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CONTRAINDICATIONS FOR MANUAL MEDICINE PART 1
Manual medicine is perhaps the oldest
form of medicine known. Yet we must firmly establish motion examination
findings assessing the osteokinematic and arthrokinematic status of
joints. The proper assessment will be discussed in the next volume of
this set. Obviously a prudent history limited physical examination,
orthopedic, neurological and motion examination findings and the ruling
out of pathology by X-ray and special tests account for indications of
Manual Medicine. However, unless we understand the differential
diagnosis associated with the diseases of locomotion, which simulate a
manipulative lesion, manual manipulative medicine may inappropriately be
provided due to a finding of restriction (+ =
Positive Evidence for SMT). Thus these Diseases have
been divided into the Key Symptom Classification, which follows:
CHEST PAIN: ABDOMINAL
Encephalitis A. Herpes
Zoster (+ ) A. Peptic Ulcer
Pleurisy B. Cholecystitis
Concussion C. Pericarditis, MI, Angina. C.
Migraine D. Pleurodyna
E. Intercostal Neuritis (+)
Sinusitis F. Rib fracture\Sternal
F. Abdominal Strain
G. Temporal Arteritis;
etc. G. Intercostal/Regional Sprain (+)
A. Fracture of vertebra
A. Essential Hypertension
B. Spondylolisthesis (+)
B. Rheumatoid Arthritis
B. Malignant Htn
C. T.B. of the
Spine. C. Gouty Arthritis
C. Coarctation of
D. Multiple Myeloma D.
Spondylitis E. Infectious Arthritis
E. Cushing’s Disease.
F. Herniated IV
Disc (+) F. Traumatic Arthritis F.
G. Osteomyelitis of
Spine G. Autoimmune Disease G. Glomerulonephritis.
H. Osteoarthritis of
Spine (+) H. Strain/sprain (+)
Osteoporosis (Kyphosis +) and Osteochondritis.
ANOREXIA, NAUSEA & VOMITING
Bronchitis A. Cor-pulmonale
A. Psychic & Neurological Factors.
Pneumonia B. Congestive Heart Failure
B. Drugs & Toxic Agents.. Bronchial
C. Pheumothorax C.
Intra Abdominal Disease.
D. Laryngeal/Tracheal Obstruction. D. Endocrine Disorders.
E. Acute Laryngotracheo-bronchitis E. Cardiac
CA F. Pulmonary Embolism
F. Miner’s Disease. Emphysema
Fibrillation G. Motion Sickness.
G. Pulmonary Edema
CONSTIPATION & DIARRHEA:
Disease G. Malabsoption Syndrome L. Diverticulitis
Disease H. Thyrotoxicosis M. Spastic Colon
Morphine & Anticholenergics I. Drugs-Antibiotics-Laxitives
Gastroenteritis J. Ulcerative
Anemia A. Lymphatic Leukemia
Hepatitis B. Hodgkin’s
C. Carcinoma Pancreas
C. Infectious Mononucleosis
D. Cirrhosis of
Liver D. Secondary Syphilis
tetrachloride F. Malignant Metastasis.
Thorazine). G. Infection-
Syncope A. Meniere’s Disease (+) A. Congestive Heart
B. Carotid Sinus
Depressor Reflex B. Cerebellar Disease B. Cirrhosis.
Hypotension C. Hypertension C.
Syndrome D. Hypotension
D. Myxedema. Cerebral Vascular
E. Cerebral Vascular
Accident E. Anemia E. Lymphedema.
F. Transient Ischemic
Attack F. Multiple Sclerosis F. Trauma to
Vestibular Neuritis G. Frolichs Syndrome
WEIGHT LOSS: COMA:
Obesity A. Malignant Disease
A. Cerebral Vascular Accident.
Hypothyroidism B. Tuberculosis
B. Subdural Hematoma.
Syndrome C. Diabetes Mellitus C.
Syndrome D. Addison’s Disease D. Uremia
Disorders E. Hyperthyroidism E. Alcohol,
Developmental F. Anorexia Nervosa
Injury-Open-Closed A. Musculardystrophy
Epilepsy B. Myasthenia Gravis
B. Cerebral Pneumonia
Syndrome C. Peripheral Neuropathy
C. Bronchogenic Carcinoma
Sclerosis D. Upper Motor Neuron Syndrome D. Pulmonary
E. Intracranial Injury,
Cerebral E. Lower Motor Neuron
Syndrome E. Abscess
HEMATEMESIS & MELENA:
A. Bleeding Peptic
Ulcer A. Infections. Carcinoma of
B. Carsinoma of the
Stomach B. Diseases of C.N.S.
C. Bleeding Esophageal
Varices C. Neoplasms.
Hernia D. Lymphoma.
E. Gastritis &
Esophagitis E. Leukemic Hemolytic Anemia,
Aplastic Anemia, Agranulocytosis
F. Thrombosis & Embolism
J. Drug Fever
Expert would not mistake the basics of differential Diagnosis and treat
a pathomechanical condition whose etiology was disease and not
biomechanical altered joint dynamics.
MD, DC, or DO to
whom the treatment of Spinal Manipulative Manual Medicine is within
their training and license within the
should use the above Key Symptom Disease Classification. True
physicians can determine chronic joint trauma superimposed over acquired
disease, combinations or pre-existent disease and disability with
subsequent acute trauma. In parts two and three of this series the
discussion will center on how to medically determine necessity for
manipulative medicine and the manipulative lesion. However this first
article is extremely important, as later there will be a series of three
cases of death associated with manual medicine where this examiner
worked on the actual malpractice cases. Finally, there will be an
article on the history of vascular accidents and compromise relative to
iatrogenic manual medicine. Understanding these first three will avoid
the pitfall associated with iatrogenic manual medicine.
nothing do men more nearly approach the gods than in giving health to
Scott D. Neff, DC DABCO
DABFE FFABS FFAAJTS