Although spinal manipulation carried out by an osteopath,chiropractor,physical therapist,or orthopaedic specialist has a very good safety record, but as practitioners we have to keep contraindications firmly in mind.
Once we satisfy ourselves that we are not manipulating for the wrong condition or where a concern for safety exists,we can manipulate safely and assist our patient on the road to recovery .
By the term "manipulation"
Personally ,and in over 30 years of practice,I have never caused a problem using manipulation but it can happen.However Im known for using the bare minimum of thrust,performing only the amount of pressure needed to restore movement and realign the area I am working on.This approach has served me well over the years.
One may well ask how we can gently manipulate yet still achieve our aims?
My answer to this conundrum is that when I encounter a joint or vertebra that is particularly "locked"or a patient that is particularly hypomobile,I apply a mix of massage and infra red heat to loosen the tight soft tissue surrounding the area .
Some may call this approach old fashioned, but it serves me and many "old school" osteopaths well( and safely),avoiding having to attack the area like an elephant in a porcelain shop;and of paramount importance,is easier and NOT TRAUMATIC to the patient.
I realise some use interferential machines to do this, but having used one myself for a short period,i did not find this nearly as effective,and patients feel they are being "strapped to a machine while the osteopath/chiropractor disappears off to treat someone else". (The patients words,not mine!!!)
So lets look at these contraindications shall we?
firstly we do not want to use an HVT when there is a disc protrusion,particularly if there is anular tearing present.
However, there is a technique I occasionally use if I suspect a minor disc bulge which involves taking the patient across my back whilst holding their crossed arm elbows.Sadly this is a technique rarely taught in the schools nowadays.
The reason this is safe is because we employ NO sidebending manipulation eg lumbar roll,and because this manipulation literally causes a vacuum
effect inside the disc,and it has been this authors experience that this literally "sucks" the bulge back into the disc.
A sidebending manipulation would push out on the disc and exacerbate the protrusion.
cervical manipulation should be approached with care and we need to test for cervical insuffiency,particularly in females,the elderly,smokers,users of warfarin or warfarin type medications and steroid users.Again, with cervical manipulation,always use MINIMAL force.
I generally prefer to use mc Timoney chiropractic manoeuvres if I am in even the slightest doubt where the cervicals are concerned.
We have to be on our guard against osteoporosis or osteopenia as the osseous integrity of bone is an obvious no no to HVT manipulation.
I will illustrate this with a cautionary tale ,that ended happily I hasten to add.One of my fellow osteopaths in the mid 90,s wife had a thoracic impingement.He asked to watch me as he wanted to learn a technique I used.
I was using a gentle thoracic rocking technique when she suddendly emitted an ouch sound.Her ribs were in obvious pain and had a minor fracture.
I phoned her doctor who was a friend of mine,and a great source of referrals,voicing my concern re osseous integrity.He immediately ordered tests and she was found to have osteopenia.The happy end was that this episode had found the condition and he was able to prescribe drugs to halt its effects.She is still very healthy to this day.Had we not discovered this ,the disease may have progressed unchecked.
Another thing to beware of is pathologies of the bones.In other words,tumours or actual bone diseases.Obviously one is aware of past cancers in other areas and the possibility of metastases.
The questions I always ask are ,is the pain worse at night? Or is the pain relieved if you lay or sit in a certain position?
A pathology would naturally worsen at night,like most diseases,and if the bone pain is a pathology ,there would be no position that would afford comfort as it would not be a mechanical problem.Be aware of these two questions,they will serve you well.
There is a story I always tell students that illustrates the importance of checking for tumour activity(stop yawning and read it!!!).
I was on the board of the institute of complimentary medicines standards committee, and received a call from one of its top men enquiring after one thing or another.Asking how he was,he complained of a pain radiating down both legs and beginning in his thoracic spine.
He said he had seen a doctor and was having treatment from a chiropractor.
I calmly asked him to drop whatever he was doing and go to the hospital for x-ray.They removed a tumour the size of an orange later that day!!!(Bilateral nerve symptoms into the lower limbs are always a case to be referred for MRI scan,as we may be looking at stenosis,tumour,central disc prolapse etc.)
The moral of the story is that some symptoms just "dont fit" with musculoskeletal disorders,and we need to be aware of this when asking a patient of their problem/pain pattern.
We must also be prudent to look at our patients vital signs eg temperature to ensure there is not an infection taking hold.
Be on the lookout for visceral problems mimicking bone or joint problems. One example;I have seen many cases of pelvic inflammatory disease present themselves as pain around the lower back/pelvic area.
Conversely,I have dealt with many cases of people with suspected heart attacks where it turned out to be a thoracic problem(including my father!!!The doctor was most interested in how I took away the symptoms of his "heart attack" using a simple thoracic manipulation!!!!
I never manipulate where there has been recent implantation of surgical hardware,and even where this is older,i use great care around the area.
Obviously this is not a greatly exhaustive list of contraindications,but i hope it cover the most common danger signs and that even one paragraph may avoid problems for you as a practitioner,and most importantly...your patient.
ABOUT DR LES BAILEY
dr les bailey phd..a brief history by Diane Davis
Les bailey first qualified as a massage therapist in 1981 ,going on to become an osteopath.He now practices physical therapies . He is also experienced in the fields of physical therapy,and effectively utilises the techniques of mc timoney chiropractic.
he is also qualified in biomechanics(
Les Bailey also qualified as an osteopathic teacher and lecturer with the northern college of osteopaths in 1993.
Dr Les Bailey phd can be contacted at drlesbailey@
article copyright Dr Les Bailey
Dr Les Bailey phd,DO,acopm,apta(