Table 3 Contraindications and precautions to perform cervical spinal manipulation [21]
From: Cervical epidural hematoma after spinal manipulation therapy: a case report
| Contraindications | Precautions |
|---|---|
| (Acute) fracture | Inflammatory disease |
| Relevant recent trauma | Rheumatoid arthritis |
| Dislocation | Ankylosing spondylitis |
| Ligamentous rupture | History of cancer |
| Instability | Long-term steroid use |
| Active cancer | Osteoporosis |
| Acute myelopathy | Systemically unwell |
| Spinal cord damage | Hypermobility syndromes |
| Upper motor neuron lesions | Connective tissue disease |
| Multi-level nerve root pathology | A first sudden episode before age 18 or after age 55 |
| Worsening neurological function | Cervical anomalies |
| Recent surgery | Local infection |
| Acute soft tissue injury | Throat infection |
| Unremitting, severe, non-mechanical pain | Recent manipulation by another health professional |
| Unremitting night pain | Vascular disease |
| Vertebral / carotid artery abnormalities | Blood clotting disorders / alterations in blood properties |
| Vertebrobasilar insufficiency | Anticoagulant therapy |
| Absence of a plausible mechanical explanation for the patient’s symptoms | |
| Immediately post-partum |