Contraindications to Manipulative Therapy

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Contraindications to Manipulative Therapy
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Red Flags

• History
• Screen for red flags that may warrant immediate
  imaging or referral
• Severe trauma
• Direct head trauma with LOC
• Nuchal rigidity
• Bladder dysfunction associated with neck pain
• Associated dysphasia
• Associated cranial nerve or CNS signs/symptoms
• Onset of new headache
• Pre-existing conditions such as RA, cancer, Down
  syndrome, alcoholism, drug abuse or
  immunosuppression

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Murphy, D (2000). Conservative management of
cervical spine syndromes. McGraw-Hill, New York.
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Red Flags

• Examination
• For patients with nuchal rigidity and/or positive
  Brudzinskis or Kernigs sign, refer for medical
  management
• Radiographs for patients with suspected fracture,
  dislocation, infection, or cancer
• For patients with radicular findings, obtain
  radiographs, including AP, APOM, lateral and
  oblique views
• Flexion-extension views if searching for
  instability
• Special imaging, including CT or MRI, reserved
  for differential of radicular or myelopathic
  cases where there is a need for further
  distinction among tumor, stenosis, herniated
  disc, or MS

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Red Flags
Murphy, D (2000). Conservative management of
cervical spine syndromes. McGraw-Hill, New York.
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Red Flags
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Referral
Murphy, D (2000). Conservative management of
cervical spine syndromes. McGraw-Hill, New York.
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Herzog, W. Clinical biomechanics of spinal
manipulation. New York, NY, Churchill Livingdtone
2000 209.
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Gatterman, MI. Standards of practice relative to
complications of and contraindications
to spinal manipulative therapy. JCCA 1991
35(4)232-36.
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References

• Herzog, W (2000). Clinical biomechanics of spinal
  manipulation. Churchill Livingstone, New York.
• Gatterman, MI. Standards of practice relative to
  complications of and contraindications to spinal
  manipulative therapy. JCCA 1991 35(4)232-36.
• Murphy, D (2000). Conservative management of
  cervical spine syndromes. McGraw-Hill, New York.