Which condition is a contraindication to high-velocity cervical manipulation besides vertebral artery insufficiency?

Which condition is a contraindication to high-velocity cervical manipulation besides vertebral artery insufficiency?

• A. Acute fracture
• B. Chronic neck pain without neurological signs
• C. Tennis elbow
• D. Knee osteoarthritis

Answer: (A)

The key idea is that rapid forces on the cervical spine require intact bone and stable alignment. An acute fracture means the bone is broken and potentially unstable. A high-velocity thrust could displace fracture fragments, worsen misalignment, or injure the spinal cord or surrounding structures. Because stability can’t be guaranteed with an acute fracture, high-velocity cervical manipulation is contraindicated until imaging confirms the fracture is not present or has adequately stabilized. In this scenario, the safest approach is immobilization and appropriate imaging first, then consider other therapies if indicated.

The key idea is that rapid forces on the cervical spine require intact bone and stable alignment. An acute fracture means the bone is broken and potentially unstable. A high-velocity thrust could displace fracture fragments, worsen misalignment, or injure the spinal cord or surrounding structures. Because stability can’t be guaranteed with an acute fracture, high-velocity cervical manipulation is contraindicated until imaging confirms the fracture is not present or has adequately stabilized. In this scenario, the safest approach is immobilization and appropriate imaging first, then consider other therapies if indicated.