Spinal Manipulation

Under the Naturopathy Act, 2007, a Member is authorized to perform prescribed procedures involving moving the joints of the spine beyond the individual’s usual physiological range of motion, using a fast, low-amplitude thrust.

Part II (Controlled Acts) of the General Regulation authorizes a Member to move the cervical, thoracic, lumbar and sacral joints of the spine of a patient. However, they may do so only if:
  • They have met the general requirements outlined on the About Controlled Acts page for performing a controlled act.
  • They use only a supine lateral flexion, supine rotary or C2-C7 seated rotary procedures when moving the cervical joints of the spine.
  • The patient does not have a contraindication listed in the regulation, and the Member has no doubts about the accuracy of the patient’s health status or history regarding any of the contraindications.
A Member may move the thoracic and lumbar joints of the spine using procedures necessary provided they have the knowledge, skill and judgment to do so (and have met all of the requirements outlined on the About Controlled Acts page).  A Member may only move the cervical joints of the spine using the three procedures noted above.

In all cases, the Member may not perform spinal manipulation if any of the identified absolute contraindications exist.


A contraindication is any condition that renders a treatment improper or undesirable.  Part II (Controlled Acts) of the General Regulation lists 21 contraindications, based on the World Health Guidelines:  
  1. Anomalies, including dens hypoplasia, unstable os odontoideum and similar diseases, disorders or dysfunctions.
  2. Acute fracture.
  3. Spinal cord tumour.
  4. Acute infection of the spine, including osteomyelitis, septic discitis and tuberculosis of the spine.
  5. Meningeal tumour.
  6. Haematomas, whether spinal or intracanalicular.
  7. Malignancy of the spine.
  8. Frank disc herniation with accompanying signs of progressive neurological deficit.
  9. Basilar invagination of the upper cervical spine (vertebrobasilar ischemia).
  10. Symptomatic Arnold-Chiari malformation of the upper cervical spine.
  11. Dislocation of a vertebra.
  12. Aggressive types of benign tumours, such as an aneurismal bone cyst, giant cell tumour, osteoblastoma or osteoid osteoma.
  13. Internal fixation/stabilization devices.
  14. Neoplastic disease of muscle or other soft tissue.
  15. Positive Kernig’s or Lhermitte’s signs.
  16. Congenital, generalized hypermobility.
  17. Syringomyelia.
  18. Hydrocephalus of unknown aetiology.
  19. Diastematomyelia.
  20. Cauda equina syndrome.
  21. Any other disease, disorder or dysfunction that the Member knows or ought to know contraindicates performance of the controlled act in the relevant circumstances of the patient.

In addition to the requirements stated in the General Regulation, Members must also comply with the Standard of Practice for Manipulation. More information regarding absolute and relative contraindications to manipulation can be found in the Contraindications for Manipulation Guideline.