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Updated: May 24, 2026

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Manipulation efficacy: Upper body.

J W Atchison1

  • 1Division of Physical Medicine and Rehabilitation, Department of Orthopaedics and Rehabilitation, College of Medicine, The University of Florida, 200B SW 62nd Blvd, Gainesville, FL 32607, USA. James-Atchison@ufl.edu.

Journal of Back and Musculoskeletal Rehabilitation
|March 6, 2012
PubMed
Summary

Manual medicine, or manipulation, is widely used for musculoskeletal disorders, but its upper body efficacy and safety remain unclear. More research is needed to guide practitioners on its use for the cervical spine and upper limbs.

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Area of Science:

  • Orthopedics
  • Physical Medicine
  • Rehabilitation

Background:

  • Manual medicine, including manipulation, is a common treatment for musculoskeletal disorders.
  • Significant questions persist regarding the efficacy and safety of manual manipulation, particularly for the upper body.
  • Existing research on upper body manipulation is limited compared to the lumbar spine.

Purpose of the Study:

  • To review published trials on manual manipulation for upper body musculoskeletal disorders (cervical, thoracic, upper limb).
  • To identify patient groups who may benefit from manual treatment, their outcomes, and study limitations.
  • To discuss the safety concerns, side effects, complications, and contraindications of cervical manipulation.

Main Methods:

  • Systematic review of published clinical trials.

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  • Analysis of patient populations, treatment outcomes, and identified limitations.
  • Examination of safety data, including adverse events and contraindications for cervical manipulation.

    • Main Results:

    • The number of studies on upper body manipulation is notably smaller than for the lumbar spine.
    • Evidence regarding patient groups, outcomes, and limitations is not uniform across studies.
    • Cervical manipulation has specific safety concerns, including potential side effects and contraindications.

    Conclusions:

    • The current evidence base for upper body manipulation is limited and lacks uniformity.
    • Practitioners must exercise clinical judgment to determine the appropriate use of manipulation for the cervical spine and upper limb.
    • Further standardized research is required to establish clear guidelines for manual medicine in the upper body.