After diagnosis, a doctor must judge for himself or herself whether the case should be treated, CO-managed or referred. It's commonly recognized that any therapeutic procedure or agent that has a potential for effectiveness has a potential for harm. Prior to any therapy being administered, the doctor is expected to be knowledgeable in the indications for, or contraindications to the physiologic effect of all therapies utilized. Moreover, prior to utilization, the patient should be informed about what to expect from the therapy. While the criteria for professional performance are generally established by usual and customary practices, this doesn't imply that there isn't more than one acceptable method to reach a therapeutic goal.
Different surgeons use different techniques to accomplish the same goal.
Likewise, the chiropractor may select from several acceptable procedures and techniques available. The ones that are selected should be determined by the doctor's knowledge, training, experience, skill and clinical judgment. Generally, contraindication can be classified as vascular, traumatic, infectious, arthritic, psychological and metabolic complications. In addition, underlying congenital and acquired deformities and weaknesses should always be evaluated, since many don't become symptomatic until after trauma. Specific disorders within these classifications may not automatically contraindicate chiropractic adjustment because of their existence, but their presence and degree should be recognized and carefully considered prior to modifying treatment if necessary.