When Not to Get a Chiropractic Adjustment: Safety Checks Before Your First Visit

Knowing when not to get a chiropractic adjustment matters as much as knowing when to get one. The short answer: skip it, or at least get examined first, whenever a serious cause of your pain hasn’t been ruled out. A good first visit is built around that exam.

When not to get a chiropractic adjustment: red flags that need medical care first

A review of 16 low back pain guidelines, from 15 countries plus Europe as a whole, found 46 distinct red flags, sorted into four groups of serious pathology: malignancy, fracture, cauda equina syndrome, and infection. The guidelines didn’t agree on which flags to use, and evidence for how well the flags predict disease was thin. Most guidelines did include two flags for fracture: major or significant trauma, and steroid use.

In plain terms, tell whoever examines you about any recent serious fall or accident, long-term steroid use, a history of cancer, unexplained weight loss, fever with back pain, or loss of bladder or bowel control. Those are the kinds of findings that point toward medical workup rather than a spinal adjustment.

Neck adjustments and stroke: what the AHA says

A 2014 scientific statement from the American Heart Association and American Stroke Association reviewed this question. Cervical artery dissection is one of the more common causes of stroke in young and middle-aged adults. Case-control studies have found an association between neck manipulation and vertebral artery dissection stroke. The statement says it’s unclear whether that comes from missed, already-developing dissections in people who then seek care, or from trauma caused by the manipulation. It calls the incidence in patients who’ve had neck manipulation probably low, and says patients should be informed of the statistical association before neck manipulation.

Early dissection can look like unilateral headache, neck pain at the back of the neck, or stroke-like symptoms. A sudden, severe headache or neck pain unlike any you’ve had belongs in an ER, not an appointment. Our guide to a stiff neck after sleeping wrong covers the ordinary version.

What a good first visit does before the first adjustment

At Brooklyn Chiropractic Care, the first visit includes a consultation and an orthopedic and neurological exam, digital X-rays if they’re clinically needed, a report of findings, and then the first adjustment. The exam comes first for exactly the reasons above.

Technique matters too. Flexion-distraction, the technique Dr. Patel uses for disc-related problems, is gentle, hands-on, and non-thrusting. See our flexion-distraction guide.

Questions to ask any chiropractor before the first adjustment

• What do you think is causing this, and what did you examine to decide?
• Will I need X-rays, and why?
• What technique will you use on my neck? Are there gentler options?
• Can I say no to part of the treatment?
• What would make you send me to another doctor?

Frequently Asked Questions

References

1. Verhagen AP, Downie A, Popal N, Maher C, Koes BW. Red flags presented in current low back pain guidelines: a review. Eur Spine J. 2016;25(9):2788-2802. PubMed: 27376890
2. Biller J, Sacco RL, Albuquerque FC, et al. Cervical arterial dissections and association with cervical manipulative therapy: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45(10):3155-3174. PubMed: 25104849
3. Carnes D, Mars TS, Mullinger B, Froud R, Underwood M. Adverse events and manual therapy: a systematic review. Man Ther. 2010;15(4):355-363. PubMed: 20097115