Brazilian Journal of Pain
Brazilian Journal of Pain
Review Article

Joint mobilization associated or not to other therapies reduces chronic musculoskeletal pain: a systematic review

Thiago dos Santos Sousa Abner; Maria Ivone Oliveira Dantas; Isabela Freire Azevedo-Santos; Josimari Melo DeSantana

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BACKGROUND AND OBJECTIVES: Joint mobilization is a non-pharmacological technique used to treat chronic musculoskeletal pain. However, it is controversial due to a lack of studies comparing its effects on this painful condition. The objective of this study was to assess the risk of bias in clinical trials investigating the effect of joint mobilization on chronic musculoskeletal pain.

CONTENTS: A systematic search on Pubmed, Cochrane Library, ScienceDirect, Scielo, PEDro, CINAHL, SPORTDiscus, LILACS, BVS, PsycINFO, Web of Science, and Scopus was performed on September 2019 from the combination of three keywords: Musculoskeletal Manipulations AND Chronic Pain AND Musculoskeletal Pain. Randomized controlled clinical trials that evaluated the use of joint mobilization associated or not to other therapies in chronic musculoskeletal pain treatment were included. Five thousand five hundred eighty-seven articles were screened, and 14 studies were analyzed, including 812 participants, with a mean age of 54 years, and female being the most affected. According to these articles, joint mobilization promoted the reduction of pain intensity in short and long terms, increase in range of motion, strength and function when used alone or in association with conventional physiotherapy. Regarding methodological quality, most of the studies were classified with low risk for selection, performance, detection and reporting bias. In the “other bias” item, which considered therapists experience time and types of treatment applied, only one study presented low risk and other study presented an unclear risk.

CONCLUSION: Joint mobilization seems to be an effective technique for the treatment of chronic musculoskeletal pain. However, it is still necessary to investigate and compile studies with greater methodological quality, thus promoting greater support to evidence-based practice.


Chronic pain, Musculoskeletal manipulations, Musculoskeletal pain


Sampath KK, Mani R, Miyamori T, Tumilty S. The effects of manual therapy or exercise therapy or both in people with hip osteoarthritis: a systematic review and meta-analysis. Clin Rehabil. 2016;30(12):1141-55.

Sahrmann S, Azevedo DC, Dillen LV. Diagnosis and treatment of movement system impairment syndromes. Braz J Phys Therapy. 2017;21(6):391-9.

Blyth FM, Noguchi N. Chronic musculoskeletal pain and its impact on older people. Best Pract Res Clin Rheumatol. 2017;31(2):160-8.

Cimmino MA, Ferrone C, Cutolo M. Epidemiology of chronic musculoskeletal pain. Best Pract Res Clin Rheumatol. 2011;25(2):173-83.

Toye F, Seers K, Allcock N, Briggs M, Carr E, Andrews J. Patients' experiences of chronic non-malignant musculoskeletal pain: a qualitative systematic review. Br J Gen Pract. 2013;63(617):e829-e41.

Gerdle B, Ghafouri B, Ernberg M, Larsson B. Chronic musculoskeletal pain: review of mechanisms and biochemical biomarkers as assessed by the microdialysis technique. J Pain Res. 2014;7:313.

Crofford LJ. Chronic pain: where the body meets the brain. Trans Am Clin Climatol Assoc. 2015;126:167.

Clauw DJ. Diagnosing and treating chronic musculoskeletal pain based on the underlying mechanism(s). Best Pract Res Clin Rheumatol. 2015;29(1):6-19.

Hirase T, Kataoka H, Inokuchi S, Nakano J, Sakamoto J, Okita M. Factors associated with chronic musculoskeletal pain in Japanese community-dwelling older adults: A cross-sectional study. Medicine. 2017;96(23).

Geneen LJ, Moore RA, Clarke C, Martin D, Colvin LA, Smith BH. Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews. Cochrane Database Syst Rev. 2017;4:CD011279.

Ushida T. Burdensome problems of chronic musculoskeletal pain and future prospects. J Orthop Sci. 2015;20(6):958-66.

Rajapakse D, Liossi C, Howard RF. Presentation and management of chronic pain. Arch Dis Child. 2014;99(5):474-80.

Krekoukias G, Gelalis ID, Xenakis T, Gioftsos G, Dimitriadis Z, Sakellari V. Spinal mobilization vs conventional physiotherapy in the management of chronic low back pain due to spinal disk degeneration: a randomized controlled trial. J Man Manip Ther. 2017;25(2):66-73.

Coulter ID, Crawford C, Hurwitz EL, Vernon H, Khorsan R, Booth MS. Manipulation and mobilization for treating chronic low back pain: a systematic review and meta-analysis. Spine J. 2018;18(5):866-79.

Richer N, Marchand AA, Descarreaux M. Management of chronic lateral epicondylitis with manual therapy and local cryostimulation: a pilot study. J Chiropr Med. 2017;16(4):279-88.

Wyke B, Polacek P. Articular neurology: the present position. J Joint Bone Surg. 1975;57(3):401.

Taylor AM, Phillips K, Patel KV, Turk DC, Dworkin RH, Beaton D. Assessment of physical function and participation in chronic pain clinical trials: IMMPACT/ OMERACT recommendations. Pain. 2016;157(9):1836-50.

Seroussi R. Chronic pain assessment. Phys Med Rehabil Clin N Am. 2015;26(2):185-99.

Kingston L, Claydon L, Tumilty S. The effects of spinal mobilizations on the sympathetic nervous system: a systematic review. Man Ther. 2014;19(4):281-7.

Lovick T. Interactions between descending pathways from the dorsal and ventrolateral periaqueductal gray matter in the rat. 1991.

Sterling M, Jull G, Wright A. Cervical mobilisation: concurrent effects on pain, sympathetic nervous system activity and motor activity. Man Ther. 2001;6(2):72-81.

Paungmali A, O'Leary S, Souvlis T, Vicenzino B. Hypoalgesic and sympathoexci-tatory effects of mobilization with movement for lateral epicondylalgia. Phys Ther.. 2003;83(4):374-83.

Slater H, Vicenzino B, Wright A. J Man Manip. Ther. 1994;2(4):156-62.

Perry J, Green A, Singh S, Watson P. A randomised, independent groups study investigating the sympathetic nervous system responses to two manual therapy treatments in patients with LBP. Man Ther. 2015;20(6):861-7.

Tsirakis V, Perry J. The effects of a modified spinal mobilisation with leg movement (SMWLM) technique on sympathetic outflow to the lower limbs. Man Ther. 2015;20(1):103-8.

Piekarz V, Perry J. An investigation into the effects of applying a lumbar Maitland mobilisation at different frequencies on sympathetic nervous system activity levels in the lower limb. Man Ther. 2016;23(1):83-9.

Moutzouri M, Perry J, Billis E. Investigation of the effects of a centrally applied lumbar sustained natural apophyseal glide mobilization on lower limb sympathetic nervous system activity in asymptomatic subjects. J Manipulative Physiol Ther. 2012;35(4):286-94.

Cleland J, Durall C, Scott SA. Effects of slump long sitting on peripheral sudomotor and vasomotor function: a pilot study. J Man Manip Ther. 2002;10(2):67-75.

Navarro-Santana MJ, Gómez-Chiguano GF, Somkereki MD, Fernández-de-las-Peñas C, Cleland JA, Plaza-Manzano G. Plaza-Manzano G. Effects of joint mobilisation on clinical manifestations of sympathetic nervous system activity: a systematic review and meta-analysis. Physiotherapy. 2019.

Vicenzino B, Cartwright T, Collins D, Wright A. Cardiovascular and respiratory changes produced by lateral glide mobilization of the cervical spine. Man Ther.. 1998;3(2):67-71.

La Touche R, París-Alemany A, Mannheimer JS, Angulo-Díaz-Parreño S, Bishop MD, Lopéz-Valverde-Centeno A. Does mobilization of the upper cervical spine affect pain sensitivity and autonomic nervous system function in patients with cervi-co-craniofacial pain?: A randomized-controlled trial. Clin J Pain. 2013;29(3):205-15.

Roy RA, Boucher JP, Comtois AS. Paraspinal cutaneous temperature modification after spinal manipulation at L5. J Manipulative Physiol Ther. 2010;33(4):308-14.

Skyba D, Radhakrishnan R, Rohlwing J, Wright A, Sluka K. Joint manipulation reduces hyperalgesia by activation of monoamine receptors but not opioid or GABA receptors in the spinal cord. Pain. 2003;106(1-2):159-68.

Martins DF, Mazzardo-Martins L, Cidral-Filho FJ, Stramosk J, Santos AR. Ankle joint mobilization affects postoperative pain through peripheral and central adenosine A1 receptors. Phys Ther. 2013;93(3):401-12.

Fredin K, Loras H. Manual therapy, exercise therapy or combined treatment in the management of adult neck pain - a systematic review and meta-analysis. Musculos-kelet Sci Pract. 2017;31:62-71.

Bennell K, Wee E, Coburn S, Green S, Harris A, Staples M. Efficacy of standardised manual therapy and home exercise programme for chronic rotator cuff disease: randomised placebo controlled trial. BMJ. 2010;340:c2756.

Tavares FA, Chaves TC, Silva ED, Guerreiro GD, Gonçalves JF, Albuquerque AA. Immediate effects of joint mobilization compared to sham and control intervention for pain intensity and disability in chronic low back pain patients: randomized controlled clinical trial. Rev Dor. 2017;18(1):2-7.

Beselga C, Neto F, Alburquerque-Sendín F, Hall T, Oliveira-Campelo N. Immediate effects of hip mobilization with movement in patients with hip osteoarthritis: a randomised controlled trial. Man Ther. 2016;22:80-5.

Crossley KM, Vicenzino B, Lentzos J, Schache AG, Pandy M, Ozturk H. Exercise, education, manual-therapy and taping compared to education for patello-femoral osteoarthritis: a blinded, randomised clinical trial. Osteoarthritis Cartilage. 2015;23(9):1457-64.

Shashua A, Flechter S, Avidan L, Ofir D, Melayev A, Kalichman L. The effect of additional ankle and midfoot mobilizations on plantar fasciitis: a randomized controlled trial. J Orthop Sports Phys Ther. 2015;45(4):265-72.

Snodgrass SJ, Rivett DA, Sterling M, Vicenzino B. Dose optimization for spinal treatment effectiveness: a randomized controlled trial investigating the effects of high and low mobilization forces in patients with neck pain. J Orthop Sports Phys Ther. 2014;44(3):141-52.

Farooq MN, Mohseni-Bandpei MA, Gilani SA, Ashfaq M, Mahmood Q. The effects of neck mobilization in patients with chronic neck pain: A randomized controlled trial. J Bodyw Mov Ther. 2018;22(1):24-31.

Mayor EE, Pérez GL, Martín YP, del Barco ÁA, Fuertes RR, Requejo CS. Ensayo clínico aleatorizado en pacientes con cervicalgia mecánica en atención primaria: terapia manual frente a electroestimulación nerviosa transcutánea. Aten Primaria. 2008;40(7):337-43.

Villafañe JH, Silva GB, Fernandez-Carnero J. Effect of thumb joint mobilization on pressure pain threshold in elderly patients with thumb carpometacarpal osteoarthritis. J Manipulative Physiol Ther. 2012;35(2):110-20.

Villafañe JH, Langford D, Alguacil-Diego IM, Fernández-Carnero J. Management of trapeziometacarpal osteoarthritis pain and dysfunction using mobilization with movement technique in combination with kinesiology tape: a case report. J Chir Med. 2013;12(2):79-86.

Villafañe JH, Silva GB, Diaz-Parreño SA, Fernandez-Carnero J. Hypoalgesic and motor effects of kaltenborn mobilization on elderly patients with secondary thumb carpometacarpal osteoarthritis: a randomized controlled trial. J Manipulative Physiol Ther. 2011;34(8):547-56.

Villafañe JH, Cleland JA, Fernandez-De-Las-Peñas C. Bilateral sensory effects of unilateral passive accessory mobilization in patients with thumb carpometacarpal osteoarthritis. J Manipulative Physiol Ther. 2013;36(4):232-7.

Horst R, Maicki T, Trąbka R, Albrecht S, Schmidt K, Mçtel S. Activity-vs. struc-tural-oriented treatment approach for frozen shoulder: a randomized controlled trial. Clin Rehabil. 2017;31(5):686-95.

Sterling M, Pedler A, Chan C, Puglisi M, Vuvan V, Vicenzino B. Cervical lateral glide increases nociceptive flexion reflex threshold but not pressure or thermal pain thresholds in chronic whiplash associated disorders: a pilot randomised controlled trial. Man Ther. 2010;15(2):149-53.

Hidalgo B, Hall T, Bossert J, Dugeny A, Cagnie B, Pitance L. The efficacy of manual therapy and exercise for treating non-specific neck pain: A systematic review. J Back Musculoskelet Rehabil. 2017;30(6):1149-69.

Hidalgo B, Detrembleur C, Hall T, Mahaudens P, Nielens H. The efficacy of manual therapy and exercise for different stages of non-specific low back pain: an update of systematic reviews. J Man Manip Ther. 2014;22(2):59-74.

Jayaseelan DJ, Scalzitti DA, Palmer G, Immerman A, Courtney CA. The effects of joint mobilization on individuals with patellofemoral pain: a systematic review. Clin Rehabil. 2018;32(6):722-33.

Haik M, Alburquerque-Sendín F, Moreira R, Pires E, Camargo P. Effectiveness of physical therapy treatment of clearly defined subacromial pain: a systematic review of randomised controlled trials. Br J Sports Med. 2016.

Stathopoulos N, Dimitriadis Z, Koumantakis GA. Effectiveness of Mulligan's Mobilization with Movement techniques on pain and disability of peripheral joints: A systematic review with meta-analysis between 2008-2017. Physiotherapy. 2018.

Gross A, Kay TM, Paquin JP, Blanchette S, Lalonde P, Christie T. Exercises for mechanical neck disorders. Cochrane Database Syst Rev. 2015;1:CD004250.

May M, Junghaenel DU, Ono M, Stone AA, Schneider S. Ecological Momentary Assessment Methodology in Chronic Pain Research: A Systematic Review. J Pain. 2018;19(7):699-716.

Swait G, Finch R. What are the risks of manual treatment of the spine? A scoping review for clinicians. Chiropr Man Therap. 2017;25:37.

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