Table 9.

Possible Contraindications to Spinal or Other Joint Manipulation or Mobilization Procedures^15,100

System	Condition
Musculoskeletal	• Primary or metastatic bone tumors
	• Severe osteoporosis
	• Structural instability (such as unstable spondylolisthesis or postsurgical joint instability)
Inflammatory	• Osteomyelitis
	• Rheumatoid arthritis in the active systemic stage, or locally if acute inflammation or atlantoaxial instability is present
Neurologic	• Progressive or sudden neurologic deficit
	• Spinal cord tumors with neurological compromise or requiring medical intervention
Hematologic	• Any unstable bleeding disorders, including high-dose anticoagulant therapy
	• Unstable aortic aneurysm
Clinician attributes	Inadequate physical examination
	Inadequate manipulative training

Soft-tissue, instrument-assisted manipulation and low-velocity, low-amplitude mobilization procedures may be considered for application, as clinically indicated on an individual basis.^15,100