Which category would include cauda equina and recent stroke as contraindications?

• A. Relative
• B. Local
• C. Absolute
• D. Systemic

Answer: (C)

Absolute contraindications to spinal manipulation are conditions where performing the therapy would pose an unacceptable risk, so treatment must be avoided entirely. Cauda equina syndrome is a neurosurgical emergency with compression of nerve roots; any thrusts or manipulative forces could worsen neurologic injury or interfere with urgent decompression, making manipulation off-limits. A recent stroke indicates cerebrovascular instability and a real risk of another stroke or hemorrhagic transformation if the neck is manipulated; until clearance from a clinician is obtained, this scenario is treated as an absolute contraindication. This category contrasts with relative contraindications, where more caution is advised and practitioners may proceed under specific conditions.