Comlex Practice Test & Exam Prep

High-velocity, low-amplitude thrusts are aimed at a joint or region with controlled stability. An acute fracture or dislocation at the treatment site is an absolute contraindication because the bone or joint is unstable, and a thrust could propagate the fracture, worsen dislocation, or injure the spinal cord or surrounding neurovascular structures. In such cases, HVLA must be avoided, and safer alternatives like soft tissue techniques, muscle energy, or gentle mobilization are preferred while the fracture or dislocation is assessed and stabilized. Mild scoliosis, advanced age alone, or patient preference for a different technique do not, by themselves, constitute absolute contraindications; they require clinical judgment and discussion about risks, benefits, and alternatives, rather than an outright ban on HVLA.