{"id":5116,"date":"2026-02-07T12:33:57","date_gmt":"2026-02-07T12:33:57","guid":{"rendered":"https:\/\/www.saludquiropractica.es\/cuando-esta-indicada-la-quiropractica-y-cuando-no\/"},"modified":"2026-02-07T12:33:57","modified_gmt":"2026-02-07T12:33:57","slug":"cuando-esta-indicada-la-quiropractica-y-cuando-no","status":"publish","type":"post","link":"https:\/\/www.saludquiropractica.es\/en\/cuando-esta-indicada-la-quiropractica-y-cuando-no\/","title":{"rendered":"When is chiropractic treatment recommended, and when is it not?"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_82_1 counter-hierarchy ez-toc-counter ez-toc-grey ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">Table of contents<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewbox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewbox=\"0 0 24 24\" version=\"1.2\" baseprofile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.saludquiropractica.es\/en\/cuando-esta-indicada-la-quiropractica-y-cuando-no\/#Cuando_esta_indicada_la_quiropractica_y_cuando_no_criterios_clinicos_orientativos_por_tipo_de_dolor_de_espalda_y_cuello\" >When chiropractic treatment is indicated and when it is not: indicative clinical criteria by type of back and neck pain<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.saludquiropractica.es\/en\/cuando-esta-indicada-la-quiropractica-y-cuando-no\/#Indicaciones_prudentes_por_tipo_de_dolor\" >Prudent guidelines by type of pain<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.saludquiropractica.es\/en\/cuando-esta-indicada-la-quiropractica-y-cuando-no\/#Cuando_no_esta_indicada_o_debe_evitarse\" >When it is not recommended or should be avoided<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.saludquiropractica.es\/en\/cuando-esta-indicada-la-quiropractica-y-cuando-no\/#Signos_de_alarma_que_exigen_valoracion_medica_previa\" >Warning signs that require prior medical assessment<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.saludquiropractica.es\/en\/cuando-esta-indicada-la-quiropractica-y-cuando-no\/#Senales_de_alarma_banderas_rojas_que_hacen_desaconsejable_la_manipulacion_vertebral_quiropractica_y_requieren_valoracion_medica\" >Warning signs (red flags) that make chiropractic spinal manipulation inadvisable and require medical assessment<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/www.saludquiropractica.es\/en\/cuando-esta-indicada-la-quiropractica-y-cuando-no\/#Deficit_neurologico_o_signos_de_compresion\" >Neurological deficit or signs of compression<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-7\" href=\"https:\/\/www.saludquiropractica.es\/en\/cuando-esta-indicada-la-quiropractica-y-cuando-no\/#Trauma_infeccion_o_neoplasia_sospechados\" >Suspected trauma, infection or neoplasm<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-8\" href=\"https:\/\/www.saludquiropractica.es\/en\/cuando-esta-indicada-la-quiropractica-y-cuando-no\/#Riesgo_vascular_y_otras_condiciones_que_incrementan_complicaciones\" >Vascular risk and other conditions that increase the likelihood of complications<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-9\" href=\"https:\/\/www.saludquiropractica.es\/en\/cuando-esta-indicada-la-quiropractica-y-cuando-no\/#Evidencia_cientifica_actual_en_que_casos_la_quiropractica_muestra_beneficios_limitados_y_en_cuales_no_cuenta_con_respaldo_suficiente\" >Current scientific evidence: in which cases does chiropractic show limited benefits, and in which cases is there insufficient evidence to support its use?<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-10\" href=\"https:\/\/www.saludquiropractica.es\/en\/cuando-esta-indicada-la-quiropractica-y-cuando-no\/#Casos_con_beneficios_limitados_segun_la_evidencia\" >Cases where the evidence suggests limited benefits<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-11\" href=\"https:\/\/www.saludquiropractica.es\/en\/cuando-esta-indicada-la-quiropractica-y-cuando-no\/#Ambitos_con_respaldo_insuficiente_o_no_demostrado\" >Areas with insufficient or unproven evidence<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-12\" href=\"https:\/\/www.saludquiropractica.es\/en\/cuando-esta-indicada-la-quiropractica-y-cuando-no\/#Situaciones_en_las_que_puede_ser_preferible_fisioterapia_ejercicio_terapeutico_o_manejo_medico_antes_que_la_quiropractica\" >Situations in which physiotherapy, therapeutic exercise or medical management may be preferable to chiropractic treatment<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-13\" href=\"https:\/\/www.saludquiropractica.es\/en\/cuando-esta-indicada-la-quiropractica-y-cuando-no\/#Cuadros_en_los_que_suele_priorizarse_el_manejo_medico\" >Conditions in which medical management is usually prioritised<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-14\" href=\"https:\/\/www.saludquiropractica.es\/en\/cuando-esta-indicada-la-quiropractica-y-cuando-no\/#Situaciones_en_las_que_puede_preferirse_fisioterapia_y_ejercicio_terapeutico\" >Situations in which physiotherapy and therapeutic exercise may be the preferred option<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-15\" href=\"https:\/\/www.saludquiropractica.es\/en\/cuando-esta-indicada-la-quiropractica-y-cuando-no\/#Precauciones_y_contraindicaciones_relativas_para_la_quiropractica_embarazo_osteoporosis_anticoagulantes_hernia_discal_con_deficit_neurologico_y_cirugia_reciente\" >Precautions and relative contraindications for chiropractic treatment: pregnancy, osteoporosis, anticoagulants, herniated disc with neurological deficit, and recent surgery<\/a><\/li><\/ul><\/nav><\/div>\n<h2><span class=\"ez-toc-section\" id=\"Cuando_esta_indicada_la_quiropractica_y_cuando_no_criterios_clinicos_orientativos_por_tipo_de_dolor_de_espalda_y_cuello\"><\/span>When chiropractic treatment is indicated and when it is not: indicative clinical criteria by type of back and neck pain<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<h3><span class=\"ez-toc-section\" id=\"Indicaciones_prudentes_por_tipo_de_dolor\"><\/span>Prudent guidelines by type of pain<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<ul>\n<li><b>Non-specific mechanical lower back pain<\/b> (acute or subacute, with no red flags): this may be managed using a conservative approach involving education, exercise and mobilisation or manipulation techniques selected according to the patient\u2019s tolerance.<\/li>\n<li><b>Chronic non-specific lower back pain<\/b>: an option to be considered as part of a multimodal plan focusing on progressive physical activity and self-care strategies; non-invasive techniques should be preferred for older people or those with comorbidities.<\/li>\n<li><b>Axial mechanical neck pain<\/b> (no radiation exposure or neurological symptoms): low-amplitude mobilisation and soft-tissue work may be prioritised, taking particular care to avoid vascular risk factors.<\/li>\n<li><b>Mild lumbar radiculopathy<\/b> on suspicion of <b>slipped disc<\/b> without progressive deficit: conservative management with pain control, education and, in selected cases, non-forceful techniques; frequent clinical reassessment.<\/li>\n<li><b>Musculoskeletal chest pain<\/b> y <b>myofascial pain<\/b>: prioritise gentle interventions and specific exercises, avoiding high-speed manoeuvres if there is a structural risk.<\/li>\n<\/ul>\n<h3><span class=\"ez-toc-section\" id=\"Cuando_no_esta_indicada_o_debe_evitarse\"><\/span>When it is not recommended or should be avoided<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<ul>\n<li><b>Progressive neurological deficits<\/b>, <b>cervical myelopathy<\/b>, <b>cauda equina syndrome<\/b> or severe neurogenic claudication: these require urgent medical assessment.<\/li>\n<li><b>Bone instability or fragility<\/b>: <b>severe osteoporosis<\/b>, recent fracture or acute compression fracture, spondylolisthesis\/segmental instability, bone tumour, vertebral infection.<\/li>\n<li><b>Risk of bleeding<\/b>: <b>coagulopathy<\/b> o <b>anticoagulation<\/b> uncontrolled; avoid high-speed and rotational movements, particularly of the neck.<\/li>\n<li><b>Cervical vascular pathology<\/b> known or suspected<\/b> (e.g., <b>vertebral artery dissection<\/b>) or <b>stroke<\/b> Recent: do not perform cervical procedures.<\/li>\n<li><b>Severe spinal stenosis<\/b> with neurological involvement, <b>recent spinal surgery<\/b> o <b>fusion<\/b> Not consolidated: not indicated until a specialist assessment has been carried out.<\/li>\n<li><b>Connective tissue disorders with instability<\/b> (e.g., <b>Hypermobile Ehlers-Danlos syndrome<\/b>, <b>Marfan<\/b>): avoid high-speed operations.<\/li>\n<li><b>Pregnancy with complications<\/b> or severe unexplained pelvic pain: exercise extreme caution; do not perform high-speed\/rotational techniques.<\/li>\n<\/ul>\n<h3><span class=\"ez-toc-section\" id=\"Signos_de_alarma_que_exigen_valoracion_medica_previa\"><\/span>Warning signs that require prior medical assessment<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<ul>\n<li><b>Major trauma<\/b>, persistent night-time pain or unexplained worsening of symptoms.<\/li>\n<li><b>Fever<\/b>, chills, <b>weight loss<\/b> unintentional, history of <b>cancer<\/b> or intravenous drug use.<\/li>\n<li><b>Sphincter disturbances<\/b>, <b>saddle anaesthesia<\/b>, marked weakness or progressive hypoaesthesia.<\/li>\n<li><b>Sudden and severe neck pain<\/b> with atypical headache, dizziness, dysarthria, diplopia or other acute neurological signs.<\/li>\n<\/ul>\n<h2><span class=\"ez-toc-section\" id=\"Senales_de_alarma_banderas_rojas_que_hacen_desaconsejable_la_manipulacion_vertebral_quiropractica_y_requieren_valoracion_medica\"><\/span>Warning signs (red flags) that make chiropractic spinal manipulation inadvisable and require medical assessment<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<h3><span class=\"ez-toc-section\" id=\"Deficit_neurologico_o_signos_de_compresion\"><\/span>Neurological deficit or signs of compression<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<ul>\n<li><b>Progressive neurological deficits<\/b>: weakness, loss of sensation or reflexes that are getting worse.<\/li>\n<li><b>Cauda equina syndrome<\/b>: \u201csaddle\u201d anaesthesia, sphincter dysfunction (retention\/incontinence) or bilateral weakness in the lower limbs.<\/li>\n<li><b>Cervical myelopathy<\/b>: clumsiness in the hands, gait disturbance, hyperreflexia, spasticity or pyramidal signs.<\/li>\n<li>Persistent severe pain at rest or at night, associated with any of the above signs.<\/li>\n<\/ul>\n<h3><span class=\"ez-toc-section\" id=\"Trauma_infeccion_o_neoplasia_sospechados\"><\/span>Suspected trauma, infection or neoplasm<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<ul>\n<li><b>Significant trauma<\/b> recently, <b>fracture<\/b> known or suspected, or <b>spinal instability<\/b>.<\/li>\n<li><b>Spinal infection<\/b> (e.g. spondylodiscitis): fever, chills, persistent axial pain, elevated inflammatory markers, risk factors such as immunosuppression or intravenous drug use.<\/li>\n<li><b>Neoplasm<\/b> vertebral\/metastatic: unexplained weight loss, a history of cancer, progressive night-time pain or localised bone pain.<\/li>\n<li>Prolonged use of corticosteroids or <b>severe osteoporosis<\/b> which increases the risk of fragility fractures.<\/li>\n<\/ul>\n<h3><span class=\"ez-toc-section\" id=\"Riesgo_vascular_y_otras_condiciones_que_incrementan_complicaciones\"><\/span>Vascular risk and other conditions that increase the likelihood of complications<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<ul>\n<li><b>Cervical arterial dissection<\/b> or suspected acute neurological event: neck pain or sudden, severe headache, vertigo, diplopia, dysarthria, ataxia or focal deficit.<\/li>\n<li><b>Coagulation disorders<\/b>, therapeutic anticoagulation or known vascular malformations.<\/li>\n<li><b>Atlantoaxial instability<\/b> (e.g. rheumatoid arthritis, Down\u2019s syndrome) and <b>connective tissue disorders<\/b> with laxity\/fragility (e.g. Ehlers-Danlos, Marfan).<\/li>\n<li><b>Recent spinal surgery<\/b>, arthrodesis, unstable spondylolisthesis or unspecified post-operative pain.<\/li>\n<\/ul>\n<h2><span class=\"ez-toc-section\" id=\"Evidencia_cientifica_actual_en_que_casos_la_quiropractica_muestra_beneficios_limitados_y_en_cuales_no_cuenta_con_respaldo_suficiente\"><\/span>Current scientific evidence: in which cases does chiropractic show limited benefits, and in which cases is there insufficient evidence to support its use?<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<h3><span class=\"ez-toc-section\" id=\"Casos_con_beneficios_limitados_segun_la_evidencia\"><\/span>Cases involving <b>limited benefits<\/b> according to the evidence<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p>The available literature suggests modest and, in general, short-lived effects for certain <b>specific musculoskeletal conditions<\/b>. These results are generally comparable to those of other conservative treatments and may be more consistent when incorporated into a multimodal approach (e.g. therapeutic exercise and education), without replacing appropriate clinical assessments or other indicated care.<\/p>\n<ul>\n<li><b>Acute or subacute non-specific mechanical low back pain<\/b>: possible minor improvements in pain and function in the short term compared with no intervention or a placebo.<\/li>\n<li><b>Chronic non-specific low back pain<\/b>: modest and variable relief, with uncertainty as to whether the effects will be sustained unless accompanied by active strategies.<\/li>\n<li><b>Mechanical neck pain and cervicogenic headache<\/b>: some patients report modest and temporary reductions in pain or frequency; the response varies and requires individual assessment.<\/li>\n<\/ul>\n<h3><span class=\"ez-toc-section\" id=\"Ambitos_con_respaldo_insuficiente_o_no_demostrado\"><\/span>Areas with <b>insufficient support<\/b> or unproven<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p>There is no solid evidence to support the effectiveness of spinal manipulation in treating <b>non-musculoskeletal conditions<\/b> nor for general health objectives. The evidence is also inconsistent or limited in complex conditions where central sensitisation or non-mechanical components of pain predominate.<\/p>\n<ul>\n<li><b>Non-musculoskeletal disorders<\/b>: asthma, high blood pressure, diabetes, infertility, infections, functional digestive disorders and immune disorders.<\/li>\n<li><b>Paediatric population<\/b> in conditions such as infant colic, otitis media or enuresis: inconclusive or negative results.<\/li>\n<li><b>Generalised chronic pain<\/b> (e.g. fibromyalgia) and syndromes involving central sensitisation: efficacy not established.<\/li>\n<li><b>Preventive or \u201coverall improvement\u201d objectives\u201d<\/b> (e.g. boosting the immune system, general well-being): no convincing evidence.<\/li>\n<\/ul>\n<h2><span class=\"ez-toc-section\" id=\"Situaciones_en_las_que_puede_ser_preferible_fisioterapia_ejercicio_terapeutico_o_manejo_medico_antes_que_la_quiropractica\"><\/span>Situations in which physiotherapy, therapeutic exercise or medical management may be preferable to chiropractic treatment<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<h3><span class=\"ez-toc-section\" id=\"Cuadros_en_los_que_suele_priorizarse_el_manejo_medico\"><\/span>Conditions in which medical management is usually prioritised<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<ul>\n<li>Signs of <b>RED FLAGS<\/b>: fever or generalised malaise with axial pain, a history of cancer, unexplained weight loss, use of immunosuppressive drugs or intravenous drug use.<\/li>\n<li><b>Acute trauma<\/b> suspected of <b>fracture<\/b> o <b>instability<\/b> spinal; recent-onset thoracic or dorsal pain with atypical characteristics.<\/li>\n<li><b>Progressive neurological deficits<\/b>, <b>cauda equina syndrome<\/b> (sphincter dysfunction, saddle anaesthesia), signs of <b>myelopathy<\/b> or radiculopathy with significant loss of strength.<\/li>\n<li>Suspicion of <b>infection<\/b> bone\/disc, <b>tumour<\/b> or spinal metastases.<\/li>\n<li>Data suggesting <b>vertebrobasilar insufficiency<\/b> o <b>cervical arterial dissection<\/b> (dizziness, diplopia, dysarthria, sudden severe headache) and headaches with a \u201cthunderclap\u201d onset.<\/li>\n<li><b>Severe osteoporosis<\/b> or marked bone fragility; treatment with <b>anticoagulants<\/b> and a high risk of bleeding.<\/li>\n<li><b>Atlantoaxial instability<\/b> (e.g. in rheumatoid arthritis) or other cervical ligament disorders.<\/li>\n<li><b>Post-operative<\/b> for early-stage spinal conditions or in cases of uncharacterised post-operative pain.<\/li>\n<\/ul>\n<h3><span class=\"ez-toc-section\" id=\"Situaciones_en_las_que_puede_preferirse_fisioterapia_y_ejercicio_terapeutico\"><\/span>Situations in which physiotherapy and therapeutic exercise may be the preferred option<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<ul>\n<li>Subacute or chronic musculoskeletal pain without red flags, where a specific approach is prioritised <b>asset<\/b> through empowerment, mobility and education.<\/li>\n<li><b>Hyperlaxity<\/b> or connective tissue disorders (e.g. Ehlers-Danlos syndrome), in which the <b>stabilisation<\/b> and motor control are usually the main areas of focus.<\/li>\n<li>Cases of persistent pain with possible <b>central awareness<\/b>, which are best addressed through programmes involving graded activity and progressive exposure to movement.<\/li>\n<li>Functional recovery following <b>soft tissue injuries<\/b> (sprains, tendinopathies) and shoulder\/knee pain, where carefully tailored exercise facilitates gradual rehabilitation.<\/li>\n<li>Recurrent neck pain or lower back pain, where the aim is to reduce recurrences by <b>strength and endurance training<\/b> and self-care strategies.<\/li>\n<li>The initial stages following an acute injury involving inflammation or severe pain, during which low-impact techniques and gradual progression may be preferred over high-speed movements.<\/li>\n<\/ul>\n<h2><span class=\"ez-toc-section\" id=\"Precauciones_y_contraindicaciones_relativas_para_la_quiropractica_embarazo_osteoporosis_anticoagulantes_hernia_discal_con_deficit_neurologico_y_cirugia_reciente\"><\/span>Precautions and relative contraindications for chiropractic treatment: pregnancy, osteoporosis, anticoagulants, herniated disc with neurological deficit, and recent surgery<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>In these clinical situations, chiropractic treatment must be tailored to the individual following a detailed preliminary assessment (medical history, neurological and orthopaedic examination) and the appropriate adjustment of techniques. The priority is to minimise mechanical risks to vulnerable tissues, avoiding high-velocity thrust manoeuvres when tissue integrity is uncertain, and setting out realistic expectations and <b>informed consent<\/b>.<\/p>\n<ul>\n<li><b>Pregnancy<\/b>: ligamentous laxity and haemodynamic changes mean that abdominal pressure, a deeply prone position and <b>high-speed handling (HVLA)<\/b> lumbopelvic mobilisation in cases of pelvic pain or instability. Safe positions (lateral recumbency, cushions) and low-load techniques are preferable, whilst monitoring for symptoms such as supine hypotension or dizziness.<\/li>\n<li><b>Osteoporosis<\/b>: bone fragility increases the risk of fracture; axial\/rotational HVLA manoeuvres are not recommended. Gentle mobilisation and non-provocative exercises are prioritised. Suspected <b>vertebral fracture<\/b> In cases of severe osteoporosis, the affected area should not be manipulated.<\/li>\n<li><b>Anticoagulants<\/b>: increased risk of bruising and bleeding in deep tissues. Avoid high-speed thrusts and sustained intense pressure; exercise caution with deep myofascial techniques. Monitor for extensive bruising, disproportionate paravertebral pain or signs of bleeding.<\/li>\n<li><b>Disc herniation with neurological deficit<\/b>: before <b>motor deficit<\/b>, marked sensory or reflex abnormalities; thrust manipulation at the affected level is high-risk and constitutes at least a relative contraindication; if the deficit is <b>progressive<\/b> If there is sphincter dysfunction or saddle anaesthesia, this is considered an emergency and manipulation is contraindicated.<\/li>\n<li><b>Recent surgery<\/b>: During the healing process, avoid intense traction or rotation and any manipulation of the operated area. Do not manipulate segments with <b>arthrodesis\/instrumentation<\/b>. Work in adjacent areas must be carried out gently and in accordance with post-operative guidelines and restrictions.<\/li>\n<\/ul>\n<p>The following are considered warning signs that indicate treatment should not be carried out and require urgent medical assessment: <b>progressive neurological deficit<\/b>, lower back pain accompanied by a fever or a history of infection, pain following significant trauma, suspected fracture, saddle anaesthesia or sphincter dysfunction, and active bleeding or an expanding haematoma in patients on anticoagulants. Interprofessional coordination and the conservative selection of techniques help to reduce risks in these scenarios.<\/p>","protected":false},"excerpt":{"rendered":"<p>Cu\u00e1ndo est\u00e1 indicada la quiropr\u00e1ctica y cu\u00e1ndo no: criterios cl\u00ednicos orientativos por tipo de dolor de espalda y cuello Indicaciones prudentes por tipo de dolor Dolor lumbar mec\u00e1nico inespec\u00edfico (agudo o subagudo, sin banderas rojas): puede considerarse dentro de un abordaje conservador con educaci\u00f3n, ejercicio y t\u00e9cnicas de movilizaci\u00f3n o manipulaci\u00f3n seleccionadas seg\u00fan tolerancia. Dolor [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":5125,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[31],"tags":[],"class_list":["post-5116","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-educacion-quiropractica"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.saludquiropractica.es\/en\/wp-json\/wp\/v2\/posts\/5116","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.saludquiropractica.es\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.saludquiropractica.es\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.saludquiropractica.es\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.saludquiropractica.es\/en\/wp-json\/wp\/v2\/comments?post=5116"}],"version-history":[{"count":0,"href":"https:\/\/www.saludquiropractica.es\/en\/wp-json\/wp\/v2\/posts\/5116\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.saludquiropractica.es\/en\/wp-json\/wp\/v2\/media\/5125"}],"wp:attachment":[{"href":"https:\/\/www.saludquiropractica.es\/en\/wp-json\/wp\/v2\/media?parent=5116"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.saludquiropractica.es\/en\/wp-json\/wp\/v2\/categories?post=5116"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.saludquiropractica.es\/en\/wp-json\/wp\/v2\/tags?post=5116"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}