Why is the prevailing model of joint manipulation (still) incorrect?

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For manipulation, this paper addresses arguably the most fundamental question that can be asked about any therapeutic intervention: what is it? In answering this question, this paper presents the prevailing model of joint manipulation (of Sandoz) and explains why this influential model is fundamentally flawed. The early research on 'joint cracking' that led to the development of this model is described in chronological order, alongside how this research was misinterpreted, which gave rise to the model's flaw. Of concern, the flaw in this model makes worrying predictions that could lead to dangerous clinical decisions. Understandably, these predictions have attracted criticism over the use of manipulation as a therapeutic intervention. A corrected model, first published by Evans and Breen more than 15 years ago, is then presented and explained. Unlike the flawed model, this corrected model makes predictions in line with all available empirical data and additionally provides reassuring answers to critics. Many current definitions of manipulation have inherited the flaw from Sandoz's model. Hence, a better, empirically derived definition, consistent with the corrected model, is now required.

Original languageEnglish
Article number51
JournalChiropractic & manual therapies
Issue number1
Publication statusPublished - 9 Dec 2022

Bibliographical note

© 2022. The Author(s).


  • Manual therapy
  • Manipulation
  • Joint
  • Metacarpophalangeal
  • Cavitation
  • Definition
  • Model


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