Spinal manipulation and mobilisation for paediatric conditions: time to stop the madness

An international taskforce of clinician-scientist physiotherapists with expertise in spinal manipulation and mobilisation, paediatric rehabilitation, and research design were recruited to develop an evidence-based position statement on the benefits and harms of spinal manipulation and mobilisation treatment in paediatric populations (<18 years) by the World Physiotherapy specialty groups; the International Federation of Orthopaedic Manipulative Physical therapists(IFOMPT) and the International Organisation of Physiotherapists in Paediatrics (IOPTP). This taskforce, formed in February 2020, was in response to controversy on the safety and efficacy of spinal manipulation in paediatric populations [Citation1,Citation2]. An independent expert review by Safer Care Victoria in 2019 identified foundational evidence to recommend to the Council of Australian Governments prohibition of spinal manipulation for general wellness or to manage non-musculoskeletal conditions in children under 12 years of age [Citation1,Citation2]. Up to this point, the international physiotherapy community had not come forward with a position statement on the use of spinal manipulation and mobilisation for paediatric populations. In this special issue of the Journal of Manual and Manipulative Therapy (JMMT), the taskforce has developed a position paper and supporting evidence-based papers to systematically synthesize the research evidence and clinical expert opinion resulting in seven actionable evidence-based practice position statements on the appropriateness of using spinal manipulation and mobilisation in paediatric populations. The taskforce completed a systematic scoping review, two systematic clinometric reviews, a Delphi survey of an international physiotherapy expert panel, and a position paper [Citation3–8]. Clinical messages supported by this body of work and stated in the position paper in this special issue have one overarching point – ‘spinal manipulation and mobilisation are not appropriate and should not be performed on infants (<2 years of age) or to treat non-musculoskeletal paediatric conditions’ [Citation6,Citation8].