What Do We Know About Spinal Manual Therapy For People With Osteoporosis? A Narrative Review

Background: Provision of spinal manual therapy for people with osteoporosis is controversial: the effect and safety have not been studied in-depth and are unclear.Objectives: To provide an overview about spinal manual therapy and its safety and applicability for people with osteoporosis. We conducted two separate search strategies of biomechanical and clinical literature in PubMed, EMBASE, and Sportdiscus (1955-2020) to answer the following research questions: (1) How much force results from spinal mobilizations and is required to fracture vertebral components with spinal mobilizations? (2) What spinal manual therapy techniques have been described and what are their effects for people with osteoporosis? (3) What adverse events have been reported?Major findings: 16 articles described forces produced by PA mobilization varying widely by grade of mobilization [(9 to 205.8 N (Grade I), 2.2 to 119.23 N (Grade II), 75.5 to 206 N (Grade III), and 89.2 to 499.8 N (Grade IV)]. One article identified vertebral components fail under PA loads of 200 to 727 N. One case study and three randomized controlled trials were included. Mobilization techniques used were Grade II to IV with no serious adverse events reported.Conclusions: Our narrative review revealed limited literature about the risk and clinical benefits of spinal manual therapy for people with osteoporosis. Further, the forces applied during spinal manual therapy techniques vary widely between therapists depending on the area being treated and patient characteristics. Further work about spinal manual therapy for people with osteoporosis is necessary to draw conclusions about safety and effectiveness.