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Journal of Alternative and Complementary Medicine
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Table 9.

Possible Contraindications to Spinal or Other Joint Manipulation or Mobilization Procedures15,100

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 attributesInadequate physical examination
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