There is a standard of care to be followed that dictates the caution that must be exercised when administering medical spinal manipulation treatments.
The medical spinal manipulation can be chiropractic, osteopathic or rendered by other medical or non-medical persons all potentially ending in disastrous results. A definitive diagnosis and prognosis must be reached prior to treatment through a comprehensive history evaluation and examination. There is a systematic medical protocol that must be adhered to. This may even lead to radiological or imaging studies (MRI) prior to spinal manipulative treatment (SMT).
Most important in this discovery procedure is to determine if this patient is a candidate for spinal manipulative treatment (SMT). There symptoms may not be coming from spinal or pelvic misalignments. There spinal and or pelvic structures may not be in good structural condition to accept a manipulation procedure. There can be so many co-morbidity factors, such as congenital abnormalities, prior accidents, family histories and or cardiovascular susceptibilities that could end in death or stroke. These all must be ruled out prior to any treatment.
Please understand that this list is not meant to decrease the scope of what spinal manipulation treats, but to minimize injuries caused by spinal manipulative treatment (SMT).
These are some of the deadly sins, but the Dirty Dozen Contraindications are as follows:
1) Rule out extruded disc myelopathy and refer out for a MRI any suspicion of a protruded disc that may have any degree of an annular tear.
2) Rule out cardiovascular predisposing factors based on family history. Perform at least four vertebral artery insufficiency tests. Especially in cases of females, smokers, or users of steroid, birth control and blood thinner medications.
3) Check the structural integrity of the osseous integrity of the osseous structures prior to spinal manipulative treatment (SMT). For example: Osteoporotic and Osteoarthiritic Degenerative Disease.
4) Check for congenital abnormalities or space-occupying lesions. Yes, this can take time, but dig deep and be a good detective and refer for additional radiological and/or diagnostic imaging studies.
5) Check vital signs, especially temperature. There could be an infectious process developing.
6) Remember that visceral symptoms mimicking musculoskeletal symptoms may not warrant spinal manipulative treatment (SMT) and may require immediate medical or emergency room referral.
7) Do not perform spinal manipulative treatment (SMT) into an acute spastic muscle region.
Do not perform spinal manipulative treatment (SMT) into a spinal region with bilateral radicular extremity symptoms without an MRI. This is crucial if other orthopedic neurological tests are positive.
9) Spinal manipulative treatment (SMT) is not going to decrease the progressive destructive effects of congenital juvenile idiopathic scoliosis.
10) The “standard of care” is that if symptoms do not abate, even a little, within two weeks of care is to refer the patient and co-treat with another medical physician for further diagnostics and treatment.
11) Unbelievable as it may seem and quite obvious, do not perform spinal manipulative treatment (SMT) into surgical fusion hardware, especially if the surgery was recent.
12) Finally, remember “What can do good can do harm!” Activator and other mechanical spinal manipulative treatment (SMT) tools can do harm to a contraindicated patient.
Please note that this listing is not meant to decrease the scope of treatment possibilities that spinal manipulative treatment (SMT) can be of value to, but to point out the need to exercise caution when considering a patient for spinal manipulative treatment (SMT), which is certainly a medical procedure.
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