CONTRAINDICATIONS TO DIRECT VERTEBRAL MANIPULATION TECHNIQUES

Dr. Antonio Ruiz de Azúa Mercadal

Osteopathic doctor (Barcelona)

 

 

 

 

 

                           Publicado en la página web Amigos de Chiari en 2004.

 

The collagen inside the cartilage, the sinews and fascias form a very compact mesh that, under a moderate traction, has a certain capacity of recovery. The abrupt or repeated vertebral manipulations, if been they have not been well indicated, can produce collagen fatigue and impede their capacity of regenerating. Injuries in the vertebral ligament collagen can be the reason for vertebral instability.

Vertebral manipulations (direct vertebral techniques, of a great speed and small amplitude) formally are contraindicated in the skull-cervical malformations. Fast movements in an irregular vertebra can produce unpredictable displacements. There are soft tissues malformations associated to bon malformations, that is the reason why the vertebral biomechanics of this zone is unstable.

Vertebral manipulations with direct techniques must assemble the following conditions:

1º. The manipulation must be properly justified and indicated.

2º. There mustn’t be any alterations in the vertebral form that constitutes the joint to manipulate. For example, neither congenital malformations nor degenerative artropatias must be manipulated

3º. During manipulation is due to apply the smaller force possible and addressed it to a precise direction. The joint must be well located.

4º. The number of sessions must be as minimum as possible.

5º. It is necessary to consider the whole human body and the effects that a manipulation may produce on other structures.

The existence of diseases in patients with a marrow in tension introduces a new element to consider in the contraindications to the direct spine manipulations. Direct manipulations are based on classic joints physiology studies, in which tension inside the vertebral conduit is not valued (marrow, meninges, etc). We can consider spinal cord and meninges like an anatomic unit in tension. So, the spinal cord and its annexes could be considered as one of the structural elements of greater length in the human body. Therefore, patients with diseases in which this traction force or spinal cord tension is increased, the abrupt manipulations of the spine could be the cause of injuries (local or remote) in the marrow.

http://porloscaminosdelaosteopatia.blogspot.com.es/2012/11/myelopathie-apres-manipulation-sans.html

http://porloscaminosdelaosteopatia.blogspot.com.es/2012/11/mielopatias-postmanipulativas-sin.html

Between the contraindications in the joint vertebral manipulations we will emphasize:

a) Joint degenerations

1º Arthritic processes: inflammatory arthritis, ankilose espondiloarthritic, inflammatory diseases, Scheuermann disease etc.

2º Degenerative arthrosis processes with danger of injures or fractures of the bony proliferations, the cartilage or the joint capsule.

3º Vertebral instability.

4º Metabolic diseases that cause bone tissue fragility (endocrine diseases, osteoporosis, treatments with corticoid drugs, etc).

5º Recent traumatism, joint fractures, rips or luxations, and specially atlanto axoidea unstability (unstable apophysis).

6º Hyperlaxityc ligament, and specially atlanto axoidea unstability (unstable apophysis).

7º Surgical vertebral union

b) Congenital bone malformations

 1º Skull-cervical malformations: Arnold Chiari malformation,

syringomielia, basilar impression, etc.

2º "Filum terminale" fixation in the spina bifida (Tethered cord syndrome).

3º Spina bifida

4º Severe idiopathic scoliosis

5º Apophysis agenesys

6º Hemi vertebral column

7º Sacralitation of lumbar vertebral column and lumbaritation of sacral vertebral column

c) Cardiovascular and haematological alterations

1º Blood circulation disorders in the skull base (vertebro-basilar insufficiency, visual disorders caused by an arterial compression, carotid blood circulation disorders , etc).

2º Arteriosclerosis with aortic calcification.

3º Aortic aneurysm.

4º Clotting disorders (including treatments for clotting disorders). Thrombosis

5º Arterial Hypertension

6º Recent myocardium infarct

d) Neurological alterations

1º Intervertebral disc herniadiagnosed by TAC or RMN. In these cases there are exceptions that will be valued according to the type of injury.

2º Tractus piramidal" syndrome

3º "Caudo Equina" Syndrome

4º Acute myelopathy.

e) Psychological diseases

1º Serious psychiatric diseases.

2º Patient that expresses fear to manipulation.

f) Others

1º Tumors that are based in the bone (benign and malignant).

2º Joint or bone infectious diseases

3º Pregnant Women.

4º Children and elder patients