Adverse events associated with manual therapy of peripheral joints: A scoping review

We performed a systematic review of potential adverse events (AEs) of manual therapy to peripheral joints using PubMed, CINAHL, PEDro, AMED, and Google Scholar with a single term for each peripheral body region (shoulder, elbow, wrist, hand, hip, knee, ankle, foot). Inclusion criteria included articles that examined or reported the occurrence of AEs. Exclusion criteria included literature discussing treatment other than manual therapy or surgery.

Twenty total articles meeting the inclusion criteria were found. A total of fifty-three adverse events were analyzed. Most AEs were benign. Little evidence exists for serious AEs with manual therapy. Scant serious AEs were reported with acupuncture or massage near the shoulder, hip, and knee.

AEs with manual therapy to the spine have garnered ample attention in literature. Traditional manual therapy consists of joint mobilization, thrust manipulation, and a variety of soft tissue techniques. However, with the popularity of other "manual therapies", outside the traditional definition, the practitioner and client should be aware of the risks.

AEs occurring with most manual therapy techniques to the peripheral joints are transient and mild. It is difficult to attribute true AEs to manual therapy in multi-modal treatment paradigms with numerous single session interventions. Since there are no international definitions or classifications of AEs, and the definition of manual.