We are fully aware that this vulnerable pediatric population often requires neuromusculoskeletal care in close collaboration with other medical and paramedical disciplines. In doing so, we thoroughly reflect on both internal clinical experience and external scientific evidence.

The recent statement from IFOMPT & IOPTP (2024) advises strongly against spinal manipulation and mobilization in infants and young children, citing limited evidence and naming potential risks. Taken literally, the statement could make training institutes like ours feel unfairly constrained or burdened with undue guilt.

This blog therefore presents a CRAFTA®-informed reflection, highlighting the importance of nuance, clinical responsibility, and international data on treatment safety and outcomes.

The  IFOMPT/ IOPTP -Statement and implications

For your convenience, here is a brief summary of the IFOMPT Taskforce.

The IFOMPT/IOPTP Taskforce (2024, 2025) presents a clear recommendation regarding the treatment of the cervical spine in young children and adolescents;

• Spinal manipulation and mobilisation should not be performed on Infants. Neck and lower back manipulation should also be avoided on children.
• Spinal manipulation and mobilisation may be appropriate for treating musculoskeletal conditions in adolescents.
• Spinal manipulation and mobilisation are not appropriate for treating non-musculoskeletal paediatric conditions not be used to treat non-musculoskeletal paediatric conditions Among infants, children and adolescents."

 Fig   Polici brief  World Physiotherapy Specialty Groups – IFOMPT & IOPTP 2024; Paediatric Manipulation & Mobilisation Evidence-based Practice Position Statement

What CRAFTA® Education Covers ??

In the CRAFTA® advanced training modules, we teach manual assessment of pediatric cranio-cervical junction with a focus on physiological and accessory movements to identify dysfunctions. Our standards: 

• If a dysfunction is present, an individualized clinical reasoning process is used to determine whether there is an indication or contraindication for treatment.
• The indication for treatment is clearly limited to musculoskeletal complaints of the cervical spine, notnon-musculoskeletal complaints (see above).
• NO MANIPULATIONS (THURSTS) are taught or performed; instead, only gentle mobilizations of physiological and accessory movements are applied, without causing discomfort.
• There is always intensive parental communication, education, and follow-up for several months after the end of treatment, as this is considered an integral part of the treatment process.

Critical Perspectives on the IFOMPT Taskforce Statement

While the IFOMPT/IOPTP (2024) recommendations are understandable from a "safety first" perspective, they can be critically questioned due to a lack of transparency in the literature selection and the exclusion of recent positive evidence.In a formal letter to the KNGF, Dutch experts express concerns about the scientific foundation of the statement (Saedt et al., 2025). They emphasize that:

• Recent literature showing positive effects of mobilization in infants has not been included in the IFOMPT statement.
• The risks presented are largely based on case histories from chiropractic treatments, and thus not representative of a practice within the specialized physiotherapist in musculoskeletal therapy. 
•  In a descriptive study of the European Workgroup of Manual Medicine (EWMM) there are >420.000 monitored treatments without serious adverse events, thus not more than in babies and children who are generally treated by other forms of therapy (Sacher et al 2025).

This criticism is shared in international professional literature citing the debate on bias and biased policy making (Kusgen & Ammermann 2025, Wuttke et al 2025).

Experiences of CRAFTA-Certified Therapists

Among the more than 400 registered CRAFTA-certified therapists, one part work with infants and young children. To date, no adverse effects have been reported. These findings can and should be used proactively in response to the recent recommendations issued by the IFOMPT Taskforce.

Speaking from personal experience: I have been working with infants and young children for over 25 years, with a strong focus on functional neuromusculoskeletal diagnosis and the application of gentle, non-provocative techniques. In particular, Maitland-based accessory mobilizations of Grades II, III, and IV—performed without discomfort and combined with craniofacial manual techniques—have shown clinical effectiveness in reducing functional impairments and suppressing persistent nociceptive stimuli (von Piekartz, 2015). Throughout all these years, I have not observed any serious side effects.This is also the experience from other CRAFTA® teachers.

CRAFTA®’s Position on the IFOMPT Recommendations

Within the CRAFTA® framework, musculoskeletal therapists are trained to apply safe, evidence-based, and ethically responsible techniques when working with infants and young children. In light of the recent IFOMPT Taskforce statement—which generally advises against spinal manipulation in infants while permitting mobilization when clinically indicated—therapists are trained to apply such techniques safely and ethically.

A CRAFTA®-certified therapist will never:

• perform spinal manipulations (thrust techniques) in infants or young children but gentle, well-controlled mobilisations
• treat non-musculoskeletal conditions such as infantile restlessness, excessive crying, ADHD, or skin conditions like neurodermatitis;
• proceed with treatment when red flags are present;
• ignore the importance of structured collaboration with referring physicians or other specialists such as pediatric physiotherapists.

Final Reflections

• The IFOMPT Taskforce’s recent recommendations require careful and nuanced interpretation. When appropriately indicated and performed by trained professionals, gentle mobilizations—such as those taught within the CRAFTA® education—are both safe and clinically beneficial for infants and young children with musculoskeletal disorders.
• Broad restrictions or blanket warnings—especially when lacking robust clinical justification—risk undermining trust in evidence-based practice. What is needed instead is a coherent, integrative approach that bridges clinical reasoning, scientific research, and the lived experiences of both therapists and families.

This discussion is ongoing. CRAFTA® remains committed to offering thoughtful, responsible, and collaborative input to shape the future of pediatric musculoskeleal therapy.

In name of all CRAFTA® Teachers and Board

Harry von Piekartz

References 

Borusiak, P., Biedermann, H., Boßerhoff, S., & Opp, J. (2010). Lack of efficacy of manual therapy in children and adolescents with suspected cervicogenic headache: results of a prospective, randomized, placebo-controlled, and blinded trial. Headache: The Journal of Head and Face Pain, 50(2), 224-230.

Joslin, R., Allen, E., & Carter, B. (2024). Understanding the importance of therapeutic alliance during physiotherapy treatment for musculoskeletal pain in children: a scoping review. Frontiers in Pain  

Research, 5, 1452771. IFOMPT & IOPTP. (2024). Paediatric Manipulation and Mobilization Evidence-based Practice Position Statement - Policy Brief. https://doi.org/10.6084/m9.figshare.26038921

Sacher, R., Saedt, E., & Wuttke, M. (2025). Restricted use of spinal mobilization and manipulation in infants: How serious is the scientific debate? Manuelle Medizin, 1-4.

Küsgen, B., & Ammermann, M. (2025). There is no madness in spinal manual techniques in the pediatric setting. Journal of Manual & Manipulative Therapy, 33(1), 16-17.

Research, 5, 1452771. IFOMPT & IOPTP. (2024). Paediatric Manipulation and Mobilization Evidence-based Practice Position Statement - Policy Brief. https://doi.org/10.6084/m9.figshare.26038921

Saedt, E.van de Woude, B., Theunissen, P., & von Piekartz, H. (2025). Letter to Board KNGF, Reaction to IFOMPT statement. EWMM NL & CRAFTA.

Piekartz, H.,Budelmann K, (2015)Neuromuskuloskeletales Assessment und Management von kindlichen Kopfschmerzenp 574- 596 in . "Kiefer, Gesichts-und Zervikalregion. Neuromusculoskeletal Assessment und Behandlungsstrategien, H. von Piekartz." (2015).

Wuttke, M., Knuedeler, M., & Wenning, K. (2025). Tendential and unscientific opinion regarding spinal manipulative therapy in the pediatric population: In Reference to: Olson KA, Clewley D, Milne, N et al.(2024): Spinal manipulation and mobilization for pediatric conditions: time to stop the madness. J Man Manip Ther. 32 (3), 207-210. Journal of Manual & Manipulative Therapy, 33(1), 10-12.

These webinars will introduce you to the latest scientific insights and practical knowledge about and from CRAFTA^®.

Webinar Content:

a. Exclusive Insights into CRAFTA^® Statements - Our goal is to keep you updated on the current approaches we teach, supported by both internal and external evidence. (Duration: 45-60 minutes, including presentation and Q&A)

b. JAM Sessions - A patient case with head, neck, or face complaints will be presented, with a discussion of assessment and treatment. Participants are welcome to present their own cases for collaborative discussion. (Duration: 120 minutes)

Language:

The webinars will be conducted in English.

Points and Schedule:

Earn CRAFTA^® Accreditation Points: 2 points per webinar

Flexible Scheduling: While we aim for consistency (e.g., Wednesdays from 7:30 PM to 8:30 PM for Statement webinars and Fridays from 4:00 PM to 6:00 PM for JAM sessions), dates may be adjusted as needed. Your feedback is appreciated.

Attached, you will  find the topics and proposed dates for the webinars.

How to Join:

Via Website: Select the webinars of interest, BOOK Now and enter your name and email address etc, and receive a Zoom link from the CRAFTA^® office the day before the event.

We welcome your feedback and ideas for additional webinars or alternative scheduling options.

Thank you in advance for your collaboration—we look forward to creating something extraordinary with you!

Despite mounting evidence supporting musculoskeletal therapy's effectiveness in treating persistent orofacial dysfunction and pain, it seems this significant area continues to receive insufficient attention in the field of the leaders in musculoskeletal Therapy; the IFOMPT . This persistent oversight calls for a closer examination, especially given the rising number of studies advocating for the integration of orofacial considerations into general musculoskeletal practice.

Orofacial pain, encompassing discomfort in the face and mouth area, as well as related structures like the neck and shoulders, can profoundly affect an individual's quality of life. (Oghli et al 2020). It often manifests as headaches, jaw pain, and even disturbances in neck functions like mobility, (muscular)stability. The causes vary from dental issues to nociceptive, nociplastic situations to lack of motor control like parafunctional activity ( e.g bruxism ) postural imbalances advocated by different psycho-emotional risk factors which making it a complex field for  assessment and treatment. From internal and external evidence, the integration of musculoskeletal orofacial therapy into treatment plans has shown promising results, offering relief where traditional methods sometimes fall short.

The evidence is clear:  several systematic reviews published last year highlighted significant improvements in patients with chronic jaw and facial pain following targeted musculoskeletal interventions (van der Meer et al 2017, von Piekartz et al 2023).These treatments, which include manual therapy, exercise, and patient education, provide a holistic approach that addresses both the symptoms and underlying causes of orofacial pain which has a good or excellent outcome.

What may be the reason?

However, despite this growing body of evidence, sessions dedicated to orofacial musculoskeletal therapy were notably sparse at recent IFOMPT conferences as you may read in table 1. This gap is not just a missed opportunity; it is a disservice to the countless patients who could benefit from these therapeutic approaches. The question then arises: why is the orofacial area not getting the attention it rightfully deserves within the musculoskeletal IFOMPT community? Some reasons are discussed  below.

Table 1 Number of (non-)orofacial presentations at the last 4 IFOMPT conferences

(i)One possible reason could be the traditional segmentation of medical specialties. Often, orofacial pain is seen as the domain of dentists and maxillofacial specialists, thus creating a barrier to interdisciplinary collaboration. Furthermore, there is a need for more specialized training and education among physical therapists to handle these complex cases effectively.

(ii) Another reason may be a lack of training in the IFOMPT curriculum in this area..Schaffer et al.'s survey(2018)  on IFOMPT education concerning TMD and upper cervical assessment and treatment reveals inconsistencies in duration and content  in how post-professional OMPT programs address TMD education. Most programs, however, consistently offer more training in cervical spine disorders than in TMD. These results point to the need for further research to evaluate whether TMD education in these programs is still insufficient.

Based on my personal experience, musculoskeletal therapists, including those who teach in the IFOMPT domain, often face challenges with average topics such as:

• Understanding the innervation of the temporomandibular joint (TMJ).
• The functions and interactions between the trigeminal and facial nerves.
• The dual compartments of the TMJ and their specific functions.
• How dental occlusion affects TMJ and neck function.
• Distinguishing between myogenous TMD and bruxism.
• Identifying types of perception changes during craniofacial-orofacial headaches.

It is reasonable to expect that an IFOMPT specialized musculoskeletal therapist, even if not intensively involved in clinical work with patients suffering from orofacial dysfunction and pain, would possess this fundamental knowledge.

(iii)Another reason may be the paradigm shift in rehabilitation where, since 2018-2019, IFOMPT has mandated the integration of "communication" more prominently into training programs. As a result, Pain Science and Pain Neuroscience Education received higher priority in the curriculum.

(iv)Another factor could be the paradigm shift towards “research” playing a significant role. It is concerning that many PhD students in Physiotherapy who do not have an IFOMPT diploma, and thus have not experienced the IFOMPT curriculum and therefore have not the clinical experience, are conducting research in musculoskeletal therapy to complete their PhDs. While more research in musculoskeletal therapy is certainly beneficial, research questions are not always posed from a clinical perspective. In my opinion, clinical questions, particularly those concerning facial-TMD issues, are significantly underrepresented. This shortfall occurs because PhD students often lack training in this area, unless their supervisors have specialized expertise that can assist them. However, it is worth noting that there are few musculoskeletal physical therapists with both an IFOMPT diploma and a PhD who are engaged in research.

The medical world recognizes orofacial dysfunction and pain, but it does not recognize cervical headaches.

Apologies, but what manual therapists might not want to hear is still the reality: the medical community still does not recognize 'cervical' headache as a distinct entity. Despite the significant efforts of experts like Gwenn Jull, Toby Hall, and Dean Watson during the 1990s and early 2000s, who began to substantiate their clinical experiences with foundational research published in well-regarded journals, there has been little change in this area.

Additionally, it is apparent that most IFOMPT musculoskeletal therapists are not familiar with the diagnostic criteria for TMD as outlined by the International Consortium for Myofascial Pain Diagnostics (accessible at InForm TMD Assessment] (https://ubwp.buffalo.edu/rdc-tmdinternational/tmd-assessmentdiagnosis/dc-tmd/) and the International Classification of Orofacial Pain (ICOP 2020).(https://journals.sagepub.com/doi/10.1177/0333102419893823). These frameworks offer significant insights for assessment, management, and research in musculoskeletal therapy and provide excellent integration with other evidence-based disciplines such as dentistry, orofacial surgery, neurology, and psychology.

Driven by this knowledge the Craniofacial Therapy Academy (CRAFTA) organized the hybrid  conference successfully held on June 7 and 8 2024 , titled "TMD AND OROFACIAL PAIN PHYSICAL THERAPY MEETS DENTISTRY," (www.crafta.org)). The conference concluded that there are clear overlaps between  dentistry and musculoskeletal therapy. Functionally-minded dentists have shown a readiness to cooperate and reach consensus, but they observe a lack of specialized craniofacial therapy with robust skills grounded in evidence-based practice. Consequently, they are welcoming physiotherapists with open arms to the American Academy of Orofacial Pain (AAOP) conferences in the US and the Deutsche Gesellschaft für Funktionsdiagnostik (DGFDT) conferences in Germany, both as participants and speakers. Interestingly, while 80% of the attendees were physical therapists, less than 15% were registered with an IFOMPT Diploma.

Crossing Bridges

Can we blame the IFOMPT Teaching organizations, like IMTA? Maybe partwise because the IMTA must deal also with the IFOMPT curriculum which prescribed the objectives and competences for an international curriculum. When IFOMPT lose the head than also the curricula of the international musculoskeletal education organizations may lose it. This is reflected also on the upcoming conference in Basel . Title is “Crossing Bridges”. Crossing Bridges sounds like connecting, challenging new, different ideas, areas, which sounds positive to move forward. This does not apply to the face and head. All proposed Symposiums on face pain are all rejected by the scientific IFOMPT commission. From the nearly 60 keynote lectures and short research presentation only two session of 90 minutes on craniocervical and  neck ,orofacial headache themes. Thus, we can conclude that the IFOMPT musculoskeletal therapist is a specialist in musculoskeletal therapy but has limited expertise regarding the face. So, who will manage in the future:

• Neck pain patients whose source of pain is not in the neck
• Face pain following facial trauma and concussions
• Complex cases of vertigo and tinnitus not originating from the vestibular organ
• Young patients experiencing face and head pain after orthodontic treatments
• Symptoms related to facial neuropathies, etc.

Probably not the standard IFOMPT musculoskeletal therapist. They would be the first choice, but perhaps we must accept that this is not the case.

The face our vital instrument for communication, using many muscles to show emotions, from smiles to frowns. It facilitates beauty and it's also key for sensing the world—our eyes see beauty and chaos, our noses detect scents, and our lips and tongue taste and speak. The specialized physical therapist get credits of the medical word to be a part of it  but at alas not really supported by the IFOMPT.

Harry von Piekartz
PhD, MSc, BSc.PT, MT (OMPT)

References

• Oghli, I., List, T., Su, N. and Häggman‐Henrikson, B., 2020. The impact of oro‐facial pain conditions on oral health‐related quality of life: A systematic review. Journal of oral rehabilitation, 47(8), pp.1052-1064.
• van der Meer, H.A., Calixtre, L.B., Engelbert, R.H., Visscher, C.M., Nijhuis–van der Sanden, M.W. and Speksnijder, C.M., 2020. Effects of physical therapy for temporomandibular disorders on headache pain intensity: A systematic review. Musculoskeletal Science and Practice, 50, p.102277.
• von Piekartz, H., van der Meer, H. and Olivo, S.A., 2023. Craniofacial disorders and headaches. A narrative review. Musculoskeletal Science and Practice, p.102815.
• Shaffer, S.M., Stuhr, S.H., Sizer, P.S., Courtney, C.A. and Brismée, J.M., 2018. The status of temporomandibular and cervical spine education in post-professional physical therapy training programs recognized by Member Organizations of IFOMPT: an investigation of didactic and clinical education. Journal of Manual & Manipulative Therapy, 26(2), pp.102-108

Course Description
Pain and dysfunction involving the temporomandibular joint(s) (TMJ) and/or masticatory muscles are collectively referred to as a temporomandibular disorder (TMD). TMD is a common source of jaw, headaches and orofacial pain and contributes to functional limitations associated with chewing, talking, and yawning.

Characteristics of patients experiencing TMD will be identified. An overview of clinical anatomy and mechanics of the TMJ will be covered. The evidence-based examination for all common diagnostic subsets of TMD are discussed. An evidence-based informed treatment will be covered for each diagnostic subset of TMD.

Treatments covered to include but not limited to patient education, behavioral modification, modalities, exercises, and manual procedures. Surgical and non- surgical treatments for disc displacements will be reviewed as well as post op physical therapy management. The rationale for the use of the various oral appliances fabricated by dentists will be highlighted. Features of an oral appliance will be covered to determine if the oral appliance is an evidence-based design.

Cervical spine considerations in the management of TMD and headache will be discussed. Team approach between the physical therapist and dentist/oral surgeon will be emphasized in this course.

Target Audience
Physical therapists and physical therapist assistants. Other healthcare professionals interested in understanding TMD management will benefit from taking this course.

Mr Kraus will offer a 10% discount. Current tuition is $395 US. A 10% Discount would be $355 US that would be offered to CRAFTA-Certified Therapist (CCTs).

More info on https://www.tmdstevekraus.com/

To get a coupon for the 10% discount, email me first on https://www.tmdstevekraus.com/contact-steve-kraus/ I will generate a coupon that I will email, and you will be directed to my web site www.TMDSteveKraus.com you will need a copy of your CRAFTA Certificate.

This course gives 40 CRAFTA accreditation points!

Date and Time: 15.April 2024 • 19:30-20:45 (Central European Time (CET)

Prepare to immerse yourself in a comprehensive webinar that brings together the expertise of Prof. Mariano Rocabado and Prof. Harry von Piekartz.

This enlightening event, brilliantly moderated by Dr. Jennifer Nelsson, focuses on the orofacial-cervical complex and its clinical implementation.

It's a must-attend for physical therapists, orthodontists, and dentists looking to enhance their understanding and skills.

Key Highlights

• Two engaging 25-minute presentations by Prof. Rocabado and Prof, von Piekartz, packed with current neurophysiological and biomechanichal insights.
• An in-depth exploration of the orofacial-cervical complex and its implications in daily clinical practice.
• A vibrant Q&A session, led by Dr. Nelsson, allowing the audience to delve depper into the subject matter.

NOTE This is more than just a webinar; it's an opportunity to connect with leading minds in the field and to translate advanced  scientific  knowledge  into  practical applications for your practice. Don't miss out on this chance to elevate your expertise and make a profound impact in the realms of physiotherapy, orthodontics, and dentistry.

Early-bird-ticket (until 01.01.2024): 340,00 € (2-days in presence) or 290,00 € (2-days online)

Regular tickets (from 02.01.2024): 390,00 € (2-days in presence) or 340,00 € (2-days online)

Meet worldwide renowned teachers from Austria, Chile, Denmark, Germany, Italy, Netherlands, Spain, Switzerland, UK, USA...

SAVE THE DATE! JUNE 7–8, 2024 HAMBURG+ONLINE

Click here for more info!

Flyer CC5 Congress now also in Turkish! - Flyer CC5 Kongresi artık Türkçe de!

05https://crafta.org/06.06.2024 jeweils 9:00 - 17:00 Uhr

16 Fortbildungspunkte

Für alle Heilmittelerbringer und Ärtze

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