Biomechanical Characteristics of Lumbar Manipulation Performed by Expert, Resident, and Student Physical Therapists

Background Lumbar manipulation is a commonly used treatment for low back pain, but little research evidence exists regarding practitioner biomechanics during manipulation. Most existing evidence describes rate of force production through the hands into instrumented manikins and it is unclear how the practitioner moves their body and legs to generate this force. Objectives To identify and characterize important kinetic and kinematic factors in practitioners of varying experience performing lumbar manipulation in order to identify which factors distinguish experts from less experienced practitioners. Study design This was a cohort observational laboratory study. Methods 43 male physical therapists (PT) and PT students (4 experts, 11 residents, 13 third year, and 15 first year students) performed 4 manipulations each on asymptomatic patient models. Angular and linear kinematics of the pelvis were measured using motion capture, and ground reaction forces were measured with force plates under the practitioner\u27s feet. Results Peak pelvic angular velocity was greater and in the opposite direction in experts compared to other groups in the frontal plane (p = 0.020) and transverse plane (p = 0.000). Experts had greater downward pelvic linear velocity than third year students and first year students (p = 0.000). Experts also demonstrated faster rate of vertical ground reaction force unloading during the manipulation (p = 0.002). Conclusions Expert performance of manipulation was characterized by increased speed of linear and angular pelvic motion, and increased modulation of vertical ground reaction force. These results help to inform educators and practitioners that teach and use this complex manual skill