When most people think of chiropractic care, they picture a spinal adjustment: a quick, precise movement of a joint, sometimes with a "pop" or "click".
Adjustments, also called spinal manipulation, can be a helpful part of care for many people with back pain, neck pain and some types of headache. But they aren't right for everyone, every time.
A good chiropractor's job isn't just knowing how to adjust. It's knowing when not to, and what to do instead. Here's how we make that call, and why it matters for your safety.
What does "contraindicated" mean?
In healthcare, a contraindication is a reason a particular treatment shouldn't be used, because the risks outweigh the potential benefits.
There are two broad types:
Absolute contraindications: situations where an adjustment to that area should not be performed at all
Relative contraindications: situations where an adjustment may still be possible, but only with caution, modification, or after further assessment or medical input
The World Health Organization's Guidelines on Basic Training and Safety in Chiropractic outline these, and they're a core part of every registered chiropractor's training.
When an adjustment should not be performed
These situations are uncommon, but they're the reason a thorough assessment always comes first. An adjustment to the affected area should not be performed if there is:
A recent fracture or dislocation of the spine
Instability of the spine, for example after significant trauma or from certain ligament problems
Infection of the spine, such as an infection of the bone or disc
Tumours affecting the spine, spinal cord or surrounding tissues, including cancer that has spread to bone
Bleeding in or around the spinal cord
Compression of the spinal cord, or a disc herniation causing progressively worsening nerve weakness
Cauda equina syndrome, a medical emergency involving compression of the nerves at the base of the spine
Certain structural conditions of the upper neck present from birth, such as specific abnormalities of the top two vertebrae or the base of the skull
Surgical hardware such as rods, screws or a fusion in the area being treated
Generalised joint hypermobility conditions where the joints are unstable
If any of these are suspected, the right next step is medical assessment, imaging or a referral, not an adjustment.
When an adjustment may need to be modified
Some conditions don't rule out chiropractic care, but they do change how it's delivered. Your chiropractor may use gentler techniques, avoid certain areas, or seek more information before proceeding. Examples include:
Osteoporosis or low bone density: high-force techniques are avoided in favour of gentle approaches
Blood-thinning medication or bleeding disorders: these increase the risk of bruising or bleeding, so techniques are chosen carefully
Inflammatory arthritis such as rheumatoid arthritis or ankylosing spondylitis, which can affect joint stability, particularly in the upper neck
Down syndrome and some connective tissue conditions, which can be associated with instability of the upper neck
Pregnancy: care is adapted with positioning and technique, and certain areas may be avoided
Recent surgery anywhere in the body
Acute, severe inflammation or a very irritable joint that isn't ready for that type of force
Significant nerve symptoms such as numbness or weakness, which need careful monitoring
This is one reason it's important to tell your chiropractor about your full health history, including medications, past surgeries and any diagnosed conditions, even if they seem unrelated.
The warning signs we screen for in the neck
Serious problems with the blood vessels in the neck, such as a tear in an artery wall (called a cervical artery dissection), are rare. But they can sometimes cause neck pain and headache that look like an ordinary musculoskeletal problem, so screening for them is an essential part of assessing anyone with neck pain.
International guidance from the International Federation of Orthopaedic Manipulative Physical Therapists, developed with input from physiotherapy, osteopathy and chiropractic experts, emphasises that these events are rare but should always be considered, and that no single test can rule them out. Instead, careful questioning and a full clinical picture are key.
Seek urgent medical attention, and don't have neck manipulation, if you have neck pain or headache along with:
Sudden, severe headache or neck pain unlike anything you've had before
Dizziness or vertigo, especially if it's new
Double vision or other changes in your vision
Difficulty speaking or swallowing
Numbness of the face or lips
Sudden falls or drop attacks without losing consciousness
Loss of coordination, unsteadiness or weakness on one side of the body
Nausea or vomiting with any of the above
If you have any of these symptoms, call 000 or go to your nearest emergency department.
Other red flags that need medical review first
Regardless of where your pain is, some symptoms suggest something other than a musculoskeletal problem and need medical assessment before chiropractic care:
Pain after a significant fall, car accident or other trauma
A history of cancer, or unexplained weight loss
Fever, chills or feeling generally unwell along with back or neck pain
Constant pain that doesn't change with movement or position, or that's worse at night
New bladder or bowel problems, or numbness in the groin area
Progressive weakness in the arms or legs
Clumsiness in the hands or difficulty walking
"I can't be adjusted. Can chiropractic still help?"
Often, yes. An adjustment is just one tool. When it isn't appropriate, there are many other ways a chiropractor can help, depending on your situation:
Mobilisation: gentle, slower movement of a joint within its comfortable range
Low-force or instrument-assisted techniques
Soft tissue therapy for tight or sensitive muscles
Stretching and nerve mobility techniques
A tailored home exercise program to build strength and mobility
Advice and education on activity, posture, sleep and workplace setup
Coordination with your GP or specialist for anything that needs medical attention
You are also always in control of your care. If you'd prefer not to be adjusted, for any reason, just let your chiropractor know. Your care can be built around what you're comfortable with.
How we keep care safe at Epoch Health
At Epoch Health, every new client starts with a thorough assessment. Our chiropractors will:
Take a detailed health history, including medications, past injuries, surgeries and medical conditions
Screen for red flags and warning signs that need medical attention
Perform a physical and neurological examination
Explain what we find and talk you through your options, including the benefits and risks of any treatment
Gain your informed consent before any treatment
Refer you to your GP or another health professional if something needs further investigation
Your safety always comes first. If an adjustment isn't right for you, we'll tell you clearly, explain why, and help you find the right path forward.
Book an appointment at our Dundas Valley or Telopea clinic: epochhealth.net.au/bookings
This article is general information only and isn't a substitute for personalised health advice. If you have any of the emergency symptoms listed above, call 000 or go to your nearest emergency department immediately.
References
World Health Organization. WHO Guidelines on Basic Training and Safety in Chiropractic. Geneva: WHO; 2005.
Rushton A, Carlesso LC, Flynn T, et al. International Framework for Examination of the Cervical Region for Potential of Vascular Pathologies of the Neck Prior to Orthopaedic Manual Therapy (OMT) Intervention. International IFOMPT Cervical Framework; 2020.