Adverse Response

Original Editor - Matt Huey

Top Contributors - Matt Huey and Kim Jackson  

Definition[edit | edit source]

The Cambridge Dictionary has defined an "adverse reaction" as "a harmful physical effect caused by a drug, a medical treatment, or another substance." In current research, there is not standard terminology nor definitions for adverse responses in physical therapy. Terms such as adverse events, adverse reactions, adverse effects, side effects, complications, and safety are commonly used interchangeably[1]. This can cause difficulty in finding accurate data at times.

Responses to Spinal Manipulation[edit | edit source]

Most reported adverse responses come from a manual therapy intervention such as manipulation of the cervical or lumbar spine dry needling. The types of adverse responses can vary greatly from mild to severe. Some common patient reported responses include[2]:

  • Stiffness or increased stiffness
  • Soreness or increased soreness
  • Increase in symptoms
  • Spread of symptoms
  • Headaches
  • Fatigue
  • Increased pain

Serious responses that are reported include[3]:

  • Death
  • Stroke
  • Paralysis
  • Fractures

One study did find that 61% of all patients reporting at least 1 of the "mild" symptoms (headache, stiffness, local discomfort, radiating discomfort, and fatigue) [4] . Another found the rate of an adverse response to between 1 in 20,000 to 1 in 250,000,000 manipulations which included the serious responses [3].

Responses to Dry Needling[edit | edit source]

Dry Needling also has reported adverse responses as well, which include "mild" symptoms such as:

  • Soreness
  • Bruising
  • Increased pain
  • Fainting
  • Skin reactions

The most common "serious" response to dry needling is a pneumothorax.

One study found that roughly 8.6% of patients report at least 1 adverse response to dry needling[5].

Minimizing Adverse Responses[edit | edit source]

To ensure that adverse responses are minimized when providing interventions such as spinal manipulation or dry needling. Proper training in the delivery of these treatments is a key component. Providers with insufficient training can cause an increase in more serious responses. Proper screening of patients as well can minimize serious responses. Patients with a medical history of fracture, infection, or osteoporosis, may not be good candidates for spinal manipulation. Likewise, patients with bleeding disorders, infections, skin disorders, allergies to metals, or fear of needles may not be candidates for dry needling.

Additional steps can be take during treatment to ensure a patient is a good candidate. With spinal manipulation, the progression of forces throughout their sessions can demonstrate a patient's response to movement of their joints. Likewise, before performing a manipulation, a pre-manipulative hold and assessing for any adverse response can demonstrate if manipulation is indicated. Testing the vertebral artery with the vertebral artery test (VAT) can be used prior to a cervical manipulation. Using the For dry needling, proper precautions such as proper needle size and depth of the needle can avoid pneumothorax.

References[edit | edit source]

  1. Carlesso, L. C., MacDermid, J. C., & Santaguida, L. P. (2010). Standardization of adverse event terminology and reporting in orthopaedic physical therapy: application to the cervical spine. journal of orthopaedic & sports physical therapy, 40(8), 455-463.
  2. Funabashi, M., & Carlesso, L. C. (2021). Symptoms patients receiving manual therapy experienced and perceived as adverse: a secondary analysis of a survey of patients’ perceptions of what constitutes an adverse response. Journal of Manual & Manipulative Therapy, 29(1), 51-58.
  3. 3.0 3.1 Nielsen, S.M., Tarp, S., Christensen, R. et al. The risk associated with spinal manipulation: an overview of reviews. Syst Rev 6, 64 (2017).
  4. Ernst E. (2007). Adverse effects of spinal manipulation: a systematic review. Journal of the Royal Society of Medicine, 100(7), 330–338.
  5. Halle, J. S., & Halle, R. J. (2016). PERTINENT DRY NEEDLING CONSIDERATIONS FOR MINIMIZING ADVERSE EFFECTS - PART ONE. International journal of sports physical therapy, 11(4), 651–662.