Which of the following is explicitly listed as a contraindication for manual therapy?

• A. Acute sprains/strains
• B. Chronic sprains
• C. Healthy joints
• D. Uninjured healing

Answer: (A)

Manual therapy is avoided when tissue damage is acute because healing tissue is fragile and inflammatory processes are active. In an acute sprain or strain, ligaments or muscles have micro-tears with swelling and heightened sensitivity, so applying manual techniques can worsen inflammation, increase pain, or disrupt the early healing process. That combination of tissue fragility and active inflammation is why acute sprains/strains are explicitly listed as a contraindication for manual therapy.

Chronic sprains, healthy joints, or tissues that are in an uninjured state do not carry that same immediate risk, so they’re not considered explicit contraindications. These states may be appropriate for manual therapy, depending on a full assessment of symptoms, function, and healing status.