The Dirty Dozen Contraindications of Spinal Manipulation

There is a standard of care to be followed that dictates the caution that must be exercised when administering medical spinal manipulation. The medical spinal manipulation can be chiropractic, osteopathic or rendered by other medical or non-medical persons all potentially ending in disastrous results. A definitive diagnosis and prognosis must be reached prior to treatment thru a comprehensive history and examination. There is a systematic medical protocol that must be adhered. This may even lead to radiological or imaging studies (MRI) prior to spinal manipulative treatment. Most important in this discovery procedure, is to determine if the patient is a candidate for SMT. Their symptoms may not be coming from spinal or pelvic misalignments. Their spinal and or pelvic structures may not be in good structural condition to accept a manipulation procedure. There can be so many co-morbidity factors such as congenital abnormalities, prior accidents, family histories and or cardiovascular susceptibilities that could end in death or stroke. These all must be ruled out prior to any treatment. Please understand that this is not meant to decrease the scope of what manipulation treats, but to minimize injuries caused by SMT. Of course, these are some of the DEADLY SINS, but the DIRTY DOZEN CONTRAINDICATIONS ARE AS FOLLOWS:

1) RULE OUT EXTRUDED DISC MYELOPATHY AND REFER OUT FOR MRI ON ANY SUSPICION OF A PROTRUDED DISC THAT MAY HAVE ANY DEGREE OF AN ANNULAR TEAR

2) RULE OUT CARDIOVASCULAR PREDISPOSING FACTORS, FAMILIAL HISTORY. PERFORM AT LEAST FOUR VERTEBRAL ARTERY INSUFFICIENCY TEST, ESPECIALLY FOR FEMALES, SMOKERS, STERIOD OR BIRTH CONTROL AND BLOOD THINNER MEDICATIONS.

3) CHECK THE STRUCTURAL INTEGRITY OF THE OSSEOUS STRUCTURES PRIOR TO SMT., FOR EXAMPLE OSTEOPORITIC, DEGENERATIVE OSTEOARTHIRITC DEGENERATIVE DISEASE, ETC.

4) CHECK FOR CONGENITAL ABNORMALITIES OR SPACE OCCUPYING LESIONS, YES, THIS CAN TAKE TIME, DIG DEEP AND BE A GOOD DETECTIVE AND EASILY REFER FOR RADIOLOGICAL AND OR DIAGNOSTIC IMAGING STUDIES.

5) CHECK VITAL SIGNS ESPECIALLY TEMPERATURE, THERE COULD BE AN INFECTIOUS PROCESS DEVELOPING.

6) REMEMBER, THAT VISCERAL SYMPTOMS MIMICKING MUSCULOSKELETAL SYMPTOMS MAY NOT WARRANT SMT AND MAY REQUIRE AN IMMEDIATE MEDICAL OR EMERGENCY ROOM REFERRAL.

7) DO NOT PERFORM SMT INTO AN ACUTE SPASTIC MUSCLE REGION.

8) DO NOT PERFORM SMT WITHOUT MRI INTO A SPINAL REGION WITH BILATERAL RADICULAR EXTREMITY SYMPTOMS ESPECIALLY IF THERE OTHER ORTHOPDEIC AND NEUROLOGICAL TESTS THAT ARE POSITIVE.

9) SMT IS NOT GOING TO DECREASE THE PROGRESSIVE DESTRUCTIVE EFFECTS OF CONGENITAL JUVENILLE IDIOPATHIC SCOLIOSIS.

10) THE STANDARD OF CARE IS THAT IF SYMPTOMS DO NOT ABATE EVEN A LITTLE BIT WITHIN TWO WEEKS OF CARE IS TO REFER OUT AND CO-TREAT WITH ANOTHER MEDICAL PHYSICIAN FOR FURTHER DIAGNOSTICS AND/OR TREATMENT.

11) UNBELIEVABLE AS IT MAY SEEM AND QUITE OBVIOUS....DO NOT PERFORM SMT INTO SURGICAL FUSION HARDWARE, ESPECIALLY IF THE SURGERY WAS VERY RECENT.

12) REMEMBER, "WHAT CAN DO GOOD, CAN DO HARM!" ACTIVATOR AND/ OR OTHER MECHANICAL SMT TOOLS CAN DO HARM TO A CONTRAINDICATED PATIENT.

PLEASE NOTE THAT THIS IS NOT TO DECREASE THE SCOPE OF TREATMENT POSSIBILITIES THAT SMT CAN BE OF VALUE TO, BUT TO SINCERELY EXERCISE CAUTION WHEN CONSIDERING A PATIENT FOR SMT, WHICH IS CERTAINLY A MEDICAL PROCEDURE.

Dr. Andrew Rodgers, BS, MS, DC, is a National Certifed Chiropractic Expert Witness with over 34 years of experience. He has worked on over 30 malpractice cases on the proper standard of care.

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