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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