What do I need to know?
What are the Risks of Osteopathy and Manual Therapy?
Manual therapy (such as mobilisation, spinal manipulation, or soft tissue techniques) is widely used in healthcare and is considered relatively safe when performed by a well-trained practitioner. Nonetheless, mild side effects are fairly common, and serious complications, though very rare, must be acknowledged.
What the Research Says
- In a comprehensive systematic review by Carnes et al. (2010), the authors estimated that about 41% of patients in observational cohort studies and 22% in randomized trials experienced minor or moderate transient side effects after manual therapy.
- In one of our studies we found around 82% of patients experienced side effects: an increase in pain, stiffness and unexpected tiredness mostly rate as ‘mild’ but 1% rated these as ‘severe’. Within the week, nearly three quarters of patients reported feeling better.
- Our team’s finding are confirmed by Swait and Finch (2017) who also found patients experiencing local soreness, stiffness, or a temporary increase in pain that was rated as mild.
- A trial of manual therapy plus exercise for rotator cuff disease reported that 31% of participants had mild adverse events — though the effects were short-lived.
- In studies on physiotherapy interventions, increased pain and stiffness emerged as the most common complaints after manual therapy or related techniques.
- In research on spinal manipulation, serious complications are rarely observed. The literature describes these events as ‘difficult to quantify’ due to underreporting and methodological challenges.
Osteopathy and Manual Therapy Takeaway Message
The benefits of manual therapy (reduced pain, improved mobility, better function — the small known risks, especially under careful clinical evaluation and technique selection, can be minimised
What Are The Possible Side-Effects of Acupuncture?
Mild side effects like soreness, stiffness, or a temporary increase in sensitivity are relatively common. They typically resolve within 24–72 hours.
Serious side effects are extremely rare. They may include injury to nerves, joints, or blood vessels, but these are seldom seen in clinical practice.
Acupuncture is considered a safe treatment when performed by a well-trained practitioner. However, as with any procedure, there are risks—some minor, some more serious, though most are rare. The following categories and examples are based on a large observational study by Witt et al. (2009) of over 229,000 patients.
Common (around 1–10 in 100 people)
- Slight bleeding or bruising at needle sites caused by small blood vessels being punctured. This happens relatively often.
Uncommon (around 1–10 in 1,000 people)
Some patients may experience:
- Redness, swelling or inflammation where the needle was inserted
- Strong pain during needling or soreness of nearby muscles
- Temporary nerve irritation or mild weakness in nearby muscles
- Headache, fatigue, dizziness (vertigo) or nausea
- A temporary worsening of symptoms before improvement begins
Rare (around 1–10 in 10,000 people)
Rare side-effects can include:
- Local infection
- Itchiness, sweating
- Changes in blood pressure, lightheadedness
- More pronounced effects such as difficulty breathing, vomiting, or worsening of general health
- Mood changes, sleep disturbance, or visual symptoms like tinnitus or altered vision
Very Rare (fewer than 1 in 10,000 people)
These side-effects are extremely uncommon but have been reported:
- Issues like needle breakage, forgotten needles
- More serious complications such as pneumothorax (air in the lung cavity) when treating certain areas like the chest region
- Rare neurological or cardiovascular injuries in highly unusual circumstances
Acupuncture Takeaway
Medical acupuncture blends traditional techniques with modern medical knowledge. When applied by a competent and experienced practitioner, it is very safe.
I have practised medical acupuncture for nearly 30 years and have taught it for over 10. I always take care to minimise risk, explain possible side-effects clearly, and ensure treatments are appropriate for each individual.
What are the possible risks from psychotherapy and counselling
Even though counselling is meant to help, sometimes people experience unexpected difficulties. Research shows these can happen, but they are usually temporary and can be managed with your therapist.
Feeling Worse Before Feeling Better
- Talking about feelings or past experiences can sometimes increase stress, anxiety, or sadness at first.
- Studies suggest this happens for 10–20% of clients temporarily, especially in trauma-focused therapy.
Feeling Overly Dependent on the Therapist
- Some people rely heavily on the therapist for support, which can slow down learning how to cope independently.
Emotional Overwhelm / Re-traumatization
- Discussing past trauma or difficult events may bring up strong emotions or memories. Therapists work carefully to manage this.
Deciding to Stop Counselling
- Some clients feel counselling isn’t helpful or too difficult and choose to stop. This can sometimes make issues feel worse if not addressed properly.
Relationship or Life Stress
- Changes in thinking or behaviour from counselling may temporarily create tension with family, friends, or work situations.