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The Effect of Joint Mobilization and Manipulation on Proprioception: Systematic Review with Limited Meta-Analysis
Stelios Hadjisavvas1, Irene-Chrysovalanto Themistocleous1, Michalis A Efstathiou1
1Department of Health Sciences, Physiotherapy Program, University of Nicosia, Nicosia 1700, Cyprus.
Journal of Functional Morphology and Kinesiology
|February 20, 2026
Summary
Articular manual therapy, including joint mobilization and manipulation, shows promise in improving joint position sense error (JPSE) in conditions like neck and patellofemoral pain. However, evidence is limited by study heterogeneity and the need for standardized protocols.
Area of Science:
- Musculoskeletal Rehabilitation
- Neuroscience
- Manual Therapy Research
Background:
- Proprioceptive deficits, measured as joint position sense error (JPSE), are common in musculoskeletal disorders.
- Articular manual therapy techniques may modulate afferent input and sensorimotor control.
Purpose of the Study:
- To systematically review and synthesize the effects of joint mobilization and high-velocity low-amplitude (HVLA) thrust manipulation on quantitative proprioception in humans.
- To assess the impact of manual therapy on joint position sense error (JPSE) across various musculoskeletal conditions.
Main Methods:
- Systematic search of PubMed, Scopus, CINAHL, and MEDLINE Complete for randomized or sham-controlled trials up to November 2025.
- Inclusion of English-language studies assessing proprioception post-mobilization or HVLA thrust manipulation.
- Risk of bias assessment (RoB 2) and random-effects meta-analysis (Hedges' g) where feasible; GRADE certainty assessment.
Main Results:
- Seven randomized clinical trials (2018-2025, n=350) evaluated manual therapy for spinal or peripheral joints.
- Cervical thrust manipulation improved cervical JPSE in chronic mechanical neck pain (large effect sizes).
- Lumbopelvic manipulation showed immediate reductions in knee JPSE for patellofemoral pain; meta-analysis of knee JPSE at 60° flexion was not statistically significant (Hedges' g = -0.21).
Conclusions:
- Articular manual therapy can immediately improve quantitative proprioception, particularly JPSE in neck and patellofemoral pain.
- Observed effects are condition- and outcome-specific, with limited confidence due to heterogeneity and sparse poolable data.
- Future research requires standardized proprioception protocols, longer follow-up, and data suitable for robust meta-analysis.
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