Spinal manipulation contraindications. Clinical case

Spinal manipulation contraindications

A woman about 60 years old. Complains of severe pain of varying intensity in the cervical, thoracic and lumbar spine, headaches, frequent numbness of the hands. Back pain is also present at night. It is provoked by some postures and even small unloaded movements.
The patient came with the words "Break me, break me!", meaning to the bony manipulations. She was not examined and did not have any consultations with related specialists. The patient came for the spinal manipulation, but has obvious contraindications.

Objective examination: Patient is labile, contacts are difficult, she is always talking about pains, family problems, how she is always sitting, smoking and crying. Movement in all parts of the spine is limited and painful. Palpation of the spinous processes of the vertebrae is also painful in all parts, 8-9 points out of 10 with slight springing.

Diagnosis and treatment: due to obvious signs of serious psychological and possible inflammatory disorders, consultations with the corresponding specialists were recommended: psychologist, neurologist, orthopedist and rheumatologist. No treatment was given.
The patient would not have passed this basic quick test.

The results of the recommendations are unknown, but it can be assumed that due to her low educational level, psychological instability, and concomitant poverty, no consultations and examinations were done.

Absolute and relative contraindications to spinal manipulation. Conclusions.

The case stands out from the successful and sometimes very sophisticated ones described here, but it is no less important. And is really appropriate to illustrate a fairly common type of patient for whom chiropractic techniques are either contraindicated or, like various soft and indirect techniques, not indicated, at least now.
And a subtype of such patients, who themselves say that they need to be crunched or set, etc. Here we must remember that the doctor should not go on the patient's advice, but make informed decisions, taking into account all the information from the anamnesis, objective examination, and clinical signs. With special attention to the so-called red and yellow flags - absolute and relative contraindications to spinal manipulation. The first are signs of possible serious diseases, the second are signs of unfavorable treatment prognosis (including numerous negative psychosocial factors).
P.S. Still, despite modern trends in some countries, we must remember that the goal of the doctor is to treat the patient, not to provide services to the client, who, as you know, is always right:)