Chiropractic care focuses on musculoskeletal complaints, often using spinal manipulative therapy to address pain and mobility issues. While generally safe, certain pre-existing medical conditions or acute injuries necessitate caution or outright avoidance of manipulation. These conditions, known as contraindications, increase the risk of adverse events. This information identifies circumstances where the potential for harm outweighs any possible benefit, guiding individuals to seek alternative medical attention.
Conditions Compromising Skeletal Integrity
When the spine’s physical structure is compromised, forceful manipulation can be hazardous, potentially leading to fractures or structural failure. Severe osteoporosis is a significant contraindication because decreased bone mineral density makes the vertebral bodies fragile. Applying a high-velocity thrust maneuver to weakened bones increases the risk of a compression fracture or other structural damage.
Unhealed or recent fractures and dislocations are absolute contraindications, as physical pressure could displace healing fragments or further destabilize the joint. Structural instability, such as severe spondylolisthesis (a condition where one vertebra has slipped forward), may be worsened by manipulation, especially if the slippage is actively progressing. Spinal fusion also elevates the risk of fractures or spinal cord injury if manipulation is performed near the surgically joined segments.
Primary or metastatic tumors involving the bony structure of the spine also make manipulation unsafe. Cancerous lesions weaken the vertebral body, creating pathological fractures that manipulation could easily exacerbate. The underlying pathology makes the skeletal structure physically incapable of safely tolerating the forces involved in spinal adjustment.
Acute Neurological and Vascular Risks
Certain neurological and vascular conditions present high risks, as manipulation could potentially trigger rapid deterioration. One scenario is an acute disc herniation accompanied by a progressive neurological deficit, such as rapidly worsening weakness or numbness in a limb. While disc issues are often treated with manipulation, progressive nerve root compression requires immediate medical evaluation, not physical manipulation.
The most serious neurological emergency is Cauda Equina Syndrome (CES), which involves severe compression of the spinal nerves at the base of the spinal cord. Signs of CES include sudden loss of bladder or bowel control and saddle anesthesia (numbness in the groin area). These symptoms mandate immediate emergency room assessment and likely surgical intervention. Manipulation is strictly contraindicated because it risks further compression of the already compromised nerve roots.
Vascular integrity, particularly in the neck, is a serious concern. A known or suspected vertebral artery dissection or aneurysm is a significant contraindication, especially for cervical spine manipulation. Vertebral artery dissection involves a tear in the artery lining, which can lead to clot formation and subsequent stroke. Serious neurological complications like stroke have been associated with cervical manipulation in susceptible patients. Acute signs of stroke or a Transient Ischemic Attack (TIA) are also absolute contraindications, requiring immediate medical attention.
Situations Involving Systemic Illness or Infection
Systemic conditions affect the entire body and can make manipulation inappropriate even if the musculoskeletal system appears locally intact. Active systemic infections, such as a high fever or a known spinal infection like osteomyelitis, make manipulation unsafe. Applying physical force to an infected area risks spreading pathogens throughout the body, potentially leading to more widespread illness.
Severe inflammatory diseases, particularly during an acute flare-up of conditions like rheumatoid arthritis, often result in ligamentous laxity or joint instability, especially in the upper cervical spine. Manipulation under these circumstances can exacerbate inflammation or lead to dangerous instability and potential spinal cord injury. The inflamed state of the tissues makes them more vulnerable to physical stress.
Patients with bleeding disorders or those taking high-dose anticoagulant medications require extra caution. Manipulation carries a risk of causing internal bleeding or hematoma formation within the soft tissues or around the spine. While low-force techniques may sometimes be used, high-velocity thrust procedures are strictly avoided to minimize the risk of hemorrhagic complications. Recent extensive surgery in the area to be treated is also a relative contraindication, as healing tissues need time to stabilize before any mechanical stress is applied.