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

Research output: Contribution to journalArticlepeer-review


  • M. Thoomes-de Graaf
  • E. Thoomes
  • L. Carlesso
  • R. Kerry
  • Ali Rushton

External organisations

  • Department of General Practice, Erasmus Medical Centre, Rotterdam, The Netherlands
  • OMPT Clinic Fysio-Experts, Hazerswoude, The Netherlands
  • 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


Background 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. Design 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. Results 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. Conclusion 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.


Original languageEnglish
Pages (from-to)20-27
JournalMusculoskeletal Science and Practice
Early online date9 Mar 2017
Publication statusPublished - Jun 2017


  • Mobilisation, Survey, Adverse effects, Adverse event, Manual therapy, Manipulation