are conditions where increased risk is acceptable in some situations and where mobilization and soft-tissue techniques may be treatments of choice. Most contraindications apply to the manipulation of the affected region. While safety has been debated, and serious injuries and deaths can occur and may be under-reported, these are generally rare and spinal manipulation is relatively safe when employed skillfully and appropriately. Adverse events are believed to be under-reported and appear to be more common following high velocity/low amplitude manipulation than mobilization. Mild, frequent and temporary adverse events occur in spinal manipulation which include temporary increase in pain, tenderness and stiffness. These effects generally are reduced within 24–48 hours Serious injuries and fatal consequences, especially from spinal manipulation in the upper cervical region, can occur, but are regarded as rare when spinal manipulation is employed skillfully and appropriately. Weak to moderately strong evidence supports causation (as opposed to statistical association) between cervical manipulative therapy and vertebrobasilar artery stroke. A 2012 review found that there is not enough evidence to support a strong association or no association between cervical manipulation and stroke. A 2008 review found chiropractic spinal manipulation is more commonly associated with serious related adverse effects than other professionals following manipulation and concluded that the risk of death from manipulations to the neck outweighs the benefits. References Chiropractic