional improvement was 1.6 (0.8 to 2.3) at three months and 1.0 (0.2 to 1.8) at 12 months. For manipulation followed by exercise the additional improvement was 1.9 (1.2 to 2.6) at three months and 1.3 (0.5 to 2.1) at 12 months. No significant differences in Outcome occurred between manipulation in NHS premises and in private premises. No serious adverse events occur-red. Conclusions Relative to "best care" in general practice, manipulation followed by exercise achieved a moderate benefit at three months and a small benefit at 12 months; spinal manipulation achieved a small to moderate benefit at three months and a small benefit at 12 months; and exercise achieved a small benefit at three months but not at 12 months.
Article
Recommendation 1: Clinicians should conduct a focused history and physical examination to help place patients with low back pain into 1 of 3 broad categories: nonspecific low back pain, back pain potentially associated with radiculopathy or spinal stenosis, or back pain potentially associated with another specific spinal cause. The history should include assessment of psychosocial risk factors, which predict risk for chronic disabling back pain (strong recommendation, moderate-quality evidence). Recommendation 2: Clinicians should not routinely obtain imaging or other diagnostic tests in patients with nonspecific low back pain (strong recommendation, moderate-quality evidence). Recommendation 3: Clinicians should perform diagnostic imaging and testing for patients with low back pain when severe or progressive neurologic deficits are present or when serious underlying conditions are suspected on the basis of history and physical examination (strong recommendation, moderate-quality evidence). Recommendation 4: Clinicians should evaluate patients with persistent low back pain and signs or symptoms of radiculopathy or spinal stenosis with magnetic resonance imaging (preferred) or computed tomography only if they are potential candidates for surgery or epidural steroid injection (for suspected radiculopathy) (strong recommendation, moderate-quality evidence). Recommendation 5: Clinicians should provide patients with evidence-based information on low back pain with regard to their expected course, advise patients to remain active, and provide information about effective self-care options (strong recommendation, moderate-quality evidence). Recommendation 6: For patients with low back pain, clinicians should consider the use of medications with proven benefits in conjunction with back care information and self-care. Clinicians should assess severity of baseline pain and functional deficits, potential benefits, risks, and relative lack of long-term efficacy and safety data before initiating therapy (strong recommendation, moderate-quality evidence). For most patients, first-line medication options are acetaminophen or nonsteroidal anti-inflammatory drugs. Recommendation 7: For patients who do not improve with selfcare options, clinicians should consider the addition of nonpharmacologic therapy with proven benefits—for acute low back pain, spinal manipulation; for chronic or subacute low back pain, intensive interdisciplinary rehabilitation, exercise therapy, acupuncture, massage therapy, spinal manipulation, yoga, cognitive-behavioral therapy, or progressive relaxation (weak recommendation, moderate-quality evidence).
Article
A 31-year-old woman suffered a brainstem infarction secondary to chiropractic neck manipulation. A dissection of both vertebral arteries could be demonstrated by MR tomography. This case report should alert therapists to be aware of vertebrobasilar complications after spinal manipulations.
OVERVIEW Independent Nursing Interventions Decision-Making Strategies for Choosing Nursing Interventions Resolving Ethical and Moral Dilemmas of Nursing Interventions MOVEMENT AND PROPRIOCEPTIVE INTERVENTIONS Progressive Relaxation Exercise Movement Therapy COGNITIVE INTERVENTIONS Guided Imagery Decisional Control Journal Reminiscence Contracting Meditation Sensation Information SENSORY INTERVENTIONS Therapeutic Touch Music Heat and Cold Massage Environmental Structuring: Timing Biofeedback Tactile Stimulation OTHER INTERVENTIONS Play Groups Humor Index.
Article
Study Design. A case of symptomatic hematoma of cervical ligamentum flavum. Objective. To report the first ligamentum flavum hematoma in the cervical spine and review the reported cases. Summary of Background Data. A herniated nucleus pulposis, spondylosis, epidural hematoma or abscess, neoplasm, or some pathology of the ligamentum flavum, such as hypertrophy, ossification, or calcification, are the most common causes of spinal cord and nerve root compression. A ligamentum flavum hematoma has also been reported as a cause of compression of the cauda equina and lumbar nerve roots but has never been found in the cervical spine. Methods. A 72-year-old man presented with left upper arm pain and left hemiparesis following traditional massage therapy. Admission magnetic resonance images showed a posterior oval-shaped mass that was continuous with the ligamentum flavum at C3–C4 level. Results. A C3–C4 laminectomy for decompression and resection of the lesion was performed. One year after surgery, the patient remained neurologically intact and symptom-free. Conclusions. Hematoma of the ligamentum flavum occurring in the cervical spine has never been reported previously. Repeated trivial injury on a degenerative ligamentum flavum might be the leading predisposing factor. Spine surgeons should be aware of a hematoma in the ligamentum flavum as a possible cause of spinal cord or root compression, especially in the mobile cervical and lumbar spine.
Article
Background Little is known about the incidence of adverse effects after chiropractic manipulation. Over representation of severe and under representation of less severe complications has to be assumed. Material and methods A total of 57 expert opinions from the malpractice advisory board of the North Rhine General Medical Council (Nordrheinische Ärztekammer), as well as judgments from German courts since 1949, were analyzed. Results and conclusions A total of 16 of 57 cases of chiropractic manipulation (since 1975) were attested as malpractice by expert opinion, seven of which had significant negative consequences. In nine cases, the judgments of German courts refer to manual therapy. Of these, five deal with informed consent. Observance of the “Bingen Declaration” would have avoided all cases of malpractice found by the advisory board over 29 years.