Osteopaths have the responsibility to properly diagnose and refer patients when the patient’s condition requires therapeutic intervention external to the osteopath’s competence. It is also necessary to recognize the existence of specific approaches and techniques that are contraindicated under specific conditions.
The contraindications identified by the community of osteopaths have grouped according to the osteopathic techniques used: these can be direct, indirect, combined, fluidic and/or reflex. Direct techniques, such as muscular energy, thrust (thrust) and articulatory maneuvers, present different risks with respect to indirect techniques, fuídiques and refexes. There are few publications showing evidence on what techniques should be avoided under specific conditions. Osteopaths use their understanding of the pathology of patients and the mechanism of action of the technique to establish absolute and relative contraindications that are biologically plausible. The following lists have been established on this basis.
Contraindications for direct techniques.
Direct techniques will be able to use ‘thrust’ (thrust), impulse, muscle contraction, fascial work or passive range of movement, to achieve tissue response. These techniques can apply specifically to a joint or specifcament in a more extensive area of the body. Often, an area where it should not apply a direct technique can be treated by means of an alternative technique in a safe and effective way, for example with indirect techniques, fountains or refexes. There are absolute and relative contraindications to direct techniques.
Systemic conditions that constitute absolute contraindications for direct techniques.
- suspicion of hemorrhagic disorder;
- episodes of prolonged bleeding;
- Anticoagulant pharmacotherapy without a recent evaluation of treatment;
- coagulation abnormalities;
- congenital or acquired connective tissue diseases that compromise
- fabric integrity;
- metabolic disorders, metastatic diseases and/or rheumatoids where there may be a
- Commitment of the integrity of bones, tendons, ligaments or joints.
Systemic conditions that constitute relative contraindications for direct techniques.
- osteoporosis;
- osteopenia.
Absolute contraindications for the specific and local application of direct techniques.
- aortic aneurysm;
- open wounds, skin disorders, recent surgery;
- acute hydrocephalus;
- hydrocephalus without differential diagnosis;
- acute intracerebral hemorrhage;
- Acute cerebral ischemia, including transient ischemia;
- suspicion of cerebral arteriovenous malformation;
- brain aneurysm;
- abdominal pain;
- Acute cholecystitis with suspected leakage or rupture;
- Acute appendicitis with suspected leakage or rupture;
- acute or sub-acute cranial cranial injury;
- Acute intervertebral disc herniation with progressive neurological signs;
- suspicion or evidence of vascular compromise;
- suspicion of vertebral artery compromise;
- congenital malformation;
- horsetail acute syndrome;
- ocular lens implant (first postoperative period);
- uncontrolled glaucoma;
- neoplasm;
- Suspicion of bone involvement, such as osteomyelitis, bone tuberculosis, etc., or risk.
Absolute contraindications for the specific and local application of ‘thrust’ or impulse technique.
- Specific technique on a joint with internal surgical fxacio.
- Bones or joints with compromised stability, as can occur in neoplastic foci, metastatic disease, suppurative arthritis, septic arthritis, diseases
- rheumatics, osteomyelitis, bone tuberculosis, etc.;
- acute fracture;
- hematoma or abscess or intramuscular bone.
Relative contraindications for the specific and local application of the ‘thrust’ or the impulse technique.
- intervertebral disc herniation;
- ligamentous distension at the site of application;
- Acute whiplash injury.
Contraindications for indirect techniques, fuídiques, balance and refences.
Indirect techniques, fuídiques, balance and refexes can apply specifically in a joint or nonspecific to a more extensive area of the body. These techniques do not imply the restrictive barrier. They can include as part of the application of the technique of compression or fascial and soft tissue traction, hydraulic pressures, respiratory phases and cranial or postural adjustments. In general, the relative contraindications for indirect techniques refer to the clinical-temporal profile of the problem.
Absolute contraindications for the local application of indirect techniques, fuídiques, balance sheets and refexes.
- acute hydrocephalus without differential diagnosis;
- acute brain hemorrhage;
- acute intracerebral vascular accident;
- suspicion of cerebral arteriovenous malformation;
- brain aneurysm;
- suspicion of acute peritonitis;
- acute appendicitis or other visceral disease with suspected leakage or rupture;
- recent closed cranial injury.
Relative contraindications for the local application of indirect, fuídique, and refex-based techniques.
- metastatic disease;
- neoplasm;
- CLOSED HEAD INJURY.