Chiropractic Care Contraindications: When Treatment Is Not Recommended

Conditions Where Chiropractic Manipulation May Be Unsafe or Inappropriate

Chiropractic spinal manipulation (HVLA thrust) is contraindicated or requires extreme caution/modification in:

Absolute/Strong Relative Contraindications

• Acute Trauma/Fracture/Dislocation: Requires medical stabilization first.
• Spinal Cord Compression / Cauda Equina Syndrome: Neurosurgical emergency.
• Vertebral Artery Dissection (VAD) or High Risk: History of VAD, connective tissue disorders (Ehlers-Danlos, Marfan), recent neck trauma. HVLA rotation/extension can precipitate stroke.
• Spinal Infection (Osteomyelitis, Discitis, Epidural Abscess).
• Spinal Tumor/Metastasis: Pathologic fracture risk, cord compression.
• Severe Osteoporosis/Osteopenia: Fracture risk (rib, vertebra). Low-force techniques may be used.
• Bleeding Disorders / Anticoagulation: Risk of epidural hematoma.
• Acute Inflammatory Arthritis (e.g., Rheumatoid Arthritis with cervical instability, Ankylosing Spondylitis with fusion).

Special Populations Requiring Modified Approach

• Pregnancy: Avoid supine positioning late pregnancy; avoid high-velocity thrusts to lumbar/sacral regions; ligament laxity (relaxin). Many techniques are safe with modification.
• Recent Surgery: Wait for healing (typically 3–6 months for spinal fusion); avoid operated segments.
• Children/Elderly: Use low-force/instrument-assisted techniques.

Not a Contraindication (But Requires Assessment)

• Arthritis (degenerative) – often helped by mobilization/soft tissue work.
• Disc herniation (without progressive neurologic deficit) – often beneficial.

Always disclose full medical history. Chiropractors should triage and refer for imaging/specialist care when red flags exist.