Indications and Contraindications for Chiropractic Manipulation

In general, patients selected for this procedure have received a minimum of six to eight weeks of conservative (nonsurgical) care and have a full understanding of both manipulation under anesthesia risks and benefits.

With that said, there are a number of specific indications and contraindications that need to considered by the patient, doctor of chiropractic, anesthesiologist and/or other relevant medical professionals prior to undertaking manipulation under anesthesia.

Manipulation under Anesthesia Indications of Use

Manipulation under anesthesia may be considered as an alternative form of treatment for patients with one or more of the following symptoms after non-surgical (conservative) care has proven ineffective:

  • Neck pain
  • Mid back and lower back pain
  • Chronic muscle pain and inflammation
  • Acute and chronic muscle spasm
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  • Decreased spinal range of motion
  • Chronic fibrositis (outdated term for fibromyalgia)
  • Nerve entrapment
  • Pseudo-sciatica
  • Sciatica where disc bulges are contained less than 5 mm
  • Failed back surgery
  • Chronic occipital or tension headaches
  • Conditions where narcotic pain relievers are of little benefit
  • Traumatic torticollis
  • Reflex Sympathetic Dystrophy (RSD).

On the other hand, certain symptoms/conditions may make manipulation under anesthesia too risky and not prudent for certain patients.

Manipulation under Anesthesia Risks/Contraindications

Contraindication to anesthesia as determined by current medical literature is the responsibility of the licensed medical co-manager (anesthesiologist).

Contraindications to manual manipulation of high velocity, low velocity or soft tissue techniques as established by current literature is relative to technique specific for articular derangements, bone weakening and destruction disorders, circulatory and cardiovascular disorders, or neurological disorders.

More specifically, situations that may exacerbate manipulation under anesthesia risks and thus likely exclude this procedure as a treatment option include:

  • Malignancy with metastasis to bone
  • Tuberculosis of the bone
  • Fractures
  • Acute arthritis
  • Acute gout
  • Uncontrolled diabetic neuropathy
  • Syphilitic articular or periarticular lesions
  • Gonorrheal spinal arthritis
  • Excessive spinal osteoporosis
  • Evidence of cord or caudal compression by tumor, ankylosis and malacia bone disease.

For patients who do not apply to these manipulation under anesthesia risks/contraindications, a thorough examination is necessary to further determine candidacy for this procedure.

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Written by Richard J. Reid, MD and Rosie Desimone, DC and Ben Eubank, DC