Cervical spine mobilisation forces applied by physiotherapy students.

OBJECTIVES Postero-anterior (PA) mobilisation is commonly used in cervical spine treatment and included in physiotherapy curricula. The manual forces that students apply while learning cervical mobilisation are not known. Quantifying these forces informs the development of strategies for learning to apply cervical mobilisation effectively and safely. This study describes the mechanical properties of cervical PA mobilisation techniques applied by students, and investigates factors associated with force application. PARTICIPANTS Physiotherapy students (n=120) mobilised one of 32 asymptomatic subjects. METHODS Students applied Grades I to IV central and unilateral PA mobilisation to C2 and C7 of one asymptomatic subject. Manual forces were measured in three directions using an instrumented treatment table. Spinal stiffness of mobilised subjects was measured at C2 and C7 using a device that applied a standard oscillating force while measuring this force and its concurrent displacement. Analysis of variance was used to determine differences between techniques and grades, intraclass correlation coefficients (ICC) were used to calculate the inter- and intrastudent repeatability of forces, and linear regression was used to determine the associations between applied forces and characteristics of students and mobilised subjects. RESULTS Mobilisation forces increased from Grades I to IV (highest mean peak force, Grade IV C7 central PA technique: 63.7N). Interstudent reliability was poor [ICC(2,1)=0.23, 95% confidence interval (CI) 0.14 to 0.43], but intrastudent repeatability of forces was somewhat better (0.83, 95% CI 0.81 to 0.86). Higher applied force was associated with greater C7 stiffness, increased frequency of thumb pain, male gender of the student or mobilised subject, and a student being earlier in their learning process. Lower forces were associated with greater C2 stiffness. CONCLUSION This study describes the cervical mobilisation forces applied by students, and the characteristics of the student and mobilised subject associated with these forces. These results form a basis for the development of strategies to provide objective feedback to students learning to apply cervical mobilisation.

[1]  K. Refshauge,et al.  Pre-manipulative testing of the cervical spine review, revision and new clinical guidelines. , 2004, Manual therapy.

[2]  M. Harms,et al.  Variability of forces applied by experienced therapists during spinal mobilization. , 1997, Clinical biomechanics.

[3]  J. Wessels,et al.  Measurement of the magnitude of force applied by students when learning a mobilisation technique. , 2003 .

[4]  Darren A Rivett,et al.  Measuring the posteroanterior stiffness of the cervical spine. , 2008, Manual therapy.

[5]  L. Hurley,et al.  Clinical practice guideline on the use of manipulation or mobilization in the treatment of adults with mechanical neck disorders. , 2002, Manual therapy.

[6]  D. Shirley,et al.  The response of posteroanterior lumbar stiffness to repeated loading. , 2002, Manual therapy.

[7]  J. M. Bryan,et al.  Joint manipulation curricula in physical therapist professional degree programs. , 2004, The Journal of orthopaedic and sports physical therapy.

[8]  K. Refshauge,et al.  Effect of feedback on learning a vertebral joint mobilization skill. , 1990, Physical therapy.

[9]  Darren A Rivett,et al.  Manual forces applied during posterior-to-anterior spinal mobilization: a review of the evidence. , 2006, Journal of manipulative and physiological therapeutics.

[10]  M. Guadagnoli,et al.  Challenge Point: A Framework for Conceptualizing the Effects of Various Practice Conditions in Motor Learning , 2004, Journal of motor behavior.

[11]  C. Cook,et al.  Predictive Factors in Poor Inter-Rater Reliability Among Physical Therapists , 2002 .

[12]  J. Neter,et al.  Applied Linear Regression Models , 1983 .

[13]  M. Lynn Palmer,et al.  Fundamentals of Musculoskeletal Assessment Techniques , 1994 .

[14]  J. M. Bryan,et al.  Spinal Mobilization Curricula in Professional Physical Therapy Education Programs , 1997 .

[15]  Jack Crosbie,et al.  Sustainable undergraduate education and professional competency. , 2002, The Australian journal of physiotherapy.

[16]  G. Maitland,et al.  Practical Orthopaedic Medicine , 1983 .

[17]  J. Fritz,et al.  Spinal manipulation in physical therapist professional degree education: A model for teaching and integration into clinical practice. , 2006, The Journal of orthopaedic and sports physical therapy.

[18]  G. Jull Use of high and low velocity cervical manipulative therapy procedures by Australian manipulative physiotherapists. , 2002, The Australian journal of physiotherapy.

[19]  Mitchell Haas,et al.  Efficacy of spinal manipulation and mobilization for low back pain and neck pain: a systematic review and best evidence synthesis. , 2004, The spine journal : official journal of the North American Spine Society.

[20]  S. Hoppenfeld,et al.  Physical examination of the spine and extremities , 1976 .

[21]  Manual forces applied during cervical mobilization. , 2007, Journal of manipulative and physiological therapeutics.

[22]  D. Rivett,et al.  Calibration of an instrumented treatment table for measuring manual therapy forces applied to the cervical spine. , 2008, Manual therapy.

[23]  Liz Cheek,et al.  Accuracy of Feedback During Training of Passive Accessory Intervertebral Movements , 2001 .

[24]  Tadeusz J. Janik,et al.  Comparisons of Lordotic Cervical Spine Curvatures to a Theoretical Ideal Model of the Static Sagittal Cervical Spine , 1996, Spine.

[25]  K. Banks,et al.  Maitland's Vertebral Manipulation , 1973 .

[26]  G. Grieve Mobilisation of the spine , 1979 .

[27]  Elizabeth Stojanovski,et al.  Forces applied to the cervical spine during posteroanterior mobilization. , 2009, Journal of manipulative and physiological therapeutics.

[28]  J. Bagust,et al.  Cutaneous two-point discrimination thresholds and palpatory sensibility in chiropractic students and field chiropractors. , 2004, Journal of manipulative and physiological therapeutics.

[29]  R Adams,et al.  A psychophysical evaluation of manual stiffness discrimination. , 1995, The Australian journal of physiotherapy.