Is osteopathy safe? Side effects and who should take care
What the research says about the safety of osteopathic and other manual therapy, the common mild side effects, who should take extra care, and what to tell your osteopath.
For most people, osteopathic care is a low-risk treatment, and the common side effects are mild and short-lived. Like any health treatment, though, it is not entirely risk-free, and it is not right for everyone. A good osteopath will explain the risks and benefits before asking for your consent.
Common, mild effects
Reviews of spinal manipulative therapy trials report that most side effects are musculoskeletal, such as muscle soreness, stiffness or a temporary increase in pain, and that they are usually transient and of mild to moderate severity. Some people also feel tired afterwards. These usually settle within a day or two.
Serious problems
Serious complications are rare. A 2019 BMJ systematic review noted that in about half of the studies adverse events were examined, and that one serious adverse event was judged possibly related to spinal manipulation. A more recent Cochrane review concluded that the evidence about adverse effects is very uncertain, and that no serious complications were registered in the studies that reported them. Because the data on harms are limited, any practitioner using manipulation should explain the possible risks to you.
Who should take extra care
- People with osteoporosis, a recent fracture, or bone problems
- People taking blood-thinning medication, or with clotting problems
- People who are pregnant, or who might be
- People with a history of cancer, or with new unexplained symptoms such as weight loss or night pain
- People with inflammatory arthritis, or with numbness, weakness or bladder or bowel changes
- Anyone with neck pain together with dizziness, visual disturbance or other new neurological symptoms
What to tell your osteopath
Tell your osteopath about your medical history, medicines, pregnancy, and any other care you are having. They should check for warning signs, explain what they plan to do and why, and only go ahead with your informed consent. You can say no to any part of treatment or stop at any time.
When to get help after treatment
Contact the osteopath, your GP or NHS 111 if pain becomes significantly worse and does not settle, or if you develop new numbness, weakness, severe headache, dizziness, or any of the urgent symptoms in the guides. Call 999 for chest pain, signs of stroke or loss of bladder or bowel control.
If you have a question that is not answered here, or you would like your symptoms assessed, you are welcome to get in touch or book an appointment.
Common questions
Can osteopathy make my pain worse?
A temporary increase in pain or soreness for a day or two is the most commonly reported side effect of manual therapy. If pain is significantly worse and does not settle, or you develop new symptoms, contact your osteopath or GP.
Is it safe to see an osteopath when pregnant?
Osteopaths regularly see pregnant women, and the approach is adapted to your stage of pregnancy. Tell your osteopath you are pregnant, and tell your midwife about any pain. Seek urgent advice for back pain with bleeding, fever or other warning signs.
Sources and further reading
Links open in a new tab. Sources were checked in October 2026.
- Rubinstein et al., BMJ 2019: Benefits and harms of spinal manipulative therapy for chronic low back pain
- Cochrane review (2026): Spinal manipulative therapy for adults with chronic low back pain
- General Osteopathic Council: What to expect at your appointment
Related guides
This page is general information to help you understand common aches and pains. It is not medical advice and cannot diagnose your problem. If you are worried about your symptoms, please speak to your GP or call NHS 111.