Chiropractic care focuses on the diagnosis, treatment, and prevention of mechanical disorders of the musculoskeletal system, primarily through manual techniques like spinal manipulation. While effective for many mechanical back and neck complaints, specific conditions fall outside the scope of chiropractic practice. These conditions represent absolute contraindications where manipulation poses an unacceptable risk of harm, or require primary management by a medical specialist.
Acute Conditions Where Manipulation is Dangerous
Certain conditions present immediate structural instability or severe pathology, making high-velocity spinal manipulation potentially harmful. These are absolute contraindications, meaning the procedure should not be performed. Acute fractures or dislocations of the spine must be stabilized and managed medically before any manual therapy is considered, as manipulation could severely worsen the injury and cause spinal cord damage. Similarly, aggressive treatment is avoided in cases of severe trauma, such as those resulting from a recent car accident or fall, until diagnostic imaging confirms the structural integrity of the spine.
Active infections involving the spine, such as osteomyelitis (bone infection) or discitis (disc space infection), also prohibit manipulation. Applying force to an infected area risks spreading the infection or causing further deterioration of the weakened bone and soft tissue. The presence of tumors or metastatic disease affecting the spinal bones can significantly weaken the vertebral structure, creating a high risk of pathological fracture if a high-velocity adjustment is performed.
Progressive neurological deficits, particularly those indicating severe nerve root or spinal cord compression, demand immediate medical attention. Cauda equina syndrome, which involves severe compression of the nerve roots in the lower spine, requires emergency surgical decompression. While manipulation itself may not increase the risk of cauda equina syndrome, the symptoms necessitate an immediate medical referral, not chiropractic treatment.
Systemic Health Issues Outside Chiropractic Scope
Chiropractors are trained to diagnose a broad spectrum of health conditions, but their primary tools are non-pharmacological and non-surgical. This restricts their ability to manage systemic diseases that primarily affect internal organs, involve widespread pathological processes, or require pharmaceutical intervention. Systemic infectious diseases, such as influenza or pneumonia, must be managed by medical doctors who can prescribe appropriate medication and monitor the illness.
Advanced cardiovascular disease, including uncontrolled hypertension or heart failure, requires specialized medical management to regulate blood pressure and heart function. Although chiropractic care may be supportive by addressing musculoskeletal pain, it is not a substitute for the primary treatment of the disease itself. This principle also applies to advanced organ failure, such as severe kidney or liver disease, where primary intervention involves medical specialists and complex protocols.
The diagnosis and primary treatment of systemic cancers are also outside the scope of chiropractic practice, even if the patient is experiencing related musculoskeletal pain. While a chiropractor can offer supportive care for mechanical pain, they cannot provide chemotherapy, radiation, or surgical management for the disease.
Patient Factors Requiring Modified Treatment or Referral
Some patient factors are considered relative contraindications, demanding a significantly modified approach or a complete referral rather than prohibiting care entirely. Severe osteoporosis causes bones to become fragile and porous, increasing the risk of a compression fracture from manipulation. In such cases, a chiropractor must use low-force techniques or mobilization instead of high-velocity adjustments to avoid causing harm.
Patients taking anticoagulant medications (blood thinners) or those with underlying bleeding disorders are at an increased risk of internal bleeding or hematoma formation following manual soft tissue work. A chiropractor must be aware of the patient’s clotting status and may need to avoid certain techniques entirely or obtain clearance from the prescribing physician.
Inflammatory conditions like rheumatoid arthritis, particularly when affecting the upper cervical spine, can lead to ligamentous laxity and joint instability. High-velocity adjustments to the neck are typically avoided in these individuals due to the risk of spinal cord injury. Advanced vascular disease, such as a known severe aortic aneurysm, also requires extreme caution, as increased pressure or strenuous maneuvers could pose a risk. Specific risk factors for vertebral artery dissection must be carefully evaluated before any cervical adjustment is performed.
Identifying Red Flags and Seeking Emergency Care
Patients should be aware of certain warning signs, known as red flags, that indicate a potentially life-threatening or rapidly progressing condition. These symptoms suggest the patient’s condition has escalated beyond the scope of conservative, mechanical treatment and requires immediate medical or emergency care.
A sudden, severe headache, often described as the “worst headache of your life” (thunderclap headache), could signal a serious intracranial event, such as an aneurysm or stroke. Other serious signs include fever associated with neck stiffness, which may suggest meningitis, or a combination of unexplained weight loss and night pain, which can indicate spinal infection or malignancy. The rapid onset of significant muscle weakness, numbness, or loss of bladder or bowel control represents a neurological emergency. Recognizing these signs and immediately seeking care from a medical doctor or emergency room is essential for patient safety.