# Knowledge and use of thoracic manipulations by manual therapists in Belgium and the Netherlands

## TL;DR

This study explores how manual therapists in Belgium and the Netherlands use thoracic manipulations, finding they rely on experience rather than screening tools.

## Contribution

The study provides new insights into the clinical practices and reasoning behind thoracic manipulations among manual therapists in two European countries.

## Key findings

- Most therapists treat muscular thoracic complaints and rely on clinical experience to exclude red flags.
- Biomechanical effects are the most favored rationale for using thoracic manipulations.
- There are inconsistencies in how therapists screen for contraindications and differentiate thoracic regions.

## Abstract

Beneficial effects of thoracic manipulations (TM) have been demonstrated; however, there is a lack of clarity regarding their use in clinical practice.

To investigate the knowledge and use of TM in primary care manual therapy in Belgium and the Netherlands.

An online survey hosted on Google Forms was designed and distributed across various platforms to manual therapists and students enrolled in a Master’s/Postgraduate program in manual therapy. Data were collected regarding demographics, types of complaints, types of manipulation, and types of intervention. Participation occurred between 1 November 2022 and 31 July 2024.

One hundred and seven surveys were analyzed. Thoracic complaints treated with TM were mostly muscular in origin (94%). Most participants (79%) did not utilize a specific screening tool, instead relying on clinical experience to exclude red flags. The majority agreed that metabolic bone diseases and metastatic diseases (n = 92) are contraindications and that thoracic fractures (n = 77) are a risk factor for TM. Almost half (44%) did not differentiate between the upper and lower thoracic spine. TM for other regions, mostly for the cervical spine (94%), was considered. TM was preferred for its biomechanical effects, followed by neurophysiological and placebo effects.

Most clinicians rely on experience rather than a pre-screening tool when assessing the thoracic region, focussing on excluding red flags and determining indications for TM, with biomechanical effects being the most favored rationale. Although most findings showed agreement, some inconsistencies were noted regarding screening and rationale, highlighting the importance of clinical reasoning for safe TM practice.