Musculoskeletal conditions are a common occurrence among older adults, often requiring physical therapy services. Physical therapy interventions, including manual therapy, have demonstrated positive outcomes in older adults. Decades of clinical research in the field of orthopedic physical therapy indicates the positive outcomes of this approach; however, the underlying basis regarding the efficacy of manual therapy interventions remains unknown. The purpose of this article is to review the evidence surrounding the neurophysiological effects of manual therapy, specifically mobilization and manipulation, in aging and older adults (ie, those ≥ 50 years of age).