Chiropractic care often involves manual therapy, primarily using spinal adjustments to improve function and reduce pain. While these techniques are generally safe for many musculoskeletal conditions, certain pre-existing health issues can make a routine adjustment potentially harmful. The physical forces involved in spinal manipulation, especially high-velocity thrusts, can place undue stress on weakened or compromised body structures. This article outlines the conditions and symptoms that make chiropractic manipulation risky or unsuitable.
Compromised Bone and Structural Integrity
Conditions that weaken the physical structure of the spine or joints represent a significant contraindication for manipulative therapy. When bone density is severely reduced, the mechanical force of an adjustment can cause unintended damage. Severe or advanced osteoporosis, particularly in elderly patients, can lead to compression or pathological fractures of the vertebrae following spinal manipulation.
Patients with active spinal tumors, whether primary cancer or metastatic lesions, should also avoid manipulation of the affected area. Cancerous growths weaken the bone structure, making it highly susceptible to fracture or collapse under pressure. Acute fractures or suspected fractures of the spine or pelvis necessitate immediate immobilization and conventional medical treatment, not adjustment. Structural instabilities, such as severe spondylolisthesis or advanced ligamentous instability, can be worsened by the forces of an adjustment, risking neurological impairment.
Conditions Affecting Blood Flow and Circulation
Issues related to the circulatory system, particularly in the neck, require careful consideration due to the proximity of major arteries. Cervical manipulation carries a risk of complicating existing vascular problems. Known arterial conditions, such as a vertebral or carotid artery dissection, which is a tear in the inner lining of the artery, are absolute contraindications. Manipulation could potentially exacerbate the tear, leading to a blood clot, obstruction, or stroke.
Patients diagnosed with an active aneurysm should also avoid spinal adjustments in the vicinity of the pathology, as mechanical stress could theoretically lead to rupture. Individuals taking high doses of anticoagulant medications, commonly known as blood thinners, must exercise caution. These medications increase the risk of internal bleeding or hematoma formation from soft tissue manipulation, requiring specific clearance before any manual therapy is performed.
Active Infections and Inflammatory Diseases
Active systemic or localized disease states can be worsened by physical manipulation. Spinal infections, such as osteomyelitis or discitis, should not be manipulated. Applying force to an infected area can spread the localized infection to other parts of the body or into the bloodstream.
Acute, severe inflammatory arthritis conditions also warrant avoidance of manipulation during flare-ups. Conditions like severe, active Rheumatoid Arthritis (RA) can cause instability in the upper cervical spine, and adjustment can potentially damage acutely inflamed joints. While chronic, quiescent phases of some inflammatory conditions may allow for modified, gentle techniques, any joint with active swelling or inflammation should be considered off-limits for high-velocity thrusts.
Recognizing Urgent Medical Conditions
Certain symptoms, often called “red flags,” indicate a need for immediate medical evaluation by a physician or emergency department, rather than a chiropractic visit. These signs suggest an underlying, potentially life-threatening condition that requires prompt diagnosis and intervention outside of manual therapy. Progressive neurological deficits are a major warning sign, including sudden, severe weakness, numbness, or loss of reflexes in the limbs that is rapidly worsening.
New-onset bladder or bowel dysfunction, often accompanied by numbness in the “saddle area” (the groin, buttocks, and inner thighs), is characteristic of Cauda Equina Syndrome (CES). CES is a serious compression of the spinal nerve roots requiring urgent surgical decompression to prevent permanent nerve damage. Unexplained severe head pain, fever associated with neck stiffness, or sudden, debilitating pain unrelated to any known mechanical injury also suggest an urgent medical issue, such as meningitis, subarachnoid hemorrhage, or an evolving vascular event.