Postgraduate Orthopedic Manual Physical Therapy Residentsʼ Physical Responses to Peer Practice of Cervical Spine Manipulation

Background and Purpose. While numerous studies have examined adverse responses from manipulation in patient populations, few studies have examined responses to the practice of thrust techniques by students on classmates. The purposes of this study were to (1) assess postgraduate student response to repeated application of thrust manipulation, and (2) determine whether changes occurred in mobility and cervical active range-ofmotion (AROM) over a 6-month period of instruction and practice. Subjects. A total of 32 physical therapists, enrolled in the second year of the Orthopedic Manual Physical Therapy (OMPT) Graduate Certificate Program at Oakland University in Rochester, Michigan), were recruited on the first day of class in the fall of the 2005 and the fall of the 2006 semesters. Methods. Participants were evaluated prior to, during, and at the completion of coursework in thrust manipulation, specifically translatoric spinal manipulation (TSM). Each evaluation included completion of a cervical questionnaire, participant rating of pain and stiffness levels using the Visual Analogue Scale (VAS), anterior-posterior (AP) joint play assessment of the cervical spine, and cervical range-of-motion (CROM) device measurements. Results. No injuries were reported during this study. In addition, there were no significant changes in pain or perceived stiffness. AP joint play improved (P ≤ .001) from hypomobility to normal mobility at the level of C7-T1, and from hypermobility to normal mobility at the levels of C4-C5 and C5-C6 (P ≤ .001). There was a statistically and clinically significant decrease in cervical extension AROM for all participants between sessions 2 and 3 (P ≤ .001). Discussion and Conclusion. The postgraduate physical therapists in this study had no adverse responses from receiving thrust manipulation from peers over a 6-month period. Improvement in C7-T1 hypomobility provides limited support for the use of TSM thrust techniques to improve AP joint play. Future research could examine the response to other forms of thrust and non-thrust manipulation among postgraduate and professional (entry-level) physical therapy populations.