Table XI. —Recommendations mobilizations and manipulations.

Profiles 1	• Do not perform mobilizations or manipulations
Profile 2 and 3	• Consider performing mobilizations and/or manipulations on patients with LBP, but only as a supplement to exercise therapy if the problem is mechanical in nature due to disorders within the neuromusculoskeletal system (e.g. decreased regional mobility during lumbar flexion or extension) • Evaluate and analyze the effects of mobilizations and/or manipulations immediately within the treatment session and at the start of the next session. Be alert to serious (rare) adverse effects, such as significant increase of pain or motor deficit • Discuss the choice of mobilization or manipulation with the patient and align with the patient’s needs, preferences and capabilities and your own knowledge and skills as a therapist. When doing so, pay attention to potential negative effects and discuss this with the patient prior to the treatment
Do not perform mobilizations or manipulations: • as singular intervention • if you are not competent and authorized to do this or you have insufficient knowledge to determine the indication and contra-indications It is preferable not to perform mobilizations or manipulations on patients with LRS

Mobilizations are understood to mean passive arthrogenic mobilizations. Manipulations are understood to mean high-velocity-thrust techniques on synovial joints.