Spinal manipulation and mobilisation among infants, children, and adolescents: an international Delphi survey of expert physiotherapists

Jenifer L. Dice, Jean Michel Brismée, Frédéric P. Froment, Janis Henricksen, Rebecca Sherwin, Jan Pool, Nikki Milne*, Derek Clewley, Annalie Basson, Kenneth A. Olson, Anita R. Gross

*Corresponding author for this work

Research output: Contribution to journalArticleResearchpeer-review

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The aim of this study was to establish international consensus regarding the use of spinal manipulation and mobilisation among infants, children, and adolescents among expert international physiotherapists. 


Twenty-six international expert physiotherapists in manual therapy and paediatrics voluntarily participated in a 3-Round Delphi survey to reach a consensus via direct electronic mail solicitation using Qualtrics®. Consensus was defined a-priori as ≥75% agreement on all items with the same ranking of agreement or disagreement. Round 1 identified impairments and conditions where spinal mobilisation and manipulation might be utilised. In Rounds 2 and 3, panelists agreed or disagreed using a 4-point Likert scale. 


Eleven physiotherapists from seven countries representing five continents completed all three Delphi rounds. Consensus regarding spinal mobilisation or manipulation included: Manipulation is not recommended: (1) for infants across all conditions, impairments, and spinal levels; and (2) for children and adolescents across most conditions and spinal levels. Manipulation may be recommended for adolescents to treat spinal region-specific joint hypomobility (thoracic, lumbar), and pain (thoracic). Mobilisation may be recommended for children and adolescents with hypomobility, joint pain, muscle/myofascial pain, or stiffness at all spinal levels.


Consensus revealed spinal manipulation should not be performed on infants regardless of condition, impairment, or spinal level. Additionally, the panel agreed that manipulation may be recommended only for adolescents to treat joint pain and joint hypomobility (limited to thoracic and/or lumbar levels). Spinal mobilisation may be recommended for joint hypomobility, joint pain, muscle/myofascial pain, and muscle/myofascial stiffness at all spinal levels among children and adolescents.

Original languageEnglish
Pages (from-to)1-11
Number of pages11
JournalJournal of Manual and Manipulative Therapy
Early online dateMar 2024
Publication statusE-pub ahead of print - Mar 2024


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