2.3 Past History

Past History

Quick Answer: Past history captures everything about the patient that existed before today's complaint — prior spine care and surgery, trauma, chronic disease, medications, allergies, and hospitalizations — because several of these directly change the safety of a spinal adjustment. Anticoagulant therapy, osteoporosis, and a history of cancer are the three past-history findings most likely to alter or contraindicate manual adjustive technique on NBCE Part III.

Why Past History Changes the Plan, Not Just the Note

Unlike the chief complaint and present illness, which describe today's problem, past history describes the patient's baseline. Its clinical purpose in a chiropractic setting is different from a general medical history: the examiner is not only building a differential diagnosis, but is also screening for factors that change whether and how a segment can be safely adjusted. A past-history item that would be a minor footnote in a general medical note — a bisphosphonate prescription, a decade-old cervical fusion — can be the single most important line in a chiropractic case history.

Prior Spine Care and Surgery

• Ask about prior chiropractic, physical therapy, osteopathic, or medical spine care and the outcome of each; response to prior conservative care is one of the best predictors of response to a similar plan now.
• Prior spinal surgery (discectomy, fusion, laminectomy) changes both biomechanics and site selection for adjustment. A fused segment cannot be adjusted at that level, and adjacent segments carry increased compensatory mechanical stress and should be evaluated with that in mind.
• Ask specifically about spinal injections, such as epidural steroid or facet blocks. A positive response to a specific diagnostic injection is clinically useful information even though it falls outside chiropractic scope of practice.

Trauma History

• Distinguish recent trauma relevant to the current episode (covered under mechanism of injury in the present illness) from remote trauma relevant to baseline structural status.
• Remote trauma — old motor-vehicle collisions, falls, sports injuries — can explain baseline asymmetries, old healed fractures, or chronic instability found on exam that are unrelated to today's complaint.
• A history of whiplash-associated disorder is particularly relevant to cervical spine case histories and should be documented with the original mechanism, symptoms at the time, and any residual symptoms that persist today.

Chronic Disease Relevant to Adjustive Risk

Medications and Allergies

• Anticoagulants and antiplatelet agents (warfarin, direct oral anticoagulants, clopidogrel, high-dose aspirin) increase bleeding risk with any technique that could cause vascular or soft-tissue injury, and this class is the most frequently tested medication category in Part III adjustive-risk case histories.
• Long-term corticosteroid use increases osteoporosis and fracture risk and can blunt a fever response, which may mask early signs of infection.
• NSAID use may mask an inflammatory pain pattern and increases gastrointestinal bleeding risk independent of the spine, which is relevant when co-managing with other providers.
• Bisphosphonates signal a prior diagnosis of osteoporosis or osteopenia even if the patient does not volunteer the diagnosis by name; always cross-reference the medication list against conditions the patient may have forgotten to mention.
• Allergies matter less for adjustive risk directly but become essential if referral, contrast imaging, or co-managed pharmacologic therapy is anticipated.

Hospitalizations Relevant to Adjustive Risk

• Any hospitalization for spinal fracture, spinal infection, or spinal surgery should be documented with dates and outcome.
• Hospitalization for stroke, transient ischemic attack, or another vascular event — especially involving the vertebrobasilar or carotid system — is a critical past-history flag before cervical spine manipulation is considered.
• Hospitalization for cancer treatment (chemotherapy, radiation) should prompt questions about whether radiation fields included the spine, since radiation can increase bone fragility, and about current disease status (active disease vs. remission).
• A recent hospitalization for any reason may indicate general deconditioning, or anticoagulation started during the stay, that the patient may not think to mention as an "ongoing medication."

Building a Contraindication Risk Picture

No single past-history item automatically forbids all chiropractic care; the goal of gathering this information is to stratify risk and modify technique, not to reflexively refuse care.

Quick Recap

• Past history is not background color — several items (anticoagulants, osteoporosis, cancer, upper cervical instability risk) directly change whether and how a segment can be safely adjusted.
• Always cross-check the medication list against conditions the patient may not volunteer, since a bisphosphonate implies osteoporosis even if unstated.
• Remote trauma explains baseline exam findings; recent trauma belongs in the mechanism-of-injury discussion within the present illness.
• The goal of past-history screening is risk stratification and technique modification, not automatic exclusion from care.