Thumb pain is a common complaint of physical therapists. The purpose of this study was to investigate the prevalence, presentation, and techniques associated with aggravation of thumb pain in physical therapists practicing spinal manipulative therapy and the management strategies used to deal with pain. A survey was sent to members of Musculoskeletal Physiotherapy Australia. Data were collected from subjects who had completed postgraduate study in manipulative physical therapy. Of the 155 subjects who responded, 83% complained of pain in their thumbs aggravated by performing manipulative therapy techniques in the preceding year (2000). The most common presentation of pain included mild pain (3.8/10) at the metacarpophalangeal joint, with multiple, short-lived episodes. Techniques most commonly responsible for aggravation of symptoms were unilateral (87%) and central posteroanterior glides (85%). Most subjects (74%) changed their choice of treatment technique to alleviate symptoms. Suggestions are made about the safe alignment of the thumb during performance of spinal manipulative therapy techniques.