What is an absolute contraindication to high-velocity, low-amplitude spinal manipulation?

What is an absolute contraindication to high-velocity, low-amplitude spinal manipulation?

• A. Suspected spinal fracture or dislocation
• B. Acute low back strain
• C. Osteoarthritis of the spine without instability
• D. Degenerative disc disease without neurologic signs

Answer: (A)

The main idea is safety: HVLA spinal manipulation relies on a stable spine to deliver a rapid, controlled thrust without causing additional injury. If a fracture or dislocation is suspected, the structural integrity of the vertebrae is compromised. A high-velocity thrust in that situation could worsen the fracture, displace bone fragments, or damage the spinal cord or exiting nerves, leading to serious neurologic consequences. That risk makes suspected fracture or dislocation an absolute contraindication to HVLA. The other conditions listed are not absolute barriers. Acute low back strain is a soft-tissue issue where pain comes from muscle or ligament spasm; HVLA may still be considered with proper assessment and precautions. Osteoarthritis of the spine without instability and degenerative disc disease without neurologic signs reflect degenerative changes but, in the absence of instability or neurological involvement, HVLA can be performed cautiously or modified as needed. In clinical practice, red flags like fracture signs or neurological deficits prompt imaging or referral before any manipulation.

The main idea is safety: HVLA spinal manipulation relies on a stable spine to deliver a rapid, controlled thrust without causing additional injury. If a fracture or dislocation is suspected, the structural integrity of the vertebrae is compromised. A high-velocity thrust in that situation could worsen the fracture, displace bone fragments, or damage the spinal cord or exiting nerves, leading to serious neurologic consequences. That risk makes suspected fracture or dislocation an absolute contraindication to HVLA.

The other conditions listed are not absolute barriers. Acute low back strain is a soft-tissue issue where pain comes from muscle or ligament spasm; HVLA may still be considered with proper assessment and precautions. Osteoarthritis of the spine without instability and degenerative disc disease without neurologic signs reflect degenerative changes but, in the absence of instability or neurological involvement, HVLA can be performed cautiously or modified as needed. In clinical practice, red flags like fracture signs or neurological deficits prompt imaging or referral before any manipulation.