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Musculoskelet Sci Pract. 2017 Jun;29:20-27. doi: 10.1016/j.msksp.2017.02.009. Epub 2017 Mar 6.

Adverse effects as a consequence of being the subject of orthopaedic manual therapy training, a worldwide retrospective survey.

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Department of General Practice, Erasmus Medical Centre, Rotterdam, The Netherlands; OMPT Clinic Fysio-Experts, Hazerswoude, The Netherlands.
OMPT Clinic Fysio-Experts, Hazerswoude, The Netherlands. Electronic address:
School of Rehabilitation, Faculty of Medicine, Université de Montréal, Centre de recherche de l'Hôpital Maisonneuve-Rosemont, Montréal, Canada.
Department of Philosophy, University of Nottingham, Nottingham, United Kingdom.
Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, United Kingdom.



Physical therapists (PTs) use a range of manual therapy techniques developed to an advanced level through postgraduate orthopaedic manipulative physical therapy (OMPT) programmes. The aim of this study was to describe the adverse effects experienced by students after having techniques performed on them as part of their OMPT training.


A descriptive online survey of current students and recent graduates (≤5 years)m of OMPT programmes across the 22 Member Organisations of the International Federation of Orthopaedic Manipulative Physical Therapists.


The questionnaire was completed by 1640 respondents across 22 countries (1263 graduates, 377 students. Some 60% of respondents reported never having experienced adverse effects during their manual therapy training. Of the 40% who did, 66.4% reported neck pain, 50.9% headache and 32% low back pain. Most reports of neck pain started after a manipulation and/or mobilisation, of which 53.4% lasted ≤24 h, 38.1% > 24 h but <3 months and 13.7% still experienced neck pain to date. A small percentage of respondents (3.3%) reported knowing of a fellow student experiencing a major adverse effect.


Mild to moderate adverse effects after practising manual therapy techniques are commonly reported, but usually resolve within 24 h. However, this survey has identified the reported occurrence of major adverse effects that warrant further investigation.


Adverse effects; Adverse event; Manipulation; Manual therapy; Mobilisation; Survey

[Indexed for MEDLINE]

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