Should your chiropractor be adjusting you?

Chiropractic adjustments can help with so much, from aches and pains to help restore motion or address specific conditions. While chiropractic care is generally safe for most people, there are a few circumstances or conditions for which an adjustment is NOT RECOMMENDED.

We can help in other ways—read all the way to the end to find out how.

Severe Osteoporosis

Osteoporosis weakens the bones (and can make them lacy in appearance). Patients with severe osteoporosis (when one has a T score of -2.5 with a DEXA, or a bone scan) are prone to have bone fractures. The pressure that is put on the body during an adjustment, even in a small amount, could cause a fracture. Gentleness is critical with osteoporotic patients.

Spine Cancer

The most significant risk with spine cancer is a fracture. When a patient has any kind of spinal cancer, it can weaken the bones and make them more prone to fracture. Some spinal cancers begin in the spine (primary), while others can metastasize from another area with cancer (secondary), like the breast or the prostate. It’s essential to keep tabs on the location of your cancer and the health of your spine. It’s best to avoid spinal adjustments.

Bone Fracture

If you have a broken bone, visit the emergency room or your primary health care provider. While chiropractors can often provide an x-ray, chiropractors do not deal in broken bones, and to try to adjust or move bones that are trying to heal would be completely counterintuitive. (But we’ll certainly sign your cast!)

Vascular-Weakening Conditions

All of your blood and lymph vessels make up your vascular system. Adjustments are not recommended when it’s weakened by specific conditions such as a previous stroke or an artery dissection.

  1. An aneurysm may rupture or dislodge a clot.
  2. If you’ve had a stroke before, you are at increased risk for another. 5% of stroke survivors are likely to have another stroke within the first year.
  3. An artery dissection (when parts of the inside artery pull away and make a flap/clot) can be indicated by neck pain and headache, which is a common symptom for chiropractors to treat. Artery dissection is rare; it often involves neck trauma or hyperextension, or rotation of the neck. Yoga, painting a ceiling, swinging a golf club, coughing, or vomiting have all been linked to artery dissection. Traditional cervical adjustments may exacerbate an existing dissection.

    Tip #1: If you’re concerned about an artery dissection, be on the lookout for these symptoms: severe headache, dizziness, vision loss (partial)Tip #2: Get your blood pressure checked. Patients with high blood pressure are the most at risk for a blood clot.


This often-congenital condition results from a smaller or misshapen skull that causes the back of the brain (cerebellum) to push down into the spinal cord. Adjustments of the spine are a big no-no here.

Specific Bone Conditions

Certain bone conditions are very sensitive to touch and movement. Adjustments are not recommended for the following specific bone conditions:

  •  DISH: Diffuse Idiopathic Skeletal Hyperostosis (DISH) is a condition where spinal ligaments may calcify. The areas of the body with DISH are prone to fracture.
  • AS: Ankylosing Spondylitis (AS) is a progressive inflammatory disease that can cause the vertebra and/or sacroiliac joints to fuse. Fused joints should not be adjusted.
  • Osteogenesis Imperfecta: Osteogenesis Imperfecta (also called Brittle Bone Disease) is a hereditary condition in which the bones are very fragile and easily fractured. Adjusting is out of the realm of possibility.


Trauma or other certain conditions may cause instability—the bones in the joints are moving more than they should (like a wobbly building).

  •  Trauma: If you have significant joint trauma like a dislocation or you’ve had whiplash, these can both cause joint instability, and chiropractic care may not stabilize it—the instability may actually worsen.
  • Rheumatoid Arthritis and Down’s Syndrome: These conditions may both cause instability of the upper cervical spine (neck), and chiropractic adjustments should be avoided.
  • Spondylolisthesis or Degenerative Spinal Disease: With this condition, your joints may become unstable over time. Monitor your progress and work together with your physician or specialist to determine whether chiropractic treatment would be okay or not.

Post-Joint Replacement

If it has been a while after your joint replacement, chiropractic adjustments may be okay with your doctor’s go-ahead. However, in the first 3-6 months after the joint replacement, it’s best to give your body time to stabilize the new joint, so the replacement hardware doesn’t shift. However, the other areas of your body not connected to your recently replaced joint can be adjusted.

Surgical Fusions

Xray of a spinal fusion In spinal fusions, such as scoliosis, Harrington rods function to fully fuse your body’s spine (or portions of it). Movement should not be happening, and chiropractic adjustments shouldn’t, either. If there is movement with a surgical fusion in the area that is fused, that’s a bad sign—something has broken.

Alternatives for Manual Adjustments

Dr. McHattie performing a gentle instrument adjustment.

Most of these conditions preclude physical or manual adjustments, wherein the chiropractor uses their hand or a chiropractic table. Instrument adjusting, however, which is gentle, can be safe for many patients with the conditions listed above—as long as it is applied in a lower amplitude to the body in a neutral position.

Chiropractors also offer soft tissue mobilization, including massage, stretching, and other applications so that you can have the benefit of relaxed muscles, even without an adjustment.

IMPORTANT: Talk to your doctor

It is essential to let your doctor know about any new symptoms, or changes in health and procedures so that he or she can determine if your current care plan is the best for you.