MINI REVIEW article
Front. Pediatr.
Sec. Pediatric Orthopedics
Screening for Red Flags and Modifying Manual Therapy Techniques for Pediatric Patients
Provisionally accepted
- 1Texas A & M University-Texarkana, Texarkana, United States
- 2Texas Woman's University, Houston, United States
- 3Texas Tech University Health Science Center, Lubbock, United States
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Objective This mini-review synthesizes evidence for safe and effective pediatric joint mobilization, discussing red flags, offering clinical recommendations, and addressing current research limitations. Methods A PubMed and PEDro search, supplemented by foundational pediatric musculoskeletal resources, identified peer-reviewed articles and guidelines, which experts collaboratively evaluated. Results Pediatric musculoskeletal systems, with open growth plates and lower bone mineral density, are vulnerable to shear forces. Safe force thresholds remain undefined. Therefore, thorough history taking, systematic red flag screening, and adherence to International Federation of Manual and Musculoskeletal Physical Therapists guidelines are crucial. Discussion The refined Pediatric Utilization of Manual Therapy tool (PUMT-2, combined with the proposed modified three-tier red flag framework, supports individualized, developmentally appropriate assessment and care. Future research should establish force guidelines and age-based technique modifications, alongside specialized clinician training to address pediatric-specific needs.
Keywords: Mobilization, Physical Therapy, Physiotherapy, PUMT, Red flags
Received: 21 Nov 2025; Accepted: 10 Feb 2026.
Copyright: © 2026 VK, Dice, Dendy and Brismee. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Henderson VK
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.