Which of the following is a contraindication to high-velocity cervical manipulation?

• A. Chronic neck stiffness
• B. Suspected vertebral artery insufficiency
• C. Mild headaches with activity
• D. Tension-type neck pain

Answer: (B)

High-velocity cervical manipulation is a rapid thrust to the neck, so if vertebral artery insufficiency is suspected, this maneuver can threaten brainstem and posterior circulation blood flow or dislodge plaques, raising the risk of vertebrobasilar stroke. That vascular risk is why suspected vertebral artery insufficiency is a contraindication to this technique. The other scenarios describe neck pain or mild symptoms without evidence of compromised vertebral artery blood flow, so they do not on their own prohibit HV cervical manipulation. In such cases, consider alternative approaches (gentle mobilizations, soft tissue work, or stabilization exercises) and screen for any red flags before applying HV techniques.