ABSTRACT
Spinal and extremity thrust joint manipulation (TJM) has been shown to be an effective intervention when treating patients with various musculoskeletal conditions. Learning skilled TJM requires the proper execution of many discrete tasks. If any of these are missing, effectiveness and safety may be limited. While it is accepted that practice and feedback are important when physical therapists are learning clinical tasks, the best type of practice has not been identified for learning to perform TJM tasks. In this paper, we propose an educational model for instruction of joint manipulation that: 1) standardizes feedback terminology and 2) describes a core set of four discrete tasks (lift, drop, pull, and combination-rotation) that apply to most TJM tasks. The model includes instructing TJM tasks followed by identifying key errors related to the components of setup and thrust. Once these key errors have been identified, intentional practice activities are provided to address the noted positional and movement errors. Finally, reassessment is performed to determine if errors have diminished. This model is similar to the test–retest approach that is commonly used when treating patients. We hope this educational model will provide a framework for teaching TJM and will also foster future research.
Acknowledgements
This material has not been presented to any other journals. We would like to acknowledge the SUNY Upstate Department of Physical Therapy for student participation.
Disclosure statement
No potential conflict of interest was reported by the author(s).
Supplementary material
Supplemental data for this article can be accessed online at https://doi.org/10.1080/10669817.2023.2299184
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Notes on contributors
Kyle R. Adams
Kyle R. Adams, PT, DPT, OCS, CSCS, FAAOMPT is a clinical assistant professor in the Department of Physical Therapy at Baylor University where he teaches musculoskeletal and pain science courses. He became board certified in Orthopaedic Physical Therapy in 2005, completed a fellowship in manual therapy through Evidence in Motion in 2011, and completed a therapeutic pain specialist certification program with Evidence in Motion in 2017. He is currently working on a Doctor of Science (DSc PT), with anticipated graduation in 2024.
William H. Kolb
William H. Kolb, PT, DPT, OCS, FAAOMPT, Assistant Professor at Radford University, Waldron College of Health Professions Department Physical Therapy, Roanoke, Virginia. Dr. Kolb is currently working towards a Doctor of Health Science degree with a concentration in education. Dr. Kolb teaches musculoskeletal, orthopedics, pain science and health policy. He has received funding for knowledge translation and pain education in regional health systems.
Mary Beth Geiser
Mary Beth Geiser PT, DPT, OCS, FAAOMPT maintains a faculty position for Concordia University St. Paul (DPT Program) where she teaches pain-related content, and for Regis University (Fellowship Program) teaching courses on manipulation, the cervical spine, and upper extremity management. Dr. Geiser has taught other DPT courses/content (radiology, pain science, orthopedics, and manual therapy/manipulation) for Marquette University, Campbell University, University of Wisconsin Milwaukee, Concordia University Wisconsin, and Regis University’s Residency Program. She sees patients for Aurora Sports Health and Marquette’s pro bono clinic. Dr. Geiser is a board-certified specialist in orthopaedic physical therapy (1999, recertifications in 2009, 2019). She completed her fellowship from Regis University in 2014.
Michelle Dolphin
Michelle Dolphin, PT, DPT, MS, OCS, FAAOMPT is a Professor in the Doctoral Physical Therapy (DPT) program at the State University of New York Upstate Medical University in Syracuse. She is the Associate DPT Program Director and College of Health Professions Assistant Dean for Faculty Engagement. Dr. Dolphin teaches musculoskeletal, orthopaedic, and sports physical therapy including physical examination, therapeutic exercise, and manipulation. She maintains clinical practice in performing arts physical therapy and has published and presented nationally in areas of orthopaedics, manual therapy, pain science and dance.