Chiropractic Contraindications

When NOT To Get Chiropractic Treatment

Chiropractic contraindications are extremely rare and chiropractic care is amazingly effective (and cost effective!) for the treatment of many types of spinal pain syndromes including back pain, neck pain, sciatica, headaches and whiplash. There are some instances however, when caution dictates that a different path should be taken.
Your chiropractor can and should take the proper steps to determine whether chiropractic care is appropriate for you. Their training dictates it!

Getting Proper Screening

My title perhaps should have been “when the #1 treatment of a chiropractor should be avoided.” There is a standard of care that should be followed to determine when and where a spinal manipulation (adjustment) is administered. A diagnosis and prognosis must be arrived at before any treatment. This can only occur when a comprehensive question-and-answer session occurs between you and your chiropractor, followed by examination and maybe even special testing such as an x-ray or MRI.
Most important in this “discovery” time is the determination of whether or not you are a candidate for spinal manipulative treatment (SMT). Understand these two things:

1. Symptoms which seem to be coming from your back may not be coming from spinal or pelvic misalignments.
2. Your spinal or pelvic structures may not be healthy enough to accept SMT.

There can be many other factors such as congenital (from birth) abnormalities of the spine or adjacent structures, prior accidents, family histories and/or cardiovascular weaknesses which could lead to danger from SMT. A good chiropractor will screen for all of these before beginning treatment.

When Chiropractic Won’t Help: Chiropractic Contraindications

Here’s a list of the most common chiropractic contraindications for SMT:

1. Ruptured disc. When evaluating for a disc injury, your chiropractor will want to rule out an extruded (or ruptured) disc and will refer you out for an MRI if he or she suspects that your disc is torn.  Ruptured discs CAN be successfully treated by chiropractors, but the methods of treatment will be unique to this condition.
2. Cardiovascular problems. When considering the potential for cardiovascular issues, your chiropractor will look for predisposing factors based upon your family history. Your chiropractor will also ask about whether you are a smoker, are on steroids or blood thinning medications, and (if you are female) whether you are on birth control medications. Your chiropractor will perform special tests to evaluate your vertebral arteries (the small arteries in your neck which run alongside and within a portion of your vertebrae).
3. Bone weakness. Your chiropractor will check for the structural integrity of your bones prior to SMT. If you have Osteoporosis, Rheumatoid or Osteoarthritic Degenerative Disease, special methods of SMT can be performed safely.  An instrument adjusting technique (Pro-Adjuster, Sigma Instruments, Pulstar Instruments) can be safely used.
4. Abnormalities. Your chiropractor will check your spine for congenital abnormalities or space-occupying problems which could (very rarely) include tumors or disease.
5. Infection. Your chiropractor will check your vital signs, especially temperature, to rule out the possibility of an infection.
6. Problems with visceral organs. Symptoms from the viscera and internal organs can mimic musculoskeletal symptoms, and may require immediate medical or emergency room referral. (Gall bladder pain or an aortic aneurysm are examples of mimicked spinal pain.)
7. Muscle spasms. If you have an acute spasm of a muscle, SMT in that immediate area will not be appropriate.
8. Certain pain patterns. Your chiropractor will not perform SMT into a spinal region if you have symptoms into BOTH arms or BOTH legs without an MRI first. This is important if other orthopedic and neurological tests are positive.
9. Congenital scoliosis. SMT is not going to decrease the progressive effects of congenital juvenile idiopathic scoliosis.
10. Surgical hardware. Your chiropractor will not perform SMT into surgical fusion hardware, especially if the surgery was recent.

The standard of care is that if your symptoms do not reduce, even a little, within two weeks of the beginning treatment, then you may be referred to another type of doctor for further diagnostic testing and treatment or co-treatment.
As in all health care, remember that what can do good can also do harm. If you doubt this, pay attention to the next drug advertisement you see and hear. The litany of contraindications, side effects and adverse reactions which every medication creates is overpowering if you are not paying attention to the flowery images on your TV screen.
The chiropractor is trained to first do no harm, and to look for chiropractic contraindications. Every health care procedure has risk, but thankfully chiropractic is one of the least risky health care methods on our planet. The next time you experience musculoskeletal pain, consider chiropractic care first.  A chiropractor is uniquely qualified to find the reason for your pain, rule out chiropractic contraindications, and when appropriate, successfully and quickly help you improve!
photo credit: Pink Sherbet Photography via photopin cc