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Table 2 Absolute and Relative Contraindications to Manual Therapy

From: Chiropractic approach to the management of children

Indication Explanation
Withdrawal of consent by the parent or child Potential for litigation
Hypermobility of the joints of the child Increased flexibility of joint structures and less muscular resistance than the adult
Long-lever and high force manual procedures Anatomically immature: no joint "lockup."
Occipito-atlantal &
Atlanto-axial instability
Common in children with Down Syndrome, Juvenile Rheumatoid Arthritis, Marquio's, Klippel-Feil Syndrome
Brain or spinal tumors Potential of neurologic damage or vascular compromise by the introduction of specific or non-specific force due to the pathophysiology or anatomical position of the tumor;
immediate referral to appropriate healthcare provider
Active metaphyseal
growth tissue
Zone of provisional calcification- the transitional region between cartilage and newly formed metaphyseal bone is subject to separation and avascular necrosis when subject to force
Cervical Spine adjustments Reduce the incidence of potential adverse event by refraining from over treating the sensitive structures of the cervical spine
Down Syndrome or other congenital anomalies If you see an anomaly in one region, be suspicious of anomalies elsewhere.
Recent upper respiratory tract virus Potential for inflammatory disruption to the atlanto-axial joint
Symptoms and signs incongruous with
palpatory findings.
Diagnosis requires corroboration of signs and symptoms with exam findings (including palpatory findings). When they are incongruous, further diagnostic studies should be ordered to rule out any potentially serious underlying pathology.
History of sleep-disorder in infants <12 weeks of age Watchful waiting first 12 weeks (rule out Arnold Chiari Syndrome)
Inversion of neonate or young infant Relative contraindication secondary to neonatal circulation and clotting factors, respiratory distress, cranial and cervical birth trauma, undiagnosed perinatal or postnatal stroke, undiagnosed hip dysplasia.