Compared to common treatments for LDH, SMT is reported to be 37,000 to 148,000 times safer than nonsteroid antiinflammatory drugs and 55,500 to 444,000 times safer than surgery . Neither worsening of symptoms nor cauda equine syndrome were observed in our participants after SMT. Epidemiologic data on the rate of injuries caused by manipulation are limited. The most common incidents are related to innocuous physiologic reactions or short-term discomfort generated at the treatment site. However, these are self-limiting events that usually resolve within 24 h after SMT .