What are absolute contraindications to manual cervical manipulation?

• A. Suspected acute cervical fracture or dislocation
• B. Mild neck strain due to overuse
• C. Chronic headaches
• D. Age under 25 with no red flags

Answer: (A)

Absolute contraindications are conditions that make cervical manipulation unsafe and require avoiding thrust techniques. The clearest example is suspected acute cervical fracture or dislocation. If there is a fracture or dislocation, applying manual manipulation could worsen instability, shift bone fragments, or injure the spinal cord or surrounding vessels. Because of that, imaging and non-thrust management are the priority until injury is ruled out.

The other options don’t meet that level of risk. A mild neck strain from overuse is a soft tissue issue that may be managed with careful assessment and alternative therapies; it’s not an automatic barrier to manipulation. Chronic headaches aren’t by themselves an absolute contraindication—you’d look at red flags or structural issues rather than dismissing treatment outright. Age under 25 with no red flags also isn’t a disqualifier; age alone doesn’t establish an unsafe condition for cervical manipulation.