A novel model for developing thrust joint manipulation skills: a teaching and learning perspective

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.

KEYWORDS:

• Education
• practice
• motor learning
• manual therapy
• physical therapy
• musculoskeletal manipulations

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

Additional information

Funding

The author(s) reported that there is no funding associated with the work featured in this article.

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.