Chiropractic management of this condition can and should be employed prior to more invasive treatment. In cases like this, the patient and the legal counsel may not view the chiropractic management as innocuous. The chiropractic profession is wholeheartedly involved in the treatment of cervical disc herniations, so practitioners should initiate protective measures, not only to ensure the best patient care, but also to prevent litigation. Known risks to chiropractic manipulation in the presence of cervical disc herniation include increasing the size of the herniation and aggravation of the herniation producing an extrusion. This deterioration of the condition may result in increased radicular symptoms and objective signs of neurological deficit.
Several authors mention contraindications, but the precise circumstances vary.
In a study by Saal, exclusionary criteria from conservative medical treatment included symptomatic cervical myelopathy and severe central canal stenosis. All patients with significant cervical injuries should be monitored for the development of neurological signs or symptoms. When symptoms begin to develop in the upper extremities that could be correlated to a nerve root, an appropriate examination should be instituted. The neurological examination should include muscle testing, deep tendon reflexes and superficial sensation examination. Provocative tests for the presence of radiculitis should be performed, such as foraminal compression and maximum cervical rotary compression tests.