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Archived Comments for: Adverse events from spinal manipulation in the pregnant and postpartum periods: a critical review of the literature

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  1. Adverse events associated with spinal manipulation during pregnancy and the postpartum period: further considerations.

    Joel Alcantara, Life Chiropractic College West

    24 July 2012

    Joel Alcantara, DC (1), Junjoe Alcantara, DC (2) and Joey D. Alcantara, DC (3)

    1. Chair of Pediatric Research, Life Chiropractic College West, Hayward, CA, USA and Research Director, International Chiropractic Pediatric Association, Media, PA, USA
    2. Private Practice of Chiropractic, Makati City, Philippines
    3. Private Practice of Chiropractic, Calgary, AB, Canada

    Stuber and colleagues [1] are to be commended on their critical review of the literature documenting adverse events associated with SMT during pregnancy and the postpartum period. In addition to effectiveness of care, safety is a germane issue for all involved in the care of patients. Their study provides much needed information in elucidating the safety and effectiveness of SMT for the aforementioned patient population. As pointed out by the investigators, the hormonal and coagulability status during pregnancy and postpartum remain to be fully defined in the etiology of adverse events associated with SMT. Furthermore, the documented adverse events thus far are not specifically associated with pregnancy or the postpartum period. From this context, the authors' comments on the possibility that SMT may be contraindicated in pregnant and postpartum patients require further consideration. Contraindications and indications to SMT are foremost for the attending clinician, regardless of the patient population or the clinical presentation/motivation for care. Absolute and relative contraindications to SMT for the patient during pregnancy and postpartum period remain to be fully defined. In this regard and from a chiropractic perspective, we would also respectfully add that the nature of SMT provided should be a consideration. First, the SMT performed by various practitioners of manual therapy are not the same. The use of SMT by the various professions involved in manual therapy remains to be characterized for their safety and effectiveness, particularly with the present patient population of interest. Secondly, SMT is the primary mode of care for chiropractors and arguably, chiropractors are the best trained and have the most experience in delivering this type of patient care. There is a long tradition within chiropractic in the care of pregnant patients [2] with measures of effectiveness [3-5]. The study by Stuber and colleagues [1] provides the starting point to examining the safety of chiropractic SMT in pregnant and postpartum patients. Third, the array of SMT techniques performed by chiropractors are varied and span the spectrum from low to high with respect to the velocity and amplitude of force applied, with or without the assistance of a mechanical device. Despite the popularity of the high velocity, low amplitude (HVLA) thrust type SMT in many chiropractic clinical studies, many more ¿techniques¿ of SMT are utilized by chiropractors (and other manual therapists) in clinical practice. This flexibility in technique must also be acknowledged as a consideration in the indications, contraindications and judicious application of SMT in patients during pregnancy and the postpartum period.


    1. Stuber KJ, Wynd S, Weis CA. Adverse events from spinal manipulation in the pregnant and postpartum periods: a critical review of the literature. Chiropr Man Therap. 2012;20:8.

    2. Gibbons RW. Forgotten parameters of general practice: The chiropractic obstetrician. Chiropractic History 1982;2(1):27-33.

    3. Alcantara J, Ohm J, Kunz K, Alcantara JD, Alcantara J. The characterisation and response to care of pregnant patients receiving chiropractic care within a practice-based research network. Chiropr J Aust 2012; 42(2): 60-67

    4. Alcantara J, Ohm J, Kunz K. The Webster Technique: results from a practice-based research network study. J Pediatr Matern and Fam Health - Chiropr:2012 WIN;2012(1): 16-21.

    5. Stuber KJ, Smith DL. Chiropractic treatment of pregnancy-related low back pain: a systematic review of the evidence. J Manipulative Physiol Ther. 2008;31(6):447-54.

    Competing interests

    None declared