Extra spinal or extremity manipulation is done by manually applying a gentle, yet specific deep thrust technique known as an adjustment to any joint outside the spine. This manipulation can ease symptoms of joint pain, and other problems that stem from minor trauma to that joint. weather its a shoulder, elbow, wrist, suboccipitals, hips, knees or ankles. The associates of Manhattan wellness Group will diagnose and decide if its necessary to correct the alignment of that joint. Often pain in the extremities is associated with issues in the spine.