Best Practices for Chiropractic Management of Patients with Chronic Musculoskeletal Pain: A Clinical Practice Guideline

doi:10.1089/acm.2020.0181

PMC full text:

J Altern Complement Med. October 2020; 26(10): 884–901.

Published online 2020 Oct 8. doi: 10.1089/acm.2020.0181

Copyright/LicenseRequest permission to reuse: Copyright © Cheryl Hawk et al. 2020; Published by Mary Ann Liebert, Inc.
This Open Access article is distributed under the terms of the Creative Commons License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Table 9.

Possible Contraindications to Spinal or Other Joint Manipulation or Mobilization Procedures^15,100

System	Condition
Musculoskeletal	• Primary or metastatic bone tumors
	• Severe osteoporosis
	• Structural instability (such as unstable spondylolisthesis or postsurgical joint instability)
Inflammatory	• Osteomyelitis
	• Rheumatoid arthritis in the active systemic stage, or locally if acute inflammation or atlantoaxial instability is present
Neurologic	• Progressive or sudden neurologic deficit
	• Spinal cord tumors with neurological compromise or requiring medical intervention
Hematologic	• Any unstable bleeding disorders, including high-dose anticoagulant therapy
	• Unstable aortic aneurysm
Clinician attributes	Inadequate physical examination
Clinician attributes	Inadequate manipulative training

Soft-tissue, instrument-assisted manipulation and low-velocity, low-amplitude mobilization procedures may be considered for application, as clinically indicated on an individual basis.^15,100