Chiropractic Contraindications: Who Should Not Be Adjusted

A contraindication is a reason not to use a particular treatment, or to change it, because it could cause harm. For chiropractic, the main ones are conditions that weaken bone or blood vessels, conditions that press on the spinal cord or nerves, and recent serious injury. In these cases, high-velocity spinal manipulation (the quick “crack”) is avoided or delayed until a doctor has assessed you. A good chiropractor screens for all of this before touching your spine. This guide explains what those conditions are, why they matter, and what to tell us before your first visit.

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TL;DR

Osteoporosis, inflammatory spine conditions, spinal cord compression, bleeding disorders, blood thinners, recent fractures and unexplained neurological symptoms are the most commonly listed reasons to avoid or delay spinal manipulation.
The neck carries more risk than the lower back, so the neck needs the most careful screening.
Loss of bladder or bowel control, new leg weakness, fever with severe back pain, or a history of cancer with new pain call for a doctor or the Emergency Department, not an adjustment.
Being told that manipulation is unsuitable does not mean you cannot get care. Gentler techniques, exercise-based care and medical treatment all exist.
Tell your chiropractor about every diagnosis, medication and recent injury. It is the single most useful thing you can do for your safety.

What “contraindicated” actually means
Conditions that need medical assessment first
Medications and conditions that change the risk
The neck needs more caution than the lower back
Spinal stenosis, disc problems and scoliosis
Warning signs: see a doctor before an adjustment
What to tell your chiropractor before treatment
If a thrust adjustment is not right for you
Book a screening before any treatment
FAQ
Sources

What “contraindicated” actually means

There are two kinds. An absolute contraindication means a technique should not be used at all, for example a high-velocity thrust over a spine segment that is unstable. A relative contraindication means the technique may still be possible, but only after assessment, with modification, or with your doctor’s input.

This matters because most people searching this topic are not asking whether chiropractic is dangerous. They are asking whether they are a suitable candidate. For the large majority of adults with mechanical back, neck or posture complaints, the answer after a proper screening is yes. For a minority, the answer is “not yet” or “not with that technique.” The Chiropractic Association (Singapore) has cited a 2023 analysis of 960,140 spinal manipulation sessions in Hong Kong that concluded serious adverse events are very rare. Screening is a large part of why that can hold true. For a broader look at the topic, see our guide on whether chiropractic care is safe.

Conditions that need medical assessment first

No single worldwide list exists, but the professional sources agree on a core set. Here is how they group.

Bone-weakening conditions

Osteoporosis and osteopenia top almost every list. The Merck Manual states that spinal manipulation is not recommended for patients with osteoporosis. Arthritis UK also lists osteoporosis among the conditions where manipulative therapies should not be used. A Singapore medical specialist quoted by CNA pointed to fractures in osteoporotic patients as one of the adverse effects that people with underlying conditions risk.

If you have had a bone density scan, the numbers on it are worth understanding before you book. A resource on how a spine T-score can be misleading explains why a single reading may not tell the whole story, which is one more reason to share your scan results and your doctor’s follow-up plan with your chiropractor.

Inflammatory and infective spine conditions

Rheumatoid arthritis and ankylosing spondylitis can loosen ligaments and thin bone around the spine. Dr Chen Haobin, a Singapore-based clinician quoted by HealthXchange, advised that people with osteoporosis, rheumatoid arthritis or ankylosing spondylitis should avoid external neck manipulation. Arthritis UK likewise lists malignant or inflammatory spine conditions.

Tumors, infection and cancer history

The Australian Physiotherapy Association’s factsheet on high-velocity manipulation lists malignancy, infective arthritis, advanced diabetes, connective tissue disease such as Ehlers-Danlos syndrome, and previous spinal surgery among its contraindications. If you have a history of cancer and new back pain, SingHealth advises going to the Emergency Department for that combination, because the pain may not be mechanical.

Blood vessel problems

The neck is where arteries run close to the spine. The same APA factsheet names suspected cervical arterial dissection and vertebrobasilar insufficiency as contraindications. The Singapore specialist quoted by CNA mentioned strokes in cases of significant carotid artery stenosis. Sudden severe neck pain with a new headache, dizziness, double vision or slurred speech is an emergency in its own right, not a reason to book a session.

Neurological symptoms

Numbness in the limbs, loss of strength in an arm or leg, and a worsening neurological picture are red flags. The Merck Manual advises against manipulation in patients with symptoms of neuropathy such as paresthesias or loss of limb strength. These symptoms need a doctor’s diagnosis first, usually with imaging.

Recent trauma

Arthritis UK lists recent fractures or dislocations. The APA factsheet lists recent major trauma and segmental instability. After a fall, a road accident or a sports collision, a fracture or ligament injury needs to be ruled out before anyone applies a thrust to the area.

Medications and conditions that change the risk

The medicines you take can matter as much as your diagnosis.

Blood thinners. Arthritis UK says manipulative therapies should not be used by people taking anti-clotting or blood-thinning drugs such as warfarin or heparin. The APA factsheet extends this to bleeding disorders such as haemophilia and to long-term steroid use.

Large-population evidence. A 2017 scoping review in Chiropractic & Manual Therapies described a retrospective survey of 6,669,603 patients aged 66 to 99. It found that the likelihood of injury after chiropractic care was higher in patients with a chronic coagulation defect, inflammatory spondylopathy, osteoporosis, aortic aneurysm and dissection, or long-term anticoagulant use. That is a useful reminder for seniors: age alone is not the issue, but age often brings the conditions that are.

Do not stop medication on your own. If you take a blood thinner or steroid, keep taking it as prescribed. Tell your chiropractor and let your doctor guide any decision about treatment.

The neck needs more caution than the lower back

Not all adjustments carry the same risk. The CNA specialist noted that manipulating the neck tends to pose more health risks than the lower back. Dr Chen explained that passive neck manipulation can push the joint beyond safe limits, particularly in the elderly and people with osteoporosis.

The APA factsheet describes how careful clinicians work in the neck: use minimum force, avoid end-range positions, avoid rotation thrusts in the upper neck, and stop if symptoms are not settling or are getting worse during testing. In practice, that means a thorough history, a physical and neurological examination, and a willingness to change the plan on the day. Many techniques do not involve a thrust at all, so a neck complaint does not automatically mean a rapid twist.

Spinal stenosis, disc problems and scoliosis

These are three of the most common questions we hear, and each has a nuance.

Spinal stenosis. It is not a simple yes or no. In an expert panel study, all clinical scenarios with major neurological findings, and some scenarios involving imaging findings of spinal stenosis, were rated inappropriate for both mobilization and manipulation. The absence of those imaging findings and no previous laminectomy were the most important characteristics predicting an “appropriate” rating. So the answer depends on your imaging, your symptoms and your surgical history. SGH notes that non-surgical management of spinal stenosis includes physiotherapy, anti-inflammatory medication and injections, and that staying active matters.

Disc problems and sciatica. Severe or painful disc pathology appears on safety lists, yet many people with leg pain from the lower back are managed conservatively. What decides it is the severity and whether there is any neurological loss. If you have leg pain, our page on sciatica treatment explains how we approach it, and the screening comes first.

Scoliosis. A Singapore specialist told CNA that in scoliosis, back manipulation does not stop progression and may delay correct treatment, and that patients should seek medical advice first. We agree that a medical diagnosis and monitoring come first, especially in growing adolescents. Our page on scoliosis care sets out what chiropractic can and cannot be asked to do.

Pregnancy and children. These are not on the lists above, but they call for modified techniques and their own screening. See our articles on chiropractic care during pregnancy and pediatric chiropractic care.

Warning signs: see a doctor before an adjustment

Some symptoms mean the problem may not be mechanical. HealthHub advises consulting a doctor urgently for low back pain with a change in urinary or bowel control, or numbness or tingling over the legs or private region. It advises seeing a doctor early for unexplained weight loss, fever or night sweats, pain that does not improve with rest or pain medication, swelling or redness in multiple joints, or loss of function such as unsteady walking.

SingHealth’s list for the Emergency Department includes back pain with loss of bladder or bowel control, new leg weakness or numbness, high fever with shivering or a stiff neck, or severe pain unresponsive to pain medication. It also includes a history of cancer, osteoporosis or recent surgery alongside back pain.

A simple rule: if your symptoms are on these lists, go to a doctor first. If you are unsure which route fits, read our guide on when to see a doctor versus a chiropractor.

What to tell your chiropractor before treatment

The 2017 scoping review concluded that assessing for signs or symptoms of pre-existing pathology is important because serious adverse events can result from them, and that patients should be informed of risks during consent. A CNA-quoted Singapore specialist added that often the medical condition is not fully known to either the patient or the chiropractor. So the more you share, the better the screening works.

Bring or mention:

Diagnoses: osteoporosis or osteopenia, arthritis of any kind, cancer, diabetes, heart or blood vessel disease, connective tissue conditions.
Medications: blood thinners, steroids, anything for bone density, and over-the-counter pain relief you take regularly.
Surgery and injuries: any spinal surgery, fractures, falls or accidents, even older ones.
Imaging and reports: X-rays, MRI or bone density scans, if you have them.
Symptoms beyond the sore area: numbness, tingling, weakness, dizziness, headaches that are new, changes in bladder or bowel function, fevers, unexplained weight loss.
Pregnancy, or the possibility of it.

We go through this at the start of a first chiropractic visit, before any hands-on treatment.

Our perspective

Contraindications are not a criticism of chiropractic. They are the reason it can be practiced responsibly. At Everton Chiropractic, we practice evidence-informed care, which means the first job in any visit is deciding whether an adjustment is right for you, and if so, which technique.

We would rather spend extra time on your history and examination than rush to a quick crack. Our approach is built around long-term movement and function, and that starts with knowing exactly who is on the table. If your findings call for a doctor’s opinion or imaging, we will say so plainly and work alongside that plan.

Many of our patients are seniors who want to stay independent, and many are office workers or athletes with ordinary mechanical problems. For both groups, personalized care means that the same complaint can be handled differently depending on bone health, medications and history. That is how we aim to keep care safe and effective.

Aman

If a thrust adjustment is not right for you

A contraindication to one technique is not the end of care. The options below come from Singapore healthcare sources.

Physiotherapist-directed exercise. A Singapore Medical Journal review describes physiotherapist-directed exercises, including the McKenzie method and strengthening, as cost-effective for acute low back pain.
Hospital physiotherapy and rehabilitation. SGH lists manual therapy, posture education, heat therapy, traction, electrical stimulation and therapeutic exercise as physiotherapy options for neck and back pain.
Staying active. HealthHub notes that exercise can help relieve low back pain, starting with simple options like walking or aqua aerobics.
Medical pathways. For chronic pain, Singapore hospitals describe multidisciplinary management combining physical, psychological and social support, with injections or surgery for selected cases when conservative care is not enough.

The right choice depends on your diagnosis. A chiropractor who screens carefully can also help you decide when you need a referral to your doctor and when gentler, non-thrust work is reasonable.

Book a screening before any treatment

If you are unsure whether you are a suitable candidate, the safest step is a proper chiropractic consultation. We take your history, review any scans and examine you before recommending anything. We do not publish a price for consultations on our site, so contact the clinic for current details.

Whether your concern is lower back pain, neck stiffness, posture correction or recovery from a sports injury, the plan is tailored to your lifestyle and goals, and adjusted to your health history. You can also start from our home page to see what we treat.

FAQ

Can a chiropractor help with spinal stenosis?

Sometimes, but it depends on your imaging, symptoms and surgical history. An expert panel rated scenarios with major neurological findings, and some with imaging findings of stenosis, as inappropriate for manipulation. Your chiropractor should review your scans, and your doctor should be involved if you have leg weakness or numbness.

Is it safe to get adjusted if I have osteoporosis?

Major sources, including the Merck Manual and Arthritis UK, advise against spinal manipulation for people with osteoporosis. Tell your chiropractor about the diagnosis and bring your bone density results. Care for you should be guided by your doctor, with thrust techniques avoided.

Can I see a chiropractor while taking blood thinners?

Arthritis UK says manipulative therapies should not be used by people taking blood-thinning drugs such as warfarin or heparin. Keep taking your medication as prescribed, and ask your prescribing doctor before any hands-on spinal treatment. Always tell your chiropractor about it first.

What should I do if I feel unwell after an adjustment?

Mild soreness or stiffness is a commonly reported short-term effect. New numbness, weakness, loss of bladder or bowel control, severe headache, dizziness or speech changes are not, and you should seek urgent medical care. Let your chiropractor know too, so the technique is not repeated.