In any patient who has had a past history of malignancy, the most thorough and searching examination should be carried out. It is essential to have an accurate diagnosis of the tissue causing symptoms. If the tissue symptom is of a mechanical nature, then there is no reason why treatment cannot be carried out. Symptoms that might originate from secondary malignancies may well appear to respond in the short term to physical treatment, but the benefit will only be temporary and is probably due to circulatory and psychological factors.


Some types of vertigo can be helped substantially by physical treatment, particularly to the neck and upper thoracic area. Some types can be aggravated. Meniere's disease and postural hypotension can be irritated by over-vigorous and rapid techniques. Both may well be helped, however, by appropriate techniques for the situation. Both cases may prefer to be treated sitting up rather than fully recumbent.


Psychological dependence on physical treatment is not uncommon and providing the operator has assured himself that the patient does have a true physical cause for his symptoms, then treatment can be valid. It must be said, nevertheless, that this type of patient becomes an expert in emphasizing minor physical disturbances. The less experienced practitioner may well find themselves treating such a patient who has been the rounds of others. Any patient who has seen several other practitioners should be looked on with extreme caution. It is easy to assume that the other practitioner has missed something obvious. They may have done, but it is far more likely that they have done the obvious thing and as this has not produced the result, the patient has moved on to someone else. Every practitioner wants to give the patient a good result; if drawn in to a situation where the patient is very importunate for treatment, it can be very difficult to resist. Several treatments later, if there is no result, it can be very difficult to extricate oneself from the situation unless a 'contract' has been established in the first place. This is the type of case where it is wise to establish an agreement to a re-examination after a predetermined number of treatments. If the desired changes have not taken place, it is best to avoid further treatment until further investigations or a second opinion have been sought.


If something just does not feel right, then this is a good reason to perform more thorough investigation or examination. The sixth sense of this combination of learned facts, experience and temporarily forgotten aspects can be very reliable. If something just feels wrong, stop and reconsider. If signs and symptoms do not match, this is the time to think again. There may be hidden pathology or anomaly. There may be psychological factors, or the patient may be overemphasizing their problem for some other reason. It is clearly necessary to find out more accurately what is going on.

The whole subject of contra-indications is dependent on accurate assessment of the cause and nature of the presenting condition. If an accurate diagnosis has been made, the contra-indications should be obvious. Slow, deliberate technique while getting feedback from the tissues is probably the guide that most practitioners rely on. It is not a finite science, but rather an application of science, art and reasoning.

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