Introduction to Contraindications in Chiropractic Care
Chiropractic care is widely used to manage musculoskeletal pain, improve joint mobility, and support overall wellness. While most patients are eligible for treatment, there are specific cases where chiropractic intervention may not be appropriate. These situations are known as contraindications.
Book your appointmentMedically reviewed by Tanesa Mohan (MChiro LRCC). Last update: 30 January 2026.
A contraindication is a clinical exclusion criterion — a medical condition, symptom, or risk factor that signals that manual therapy or spinal manipulation may cause harm rather than benefit. In chiropractic, this typically involves scenarios where applying force to the spine or musculoskeletal system may aggravate an existing problem, trigger new symptoms, or delay more urgent medical care.
Understanding contraindications is essential not just for chiropractors, but also for patients seeking care. If you’ve ever asked, “Can anyone receive chiropractic treatment?”, the honest answer is: not always. Identifying contraindications allows clinicians to apply evidence-based judgment, protecting patients while tailoring care to individual needs.
At Freedom Clinics, we prioritise patient safety in every interaction. Our chiropractors are trained to identify both absolute contraindications (where treatment is strictly avoided) and relative contraindications (where modified care may still be appropriate). This process includes detailed clinical screening, risk assessment, and — when necessary — referral to other healthcare professionals.
By recognising contraindications early, we ensure that every patient receives the right treatment, at the right time — or is safely directed to the appropriate provider.
Categories of Chiropractic Contraindications
When considering chiropractic care, it’s essential to understand the types of medical conditions that may increase risk during treatment. Chiropractors classify these risks into two major categories:
- Absolute contraindications – where treatment is strictly avoided
- Relative contraindications – where treatment may proceed with clinical modifications
This classification helps guide safe clinical decision-making, ensures patient-specific care plans, and upholds regulatory safety standards.
Absolute Contraindications to Chiropractic Care
Absolute contraindications are medical conditions where chiropractic intervention poses a high probability of harm, and therefore, treatment is strictly avoided.
If any of these conditions are present, spinal manipulation, mobilisation, or manual therapy is contraindicated and not performed.
Common absolute contraindications include:
- Spinal fractures – structural instability that may worsen with manual adjustments
- Spinal malignancy – cancer involving the vertebrae or spinal tissues
- Spinal infections – such as osteomyelitis or discitis
- Vertebral artery dissection – a serious vascular injury associated with increased risk of stroke, particularly following cervical manipulation
- Cauda equina syndrome – an emergency involving lower spinal nerve compression
- Severe osteoporosis with fragility fractures – where spinal adjustments could result in compression or collapse
- Unstable spinal cord compression – posing neurological risk
- Progressive neurological deficits – indicating worsening spinal or neural pathology
These conditions are recognised across international guidelines as clinical exclusions to chiropractic care. Attempting manual therapy in these situations can lead to neurological compromise, vascular injury, or irreversible harm.
Freedom Clinics follows evidence-based protocols to identify these absolute contraindications early and refers patients for urgent medical care where necessary.
Relative Contraindications: When Treatment Requires Modification
Relative contraindications are conditions where chiropractic treatment may still be possible, but only after a risk-benefit evaluation and careful technique adjustment. Chiropractors must modify their approach or collaborate with other healthcare professionals when these conditions are present.
Situations requiring modified care include:
- Mild to moderate osteoporosis – without active fractures; requires low-force techniques
- Use of anticoagulants – such as warfarin or apixaban; increases bleeding risk
- Pregnancy (especially third trimester) – necessitates gentler approaches and specific positioning
- Post-surgical spine – where surgical hardware or fusion may limit movement or increase risk
- Joint hypermobility syndromes – such as Ehlers-Danlos syndrome; high risk of joint instability
- Stable disc herniation – with minimal neurological signs; may be treated with soft tissue therapy or mobilisation
- Severe osteoarthritis – involving joint degeneration; requires technique adaptation
In these cases, Freedom Clinics may use:
- Low-force chiropractic adjustments
- Instrument-assisted manipulation
- Referral coordination with GPs, orthopaedic specialists, or radiologists
Relative contraindications don’t automatically rule out care — but they do demand careful modification and professional oversight.
Red Flag Symptoms to Screen Before Chiropractic Care
Definition: In chiropractic clinical screening, red flag symptoms are early-warning indicators of potentially serious medical conditions that may contraindicate chiropractic treatment. These include signs of spinal malignancy, vascular compromise, or neurological compression — all of which require urgent medical evaluation before manual therapy can proceed.
At Freedom Clinics, we incorporate red flag screening into every initial consultation to ensure safe, evidence-based care. While these symptoms do not always indicate a diagnosis, they highlight the need for further investigation, diagnostic imaging, or specialist referral.
Recognising red flags early protects patients from harm and supports accurate clinical decision-making, reinforcing our commitment to ethical practice and multidisciplinary safety protocols.
What Are Red Flag Symptoms?
Red flag symptoms are clinical warning signs that accompany back, neck, or neurological pain but suggest an underlying systemic or structural problem. These symptoms may signal the presence of:
- Absolute contraindications (e.g., vertebral artery dissection, cauda equina syndrome)
- Relative contraindications requiring diagnostic clarity before treatment
- Referral triggers for imaging, specialist evaluation, or emergency care
At Freedom Clinics, no patient begins chiropractic treatment until we’re confident no red flags are present.
Red Flag Symptoms We Screen For
| Symptom | Associated Risk | Clinical Response |
|---|---|---|
| Sudden neck pain with dizziness or vertigo | May indicate vertebral artery dissection or cervical vascular injury | Referral for vascular imaging before cervical manipulation |
| Blurred vision, slurred speech, or facial droop | Suggestive of stroke or transient ischemic attack (TIA) | Emergency medical referral |
| Persistent fever or unexplained weight loss | Could suggest spinal malignancy or systemic infection | Postpone care and refer for MRI |
| Loss of bladder or bowel control | Indicates possible cauda equina syndrome | Immediate A&E referral |
| Progressive limb weakness or numbness | May reflect spinal cord compression or neurological deficit | Full neuro-orthopaedic screening |
| Recent trauma or significant fall | Risk of vertebral fracture, particularly in older adults | Require imaging prior to any spinal manipulation |
| Night pain unrelieved by rest | Could indicate bone tumour or vertebral infection | Delay care, refer to imaging or oncology pathway |
These symptoms are recognised by regulatory bodies like the General Chiropractic Council (GCC) and NICE as critical screening criteria prior to any spinal adjustment or manual intervention.
What Happens If a Red Flag Is Detected?
If any red flag symptoms are identified during your chiropractic assessment, Freedom Clinics follows a strict referral and clearance process:
- Record clinical history and symptom onset
- Conduct orthopaedic and neurological examinations
- Pause treatment and inform patient
- Refer to GP, emergency services, or specialists for diagnostics
- Resume care only after medical clearance and imaging review
This approach ensures that chiropractic treatment remains safe, appropriate, and fully integrated within your broader healthcare plan.
Red flag detection is more than a checklist — it’s a core part of our duty of care to every patient we serve.
Risk-Benefit Analysis in Chiropractic Decision-Making
At Freedom Clinics, every treatment decision begins with a formal risk-benefit analysis — a clinical evaluation designed to determine whether the therapeutic potential of chiropractic care outweighs any safety concerns.
This is especially important when patients present with relative contraindications, take medications like anticoagulants, or have existing conditions such as osteoporosis, disc herniation, or post-surgical spine changes.
A chiropractic risk-benefit analysis involves assessing:
- The potential benefits of treatment — such as pain relief, enhanced mobility, and functional recovery
- Against the likelihood of adverse events, treatment intolerance, or condition aggravation
This ensures that our care is safe, evidence-based, and tailored to each patient’s medical profile and personal goals.
How We Assess Risk in Chiropractic Practice
To determine if spinal manipulation or manual therapy is appropriate, our chiropractors evaluate:
- Comorbidities such as cardiovascular disease, bone fragility, or inflammatory disorders
- Current medications including anticoagulants or immunosuppressants
- Neurological examination results indicating nerve involvement or spinal cord risk
- Orthopaedic testing for joint integrity and musculoskeletal stability
- Imaging reports (e.g., X-ray, MRI) showing degenerative changes or surgical implants
- Patient preference, tolerance, and values — forming the basis for shared clinical decision-making
This comprehensive assessment aligns with UK chiropractic safety guidelines, upholding our duty of care under General Chiropractic Council (GCC) standards.
Clinical Examples of Risk-Benefit Outcomes
| Clinical Factor | Risk Concern | Chiropractic Adaptation |
|---|---|---|
| Mild osteoporosis | Risk of fracture from HVLA (high-velocity low-amplitude) adjustments | Apply low-force chiropractic techniques like the Activator Method |
| Use of anticoagulants (e.g., warfarin) | Bruising or bleeding from deep pressure | Modify to instrument-assisted adjustments and avoid aggressive techniques |
| Post-spinal fusion surgery | Risk of damaging adjacent structures or hardware | Mobilise above or below the surgical site and refer to surgical reports |
| Third trimester pregnancy | Ligament laxity and abdominal sensitivity | Use side-lying positioning, avoid lumbar thrusts |
| Stable disc herniation | Flare-ups or increased nerve root compression | Focus on non-thrust decompression therapy and soft tissue work |
Each case is assessed individually — we do not generalise treatment protocols.
Risk-Aware Chiropractic Techniques
For patients where risks are elevated but manageable, we use alternative approaches proven to be safe and effective, including:
- Activator Method® – delivers targeted, low-force impulses via a handheld tool
- Drop-table techniques – utilise gravity-assisted, segmental mobilisation
- Soft tissue therapies – address pain and mobility without stressing joints
- Myofascial release and neuromuscular re-education – improve muscular support and reduce neurological load
These methods allow chiropractors to provide meaningful care while reducing mechanical load on the spine, supporting high-risk patients safely and confidently.
Why Risk-Benefit Analysis Matters
Risk-benefit analysis is not a formality — it’s a safeguard.
It ensures that:
- Contraindications are not overlooked
- Treatment is adapted to each patient’s condition
- Informed consent is truly informed
- Clinical outcomes improve while minimising adverse events
At Freedom Clinics, we deliver care with both clinical accuracy and human insight — helping patients make informed choices about chiropractic treatment without compromising on safety or effectiveness.
Informed Consent and Patient Communication in Chiropractic Care
At Freedom Clinics, we believe that informed consent is the foundation of ethical and effective chiropractic care. It ensures that patients are not just recipients of treatment — but active, informed participants in their healthcare journey.
Informed consent means that each patient clearly understands:
- What the proposed chiropractic treatments involve
- The benefits and goals of care
- The potential risks, including rare side effects of manual therapy
- Available alternatives, both within and outside chiropractic modalities
- Their right to decline or modify treatment at any stage
We treat consent as a conversation, not a checkbox — and that conversation is ongoing.
What Our Informed Consent Process Includes
Our chiropractors follow the standards set by the General Chiropractic Council (GCC) and adopt protocols rooted in clinical communication ethics and shared decision-making frameworks.
Each informed consent session includes:
- A clear explanation of techniques such as spinal manipulation, mobilisation, or soft tissue therapy
- Disclosure of possible complications — from post-treatment soreness to rarer neurological symptoms
- Discussion of any relative contraindications identified in the patient’s history or imaging
- Reassurance that all care is voluntary, and consent can be withdrawn at any time
- Documentation of verbal agreement and any expressed preferences or concerns
This process ensures that consent is genuine, documented, and tailored to individual needs and understanding.
Dynamic Consent as a Continuous Process
Informed consent is not static. It evolves alongside the patient’s condition, treatment options, and preferences.
Scenarios where dynamic consent is reapplied include:
- Introduction of new therapeutic techniques, such as the Activator Method or spinal decompression
- Discovery of new risk factors or changes in diagnosis following imaging
- Changes in treatment goals or symptom profile
- Reassessment of comfort with certain interventions (e.g. declining cervical manipulation)
This ensures our approach respects patient autonomy and adapts to new clinical insights without compromising safety or trust.
We re-consent when treatment changes — because your voice matters at every stage.
Building Trust Through Open Communication
Beyond formal consent, we prioritise clear, honest, and jargon-free communication:
- We explain every technique before using it
- We invite questions and provide understandable answers
- We respect all treatment refusals without pressure
- We use visual aids and demonstrations when helpful
- We document every step of the dialogue — from initial discussion to changes in plan
This approach ensures that trust, transparency, and collaborative decision-making remain central to the patient experience.
Consent is part of the care — not just the paperwork.
This approach ensures that informed consent remains central to safe, ethical chiropractic care at Freedom Clinics.
Common Misconceptions About Chiropractic Contraindications
Many individuals avoid chiropractic care due to misunderstandings about contraindications. At Freedom Clinics, we often clarify that not all health conditions are absolute barriers to treatment. Most clinical concerns can be addressed through screening, modification of technique, or collaborative care planning.
This section dispels the most common myths and outlines what modern, evidence-informed chiropractic care actually looks like in high-safety environments.
Understanding the difference between a true contraindication and a treatable condition can open the door to safe, effective care.
Misconception 1: “Chiropractic isn’t safe for anyone with back pain.”
Fact: Chiropractic care is designed to address most forms of mechanical back pain, including joint dysfunction and muscular imbalance. Only cases involving serious spinal pathology — like tumours, fractures, or infections — would qualify as absolute contraindications.
According to systematic review evidence from the Cochrane Collaboration, spinal manipulative therapy (SMT) — commonly used by chiropractors — appears to be as effective as other recommended therapies for chronic non-specific low back pain when it is mechanical in nature (i.e., not caused by serious underlying pathology).
If red flag symptoms are present, chiropractors refer patients for urgent imaging or medical care before proceeding.
Misconception 2: “If you have osteoporosis, you can’t see a chiropractor.”
Fact: Osteoporosis does not automatically exclude you from chiropractic treatment. Instead, chiropractors adjust their approach using:
- Low-force techniques such as the Activator Method®
- Drop-table adjustments to minimise compression
- Soft tissue therapy for support and flexibility
Patients with mild to moderate bone density loss often receive safe, adapted care after screening and clinical risk stratification.
Misconception 3: “Chiropractic adjustments can cause strokes.”
Fact: This myth is based on outdated or misinterpreted research. The concern relates to a rare vascular event known as vertebral artery dissection (VAD). However:
- There’s no proven causal relationship between chiropractic cervical manipulation and VAD
- Many people experiencing early VAD symptoms seek chiropractic help, creating a reverse causality illusion
- Chiropractors at Freedom Clinics follow strict vascular screening protocols to ensure patient safety
Patient safety is always the priority — and screening protects against vascular risks.
Misconception 4: “Once you start chiropractic, you can’t stop.”
Fact: This is a common myth with no clinical basis. At Freedom Clinics:
- Treatment plans are based on individual goals and outcomes
- You are free to pause, stop, or change your plan at any time
- We promote self-management, posture training, and mobility exercises so that you stay in control
Our aim is to empower patients — not make them dependent.
Misconception 5: “If you’ve had spinal surgery, chiropractic is off limits.”
Fact: Having had spinal surgery (e.g., spinal fusion, laminectomy, or discectomy) does not automatically disqualify you from chiropractic care. Instead, our approach includes:
- Thorough review of surgical reports and imaging
- Avoidance of direct manipulation near surgical hardware
- Use of mobilisation techniques, instrument-assisted adjustments, and adjacent-segment therapy
Chiropractic care is adapted to your spine’s post-surgical profile — never delivered generically.
This helps patients better understand when back pain treatment can be delivered safely and when further investigation is required.
Frequently Asked Questions About Chiropractic Contraindications
Chiropractic contraindications are widely misunderstood. Below, we answer the most common questions patients ask about conditions, procedures, and risks related to manual therapy, spinal manipulation, and chiropractic care in complex clinical scenarios. These answers are based on both current evidence and the safety-first protocols we follow at Freedom Clinics.
Q1: Can I get chiropractic care if I have a herniated disc?
Yes — with clinical screening and modified techniques. A herniated disc (also called a “slipped disc” or “disc bulge”) is not an automatic exclusion for chiropractic care.
At Freedom Clinics, we assess:
- Nerve compression signs (e.g., weakness, numbness)
- Imaging or MRI findings
- Pain pattern and symptom stage
Treatment may include:
- Spinal decompression therapy
- Gentle mobilisations instead of high-velocity thrusts
- Myofascial release and postural rehabilitation
If signs of cauda equina syndrome appear, we refer immediately for emergency care.
Q2: What are the true contraindications to chiropractic treatment?
Absolute contraindications are rare but critical to identify. Chiropractors do not treat conditions that may be worsened by spinal manipulation, such as:
- Spinal malignancy or cancer with vertebral involvement
- Active spinal infection (e.g., discitis, osteomyelitis)
- Unstable spinal fractures
- Advanced osteoporosis with high fracture risk
- Neurological red flags, including acute cauda equina syndrome
All Freedom Clinics chiropractors conduct detailed clinical histories, orthopaedic and neurological exams, and refer when indicated.
Q3: Is chiropractic care safe during pregnancy?
Yes — when techniques are adapted to gestational stage. Chiropractic care in pregnancy helps with back pain, pelvic alignment, and postural support.
We use:
- Pregnancy-adjustable tables
- Side-lying or pillow-supported positioning
- Avoidance of lumbar thrust techniques in later trimesters
- Gentle manual therapies for comfort and mobility
Contraindications during pregnancy (e.g., placenta previa, preeclampsia) are always screened for in advance.
Q4: Can I get adjusted if I’m taking blood thinners?
Yes, but care is modified. If you take anticoagulant medications (e.g., warfarin, apixaban), you may have a higher risk of bruising or bleeding from deep pressure techniques.
We adapt treatment by:
- Using instrument-assisted adjustments
- Avoiding deep soft tissue work
- Prioritising gentle mobilisation and rehabilitation exercises
We also coordinate with your GP if needed and document all adaptations.
Q5: What if I’ve had spinal surgery?
Chiropractic care is still possible — with surgical awareness. Many patients with prior spinal fusion, laminectomy, or discectomy benefit from non-invasive therapies.
Our post-surgical care includes:
- Review of imaging and surgical reports
- Avoiding adjustments near hardware
- Use of adjacent segment mobilisation, soft tissue release, and core stability protocols
Treatment is always informed by your surgical history, goals, and physical limitations.
Q6: Will the chiropractor tell me if I’m not suitable for treatment?
Absolutely. Every patient at Freedom Clinics receives a comprehensive:
- Medical history and medication review
- Orthopaedic and neurological screen
- Contraindication risk assessment
- Risk-benefit analysis for all proposed techniques
If we determine that chiropractic care isn’t appropriate, we will explain why and offer referral options.
Informed consent and clinical transparency are at the core of our care model.
These considerations are especially important for patients managing disc injury and nerve compression.
Next Steps: Safe Chiropractic Care with Confidence
Understanding chiropractic contraindications is the first step toward receiving safe, effective, and personalised treatment. At Freedom Clinics, our priority is to deliver evidence-based chiropractic care that is fully aligned with each patient’s medical history, health status, and treatment goals.
Whether you’re managing a chronic condition or simply seeking spinal support, we’re here to guide you through every step — from clinical screening to informed consent and beyond.
We Begin with Safety and Clinical Insight
Every new patient journey starts with a detailed assessment to ensure that chiropractic care is safe and appropriate.
Our intake process includes:
- Comprehensive medical history and contraindication screening
- Orthopaedic, postural, and neurological examination
- Identification of absolute and relative contraindications
- Personalised risk-benefit analysis
- A formal, transparent informed consent process
This structure ensures that treatment is never generic. We make clinical decisions based on safety criteria, therapeutic goals, and patient preferences — not assumptions.
Ethical, Regulated, and Adaptable Chiropractic Care
Freedom Clinics adheres to all standards set by the General Chiropractic Council (GCC) and follows protocols aligned with the latest UK clinical guidelines for:
- Contraindication identification
- Technique modification (e.g., low-force techniques, Activator Method®)
- Referral protocols for non-suitable cases
- Documentation of all informed consent, changes in care, and risk disclosures
We routinely adapt care for patients with:
- Osteoporosis
- Disc herniations
- Post-surgical spinal conditions
- Pregnancy
- Use of anticoagulant medication
- Complex health profiles
Every adjustment, mobilisation, or hands-on therapy is performed with full regard to your health status and desired outcomes.
Explore Related Chiropractic Services
To understand more about your care options, explore our related services:
- What Is Chiropractic? – What conditions chiropractic care treats and how it works.
- Spinal Decompression Therapy – Targeted care for disc injuries and nerve compression.
- Low-Force Techniques – Gentle chiropractic methods for sensitive or high-risk patients.
- Postural & Rehabilitative Therapy – Strengthen and stabilise through personalised movement therapy.
- Meet Our Chiropractors – Discover our team’s qualifications and patient-centred approach.
These services support safe, versatile treatment plans — even when contraindications apply.
Book Your Consultation Today
Have questions about whether chiropractic is right for you? Our team is here to help. We’re committed to clarity, safety, and your complete confidence.
Freedom Clinics – Canary Wharf
Canada Place Shopping Mall
34 North Colonnade
London E14 5HX
Phone: 0203 197 9100
Email: canarywharf@freedomclinics.com
Opening Hours:
Mon–Fri: 7 am–8 pm
Sat & Sun: 10 am–4 pm
Take your next step toward safe, individualised chiropractic care — backed by clinical screening, expert insight, and a trusted name in spinal health.
This ensures your first chiropractic appointment begins with safety, clarity, and appropriate clinical screening.
Our Chiropractors
References
- Rubinstein, S. M., van Middelkoop, M., Assendelft, W. J. J., de Boer, M. R., & van Tulder, M. W. (2019). Benefits and harms of spinal manipulative therapy for the treatment of chronic low-back pain: systematic review and meta-analysis. BMJ, 364, l689. https://doi.org/10.1136/bmj.l689
