Considering that there are no abnormalities such as hypomobility or decreased bone mineral density, what is the average youngest and oldest age that you would perform a joint mobilization on? And how soon after a joint surgery would you complete a mobilization (considering it is just a grade 1 or 2 for pain relief)?

Manipulation is a passive technique where the therapist applies a specifically directed manual impulse, or thrust, to a joint, at or near the end of the passive (or physiological) range of motion. Joint manipulations can relieve pain by taking pressure off sensitive nerves or tissue, by increasing range of motion, by restoring blood flow, by reducing muscle tension, and like active exercise, by promoting the release of endorphins within the body to act as natural painkillers.

Specific safety precautions associated with manipulation in general and manipulation in specific regions such as the cervical spine are, of course, a necessary component of application such as deciding when to utilize manipulation, when not to, and when to refer to a physician or other practitioner based on known signs of safety or other medical concerns. Contraindications associated with the utilization of joint manipulation to date have been based primarily on the opinion of the practitioner (joint mobilizations techniques are not exclusive to physical therapists alone) and not based on any rigid set of age guidelines. In general, manual therapy procedures are contraindicated when motion into a segmental region is contraindicated by the patient examination data collected. Specifically, for spinal joint manipulations (for any age), the following scenarios are contraindicated for the use of joint mobilization techniques in the management of low back pain:

• Any pathology that leads to significant bone weakening
• Neurological: cord compression, cauda equina compression, nerve root compression with increasing neurological deficit
• Vascular: aortic aneurism, bleeding into joints
• Lack of diagnosis
• Patient positioning that cannot be achieved because of pain or resistance.

Typically, the pediatric/juvenile population are seldom candidates for joint mobilizations/manipulations because of their resiliency. Furthermore, irrespective of the absence of decreased bone mineral density, extra care is taken when manipulations of any kind is being considered for members of  the geriatric population.

Finally, the first few weeks following surgery (about 6 weeks post surgery) is generally considered the protective phase. Gentle mobilizations, including non-thrust manipulations may be applied following this phase in order to relieve pain and to carefully increase range of motion. The last stage following the mobilization stage is usually the strengthening phase.

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