The Brookbush Institute (BOC AP# P10038) is approved by the Board of Certification, Inc. to provide continuing education to Athletic Trainers (ATs). This program is eligible for a maximum of {{credits}} hours/ Category A CEUs. ATs should claim only those hours actually spent in the educational program.

Board Of Certification

Providers of Approved Continuing Education

Joint manipulations for the lumbar spine, sacroiliac joint, and pubic symphysis. Types of manipulations, manipulations vs. mobilizations of the spine, lumbar spine, SI joint, and pubic symphysis. Optimal intervention for anterior pelvic tilt, low back pain, inadequate forward lean, asymmetrical weight shift, sacroiliac joint dysfunction, knee bow in, knee bow out, and hip symmetry. The risk of adverse events, accuracy vs sensitivity, screening, reliability, and validity of lumbar spine, SIJ, and pubic symphysis manips.

Joint Manipulation: Lumbar Spine, Sacroiliac Joint and Pubic Symphysis

Access to all courses with monthly membership

Brookbush Institute

I have almost completed my CPT certification and am half-way through the Human Movement certification to inform my massage practice. The different modalities of reading, watching audiovisual materials, and attending live or recorded webinars have been important to my learning style and for review.

Brookbush Institute has the most detailed, specific and effective tools for online learning for movement and/or bodywork professionals. I love the combination of the videos as well as the text available online.

I recently completed the CPT course. It was demanding yet practical. I would highly recommend it for anyone wanting an education about human movement.

I have my personal trainer certificate through here and am almost finished my human movement specialist certification. Overall, the education that Brookbush has packaged together for clinicians and trainers is invaluable. I am a physio assistant so coming from more of a rehab background I appreciate that this education has been beneficial both as a trainer and in a rehab setting. I love that I have been able to do all learning at my own pace and able to work around my schedule. Thank you for setting up this platform! Highly recommend :)

I have been a massage therapist for 10 yrs and I feel like all the “pieces” I’ve learned throughout the yrs have been put into place and can see the full picture. I am also a member to tons of great content since I love to learn! I plan to get my CPT through them as well.

I have been following Brent Brookbush for nearly a decade- back when I was a personal Trainer and now as a Physical Therapist. BBI is an incredible resource for any movement nerds and corrective exercise specialists! The information is thorough with multiple real world applications. I am looking forward to an in-person Manual Therapist course the second they do one a little bit closer to Virginia ;)

I have taken both the Human Movement Specialist and Certified Personal Trainer certificate programs and have found the value in understanding the how and ways the body moves and functions and from evidence, non-biased, outcome, conceptual, theoretical, and practical approach to helping my clients/patients look better, feel better, and move better.

Over the last years I've returned time and again to Brookbush Institute for stellar coursework as I've worked toward a Human Movement Specialist certification. (I'm currently ACE CPT, and in training with Anatomy Trains for Structural Integration Manual Therapy.) Every Brookbush Institute module is fantastic and each one includes detailed informational videos, written descriptions of how to-do, and, more importantly, why to-do!

I am a 70 yr old chiropractor and no other healthcare provider was able to come up with an exercise protocol particular to my structural and balances and muscle deficits and keep me in the game. And as for continuing education on human skeletal movement, the website is phenomenal full of great exercises for particular mechanical dysfunction.

The H.M.S. is the most valuable certificate I have earned and was a fraction of the the cost of my others. Define the best bang for your buck!

Brookbush is the most efficient Personal Training Certification I have ever come across. All the lessons are well thought out and very straight to the point.

I am getting my Master's degree in Kinesiology, and I would like to say that I have benefited greatly from the rich, comprehensive, well-documented scientific content of Brookbush Institute that links theory to practical applications. Proudly I've got my CPT certificate, and I am on my way to get my HMS certificate.

Having courses count towards different certifications makes it so users can transition seamlessly from one certification to another. In my case, going from earning the BI CPT to earning the BI HMS was an easy decision and I am proud to have earned both certifications. I have also had the pleasure of going to a Live HMS workshop that was well taught by Instructor Boettcher and that was excellent to see how the methods and techniques are implemented.



I have been a member of BBI for years and every course I have taken has been incredibly informative. I learn more from these courses than I do at local CEU courses for my PTA license. I also earned my CPT and HMS certifications through the platform. It was so convenient and the content was top notch! Forever member.

We learn principles in academia, we learn cool new modalities via whatever specialty certification, but BBI really concentrates on the nuances of passive treatment and they do a fantastic job. The format in which BBI instructs soft tissue specialists (DPTs, Chiros, ATs) like myself feels like almost like an apprenticeship. You get a thoroughly detailed explanation of the “why’s”, and a visual comprehension of how to apply. Personally, I believe application is where the good and the great are distinguished.

Brookbush has been incredibly helpful since I was in massage school and now as I’m in my career! I run my own practice and it gives me the resources I need to not only improve what I already know, but also help me navigate better, more efficient ways of treatment.

Totally loving the convenience and affordability of this program with my crazy lifestyle! I feel like I am getting a quality education without a massive cost! My favorite part is the videos I can watch in the courses. I learn so much better that way. Once I really spent more time on the site, I figured out how to maneuver around a lot better! I enjoy the sense of humor, as well as the easy explanation, and short tests. And if I am really tired, I can have the computer read me the lessons. 😁

Challenging concepts are explained in very understandable terms without dumbing down the material, and I find this program to be superior in quality to other personal training programs.

Home

Courses

This course describes joint manipulation techniques for the lumbar spine, sacroiliac joint (SIJ), and pubic symphysis. Various synonyms and definitions have been used to describe the term "manipulation". The Brookbush Institute uses one conventional definition of the term "manipulations;" implying low-amplitude (relatively small motions), high-velocity (quick) techniques, intended to target and reduce the stiffness of specific joints or segments, that exhibit a decrease in passive accessory range of motion (a.k.a. stiffness during arthrokinematic motion; specifically glide). Research does imply that manipulations affect multiple joints simultaneously; however, the Brookbush Institute asserts that efforts to target the stiffest joints or segments will increase the likelihood that the stiffest segments are included in the "multiple joints" affected.

The Brookbush Institute has carefully selected manipulation techniques with the intent to increase the probability of practitioner success. That is, techniques have been chosen that are relatively easy to teach, reliably improve outcomes, and are the most commonly used. The Brookbush Institute does not wish to assert that these manipulation techniques are the only techniques that are effective, and/or that these are the best techniques for every outcome measure. It is possible that a highly complex, and/or advanced technique, may result in better outcomes, or that a particular pathology is better addressed with a rarely used technique.

Note, that the term "mobilization" is reserved for low-velocity techniques that are taught in a separate set of courses.

This course includes manipulation techniques that intend to reduce excessive stiffness of the lumbar spine (low back), SIJ, and the pubic symphysis (lumbopelvic manipulations), improve spine range of motion (ROM), improve lumbopelvic alignment, and potentially reduce hip dysfunction. For example, research has demonstrated a correlation between asymmetrical SIJ stiffness, asymmetrical hip range of motion, and a correlation between low back pain, and future lower extremity injury. These techniques may also be used in an integrated approach for improving 

lumbopelvic hip complex dysfunction (LPHCD)

 including sacroiliac joint pain (SIJD), lumbar radiculopathy, iliotibial band syndrome (ITBS), femoroacetabular impingement (FAI), patellofemoral pain syndrome (PFPS), etc. Additionally, due to the relationship between lumbopelvic alignment and hip mobility, and the relationship between hip mobility and ankle motion during gait, these techniques may aid in the treatment of pes planus, Achilles tendinopathy, and plantar fasciitis.

The techniques in this course are recommended for all clinical human movement professionals (physical therapists, physical therapy assistants, athletic trainers, massage therapists, chiropractors, occupational therapists, etc.) to develop an evidence-based, systematic, integrated, patient-centered, patient-centered, and outcome-driven approach.

Sample Intervention: Left Asymmetrical Weight Shift

Joint Manipulation: Lumbar Spine, Sacroiliac Joint, and Pubic Symphysis

Joint Manipulation: Elbow (Radial Head) and Wrist

Joint Manipulation: Ankle, Midfoot, and Tibiofibular Joint

For an introduction to joint mobilizations and manipulations:

Joint Mobilization and Manipulation: Introduction

Joint Mobilization and Manipulation: Reliability

Joint Mobilizations and Manipulations: Effects

Joint Mobilization and Manipulation: Risk of Adverse Effects

Joint Mobilizations and Manipulations: Evidence-based Teaching and Learning

Course Description:  Lumbar Spine, Sacroiliac Joint, and Pubic Symphysis Joint Manipulation

Introduction

Hip Internal Rotation Goniometry in Prone

Hip Internal Rotation Goniometry in Supine

Hip External Rotation Goniometry in Prone

Hip External Rotation Goniometry in Supine

Gluteus Maximus Manual Muscle Testing (MMT)

 - Weak or With Compensation (Lumbar extension and/or knee flexion)

Gluteus Medius Manual Muscle Testing (MMT)

 - Weak or With Compensation (Lumbar lateral flexion and/or hip flexion)

Research Summary

Sacroiliac Joint (SIJ) Manipulation Summary:

Lumbar Pain

Comparing Manipulation to Other Interventions

Combining Manipulations with Other Interventions

Comparing Manipulation and Mobilization Techniques

Kinematics of Manipulation

Systemic Effects of Manipulations

Adverse Events

Research Corner: Lumbar Spine Manipulation

Research Corner: Sacroiliac Joint 

Does Sacroiliac Joint (SIJ) Dysfunction Contribute to Low Back Pain?

Sacroiliac joint (SIJ) manipulation is a controversial topic, primarily due to false notions regarding SIJ motion and SIJ assessment. Several studies have used injection to demonstrate that SIJ dysfunction contributes to low back pain. In a study by Fortin et al. on asymptomatic individuals, injection into the SIJ immediately revealed an area of buttock hyperesthesia extending approximately 10 cm caudally and 3 cm laterally from the posterior superior iliac spine (Fortin area) (127). In a follow-up study, 16 patients were selected whose pain most closely matched the "Fortin area", of these patients 10 benefited from therapeutic injection (128). Van der Wurff et al. mapped the area and intensity of chronic low back pain patients and then compared responder and non-responders to double diagnostic SIJ injection. The findings suggest that there were no significant differences in area; however, the intensity of specific areas did differ; with 100% of SIJ injection responders exhibiting more intense pain in the "Fortin area" and only 10% of SIJ injection responders with more intense pain at the ischial tuberosity (129). Maigne et al. demonstrated that nearly 20% of individuals with low back pain and diagnosed SIJ dysfunction, experienced at least temporary relief from fluoroscopic guided SIJ anesthetic block (130). Slipman et al. demonstrated that fluoroscopic guided injections effectively reduced pain, disability, and increased time at work during a 2-year follow-up of patients diagnosed with SIJ dysfunction (131). Soneji et al. demonstrated no significant difference between ultrasound-guided and fluoroscopy guided SIJ injections, with both resulting in a significant reduction from baseline mean pain scores, as well as improvements in physical functioning, discomfort, opioid utilization, and patient satisfaction (132). Although more research is needed to aid in refining assessment and injection interventions, the effect of SIJ injection on low back pain provides strong evidence that SIJ dysfunction is a significant contributor to low back pain.

Sacroiliac Joint Motion

Testing

SIJ Manipulations

Comparing Manipulation Techniques

Systemic Response to SIJ Manipulation

Pubic Symphysis Manipulation

The technique taught in this course is commonly observed in practice; however, there is almost no research on pubic motion or this technique. Garras et al. demonstrated that single-leg stance resulted in pubic motion of 1.4 mm of motion in men, 1.6 mm in nulliparous (never given birth) women, and 3.1 mm in multiparous women (233). Note these values are similar to the amount of motion described for the sacroiliac joint. Considering each innominate is one solid structure, the pubic symphysis and sacroiliac joint must move together, and similar motion may have been expected. An RCT by Hensel et al. demonstrated that pregnant women in their 3rd trimester benefited from an integrated plan of care, including conventional physician care and 12 osteopathic techniques - including the shotgun pubic symphysis manipulation taught below. The integrated care plan resulted in significantly less low back pain than standard care, slower deterioration of low back pain function, no increase in the number of patients who experienced complications; however, there was no impact on outcome measures related to labor itself (234). Considering that the shotgun pubic symphysis manipulation was one of 12 techniques, it is impossible to determine the technique's contribution to the outcome. Although the amount of research on the pubic symphysis and manipulation is less than ideal, it may be reasonable to suggest that it supports the plausibility of its effective implementation.

In practice, pubic manipulation is most often attempted when SIJ dysfunction has been confirmed, and SIJ techniques alone do not completely resolve symptoms. However, certain symptoms may specifically indicate pubic manipulation. Subjective symptoms specific to pubic symphysis dysfunction include 

 tendonitis or pain, and symptoms similar to femoral acetabular impingement (FAI). Pubic symphysis caudal and cranial mobilizations may be used to aid in the assessment of stiffness via palpation; however, this is a sensitive region for the patient, and the technique may have limited reliability. In summary, research suggests that the effective inclusion of pubic symphysis shotgun manipulation is plausible; however, the limited amount of research results in reliance on clinical outcomes.

Lumbar Manipulation

Sacroiliac Joint Chicago Technique Manipulation

Shotgun Manipulation (Pubic Symphysis)

Video Demonstration

Walker, B. F., Hebert, J. J., Stomski, N. J., Losco, B., & French, S. D. (2013). Short-term usual chiropractic care for spinal pain: a randomized controlled trial. 

Licciardone, J. C., Stoll, S. T., Fulda, K. G., Russo, D. P., Siu, J., Winn, W., & Swift Jr, J. (2003). Osteopathic manipulative treatment for chronic low back pain: a randomized controlled trial. 

Dougherty, P. E., Karuza, J., Dunn, A. S., Savino, D., & Katz, P. (2014). Spinal manipulative therapy for chronic lower back pain in older veterans: a prospective, randomized, placebo-controlled trial. 

Geriatric orthopaedic surgery & rehabilitation

Oh, K. O., Kim, C. H., & Choi, S. H. (2016). The Effect of spinal manipulation on the Lumbar Spine with LBP patients. 

The Journal of Korean Academy of Orthopedic Manual Physical Therapy

Annen, M., Peterson, C., Leemann, S., Schmid, C., Anklin, B., & Humphreys, B. K. (2016). Comparison of outcomes in MRI confirmed lumbar disc herniation patients with and without modic changes treated with high velocity, low amplitude spinal manipulation. 

Journal of manipulative and physiological therapeutics

Kuo, P. P., & Loh, Z. C. (1987). Treatment of lumbar intervertebral disc protrusions by manipulation. 

Clinical orthopaedics and related research

Glover, J. R., Morris, J. G., & Khosla, T. (1974). Back pain: a randomized clinical trial of rotational manipulation of the trunk. 

Schwerla, F., Rother, K., Rother, D., Ruetz, M., & Resch, K. L. (2015). Osteopathic manipulative therapy in women with postpartum low back pain and disability: a pragmatic randomized controlled trial. 

Shokri, E., Kamali, F., Sinaei, E., & Ghafarinejad, F. (2018). Spinal manipulation in the treatment of patients with MRI-confirmed lumbar disc herniation and sacroiliac joint hypomobility: a quasi-experimental study. 

Santilli, V., Beghi, E., & Finucci, S. (2006). Chiropractic manipulation in the treatment of acute back pain and sciatica with disc protrusion: a randomized double-blind clinical trial of active and simulated spinal manipulations. 

Burton, A. K., Tillotson, K. M., Edwards, V. A., & Sykes, D. A. (1990). Lumbar sagittal mobility and low back symptoms in patients treated with manipulation. 

Haas, M., Groupp, E., & Kraemer, D. F. (2004). Dose-response for chiropractic care of chronic low back pain. 

Haas M, Vavrek D, Peterson D, Polissar N, Neradilek MB. Dose-response and efficacy of spinal manipulation for care of chronic low back pain: a randomized controlled trial. Spine. 2014;14(7): 1106-16.

Bronfort, G., Goldsmith, C. H., Nelson, C. F., Boline, P. D., & Anderson, A. V. (1996). Trunk exercise combined with spinal manipulative or NSAID therapy for chronic low back pain: a randomized, observer-blinded clinical trial. 

Senna, M. K., & Machaly, S. A. (2011). Does maintained spinal manipulation therapy for chronic nonspecific low back pain result in better long-term outcome?. 

Flynn, T., Fritz, J., Whitman, J., Wainner, R., Magel, J., Rendeiro, D., … & Allison, S. (2002). A clinical prediction rule for classifying patients with low back pain who demonstrate short-term improvement with spinal manipulation. 

Childs, J. D., Fritz, J. M., Flynn, T. W., Irrgang, J. J., Johnson, K. K., Majkowski, G. R., & Delitto, A. (2004). A clinical prediction rule to identify patients with low back pain most likely to benefit from spinal manipulation: a validation study. 

Fritz, J. M., Whitman, J. M., Flynn, T. W., Wainner, R. S., & Childs, J. D. (2004). Factors related to the inability of individuals with low back pain to improve with a spinal manipulation. 

Hancock, M. J., Maher, C. G., Latimer, J., Herbert, R. D., & McAuley, J. H. (2008). Independent evaluation of a clinical prediction rule for spinal manipulative therapy: a randomised controlled trial. 

Dougherty, P. E., Karuza, J., Savino, D., & Katz, P. (2014). Evaluation of a modified clinical prediction rule for use with spinal manipulative therapy in patients with chronic low back pain: a randomized clinical trial. 

von Heymann, W. J., Schloemer, P., Timm, J., & Muehlbauer, B. (2013). Spinal high-velocity low amplitude manipulation in acute nonspecific low back pain: a double-blinded randomized controlled trial in comparison with diclofenac and placebo. 

Hondras, M. A., Long, C. R., Cao, Y., Rowell, R. M., & Meeker, W. C. (2009). A randomized controlled trial comparing 2 types of spinal manipulation and minimal conservative medical care for adults 55 years and older with subacute or chronic low back pain. Journal of manipulative and physiological therapeutics, 32(5), 330-343.

Doran, D. M., & Newell, D. J. (1975). Manipulation in treatment of low back pain: a multicentre study. 

Bishop, P. B., Quon, J. A., Fisher, C. G., & Dvorak, M. F. (2010). The Chiropractic Hospital-based Interventions Research Outcomes (CHIRO) study: a randomized controlled trial on the effectiveness of clinical practice guidelines in the medical and chiropractic management of patients with acute mechanical low back pain. The Spine Journal, 10(12), 1055-1064.

Hancock MJ, Maher CG, Latimer J, McLachlan AJ, Cooper CW, Day RO, et al. Assessment of diclofenac or spinal manipulative therapy, or both, in addition to recommended first-line treatment for acute low back pain: a randomised controlled trial. Lancet. 2007;370(9599):1638-43.

Giles, L. G., & Müller, R. (1999). Chronic spinal pain syndromes: a clinical pilot trial comparing acupuncture, a nonsteroidal anti-inflammatory drug, and spinal manipulation. 

Journal of Manipulative and Physiological Therapeutics

Giles, L. G., & Muller, R. (2003). Chronic spinal pain: a randomized clinical trial comparing medication, acupuncture, and spinal manipulation. 

Jüni, P., Battaglia, M., Nüesch, E., Hämmerle, G., Eser, P., van Beers, R., … & Reichenbach, S. (2009). A randomised controlled trial of spinal manipulative therapy in acute low back pain. 

Burton, A. K., Tillotson, K. M., & Cleary, J. (2000). Single-blind randomised controlled trial of chemonucleolysis and manipulation in the treatment of symptomatic lumbar disc herniation. 

McMorland, G., Suter, E., Casha, S., du Plessis, S. J., & Hurlbert, R. J. (2010). Manipulation or microdiskectomy for sciatica? A prospective randomized clinical study. Journal of manipulative and physiological therapeutics, 33(8), 576-584.

Hurley, D. A., McDonough, S. M., Dempster, M., Moore, A. P., & Baxter, G. D. (2004). A randomized clinical trial of manipulative therapy and interferential therapy for acute low back pain. 

Hsieh CY, Adams AH, Tobis J, Hong CZ, Danielson C, Platt K, et al. Effectiveness of four conservative treatments for subacute low back pain: a randomized clinical trial. Spine. 2002;27(11):1142-8.

Hoehler, F. K., Tobis, J. S., & Buerger, A. A. (1981). Spinal manipulation for low back pain. 

Bronfort, G., Maiers, M. J., Evans, R. L., Schulz, C. A., Bracha, Y., Svendsen, K. H., … & Transfeldt, E. E. (2011). Supervised exercise, spinal manipulation, and home exercise for chronic low back pain: a randomized clinical trial. 

Ferreira ML, Ferreira PH, Latimer J, Herbert RD, Hodges PW, Jennings MD, et al. Comparison of general exercise, motor control exercise and spinal manipulative therapy for chronic low back pain: A randomized trial. Pain. 2007; 131(1-2):31-7.

Hawk, C., Rupert, R. L., Colonvega, M., Boyd, J., & Hall, S. (2006). Comparison of bioenergetic synchronization technique and customary chiropractic care for older adults with chronic musculoskeletal pain. 

Nwuga, V. C. (1982). Relative therapeutic efficacy of vertebral manipulation and conventional treatment in back pain management. 

El Gendy, M. H., Karkousha, R. N., Hassan, A. S. E., & Mourad, R. R. (2017). THRUST MANIPULATION VERSUS MUSCLE ENERGY TECHNIQUE ON SOMATIC DYSFUNCTION IN MECHANICAL LOW BACK PAIN PATIENTS. 

Mahmoud, W. S. (2015). Effect of neural mobilization versus spinal manipulation in patients with radicular chronic low back pain. 

Cherkin, D. C., Deyo, R. A., Battié, M., Street, J., & Barlow, W. (1998). A comparison of physical therapy, chiropractic manipulation, and provision of an educational booklet for the treatment of patients with low back pain. 

Gibson, T., Harkness, J., Blagrave, P., Grahame, R., Woo, P., & Hills, R. (1985). Controlled comparison of short-wave diathermy treatment with osteopathic treatment in non-specific low back pain. 

Cecchi, F., Molino-Lova, R., Chiti, M., Pasquini, G., Paperini, A., Conti, A. A., & Macchi, C. (2010). Spinal manipulation compared with back school and with individually delivered physiotherapy for the treatment of chronic low back pain: a randomized trial with one-year follow-up. 

Dougherty, P., Bajwa, S., Burke, J., & Dishman, J. D. (2004). Spinal manipulation postepidural injection for lumbar and cervical radiculopathy: a retrospective case series. 

Goertz CM, Long CR, Hondras MA, Petri R, Delgado R, Lawrence DJ, et al. Adding chiropractic manipulative therapy to standard medical care for patients with acute low back pain: results of a pragmatic randomized comparative effectiveness study. Spine. 2013; 38(8):627-34.

Bronfort, G., Hondras, M. A., Schulz, C. A., Evans, R. L., Long, C. R., & Grimm, R. (2014). Spinal manipulation and home exercise with advice for subacute and chronic back-related leg pain: a trial with adaptive allocation. 

Balthazard, P., de Goumoens, P., Rivier, G., Demeulenaere, P., Ballabeni, P., & Dériaz, O. (2012). Manual therapy followed by specific active exercises versus a placebo followed by specific active exercises on the improvement of functional disability in patients with chronic non specific low back pain: a randomized controlled trial. 

Mohseni-Bandpei, M. A., Critchley, J., Staunton, T., & Richardson, B. (2006). A prospective randomised controlled trial of spinal manipulation and ultrasound in the treatment of chronic low back pain. Physiotherapy, 92(1), 34-42.

Rasmussen, J., Lætgaard, J., Lindecrona, A. L., Qvistgaard, E., & Bliddal, H. (2008). Manipulation does not add to the effect of extension exercises in chronic low-back pain (LBP). A randomized, controlled, double blind study. 

Selhorst, M., & Selhorst, B. (2015). Lumbar manipulation and exercise for the treatment of acute low back pain in adolescents: a randomized controlled trial. 

Evans, R., Haas, M., Schulz, C., Leininger, B., Hanson, L., & Bronfort, G. (2018). Spinal manipulation and exercise for low back pain in adolescents: a randomized trial. 

Murphy, D. R., Hurwitz, E. L., Gregory, A. A., & Clary, R. (2006). A non-surgical approach to the management of lumbar spinal stenosis: a prospective observational cohort study. BMC Musculoskeletal Disorders, 7(1), 16.

Murphy, D. R., Hurwitz, E. L., & McGovern, E. E. (2009). A nonsurgical approach to the management of patients with lumbar radiculopathy secondary to herniated disk: a prospective observational cohort study with follow-up. 

Beyerman, K. L., Palmerino, M. B., Zohn, L. E., Kane, G. M., & Foster, K. A. (2006). Efficacy of treating low back pain and dysfunction secondary to osteoarthritis: chiropractic care compared with moist heat alone. 

Rosner, A. L., Conable, K. M., & Edelmann, T. (2014). Influence of foot orthotics upon duration of effects of spinal manipulation in chronic back pain patients: a randomized clinical trial. 

Xia, T., Long, C. R., Gudavalli, M. R., Wilder, D. G., Vining, R. D., Rowell, R. M., … & Meeker, W. C. (2016). Similar Effects of Thrust and Non-Thrust Spinal Manipulation Found in Adults With Subacute and Chronic Low Back Pain–A Controlled Trial with Adaptive Allocation. 

Sims-Williams, H., Jayson, M. I., Young, S. M., Baddeley, H., & Collins, E. (1978). Controlled trial of mobilisation and manipulation for patients with low back pain in general practice. 

Cook, C., Learman, K., Showalter, C., Kabbaz, V., & O'Halloran, B. (2013). Early use of thrust manipulation versus non-thrust manipulation: a randomized clinical trial. 

Perry, J., Green, A., Singh, S., & Watson, P. (2011). A preliminary investigation into the magnitude of effect of lumbar extension exercises and a segmental rotatory manipulation on sympathetic nervous system activity. 

Cleland, J. A., Fritz, J. M., Kulig, K., Davenport, T. E., Eberhart, S., Magel, J., & Childs, J. D. (2009). Comparison of the effectiveness of three manual physical therapy techniques in a subgroup of patients with low back pain who satisfy a clinical prediction rule: a randomized clinical trial. 

Carrasco-Martínez, F., Ibáñez-Vera, A. J., Martínez-Amat, A., Hita-Contreras, F., & Lomas-Vega, R. (2019). Short-term effectiveness of the flexion-distraction technique in comparison with high-velocity vertebral manipulation in patients suffering from low-back pain. 

Thomson, O., Haig, L., & Mansfield, H. (2009). The effects of high-velocity low-amplitude thrust manipulation and mobilisation techniques on pressure pain threshold in the lumbar spine. 

International Journal of Osteopathic Medicine

Ward, J., Ramcharan, M., Coats, J., Chu, C., & Zuniga, J. (2013). Lumbar Spine Manipulation Impact on Exercise Science Measures. 

Journal of the American Chiropractic Association

Olson, E., Bodziony, M., Ward, J., Coats, J., Koby, B., & Goehry, D. (2014). Effect of lumbar spine manipulation on asymptomatic cyclist sprint performance and hip flexibility. 

Gong, W. (2018). The Effects of Pelvis, Lumbar Spine and Cervical Spine Manipulation on Joint Position Sense in Healthy Adults. 

Journal of International Academy of Physical Therapy Research

Alveranga, B., Lara, J., Joao, F., & Veloso, A. (2019). The effects of lumbar spinal manipulation on athletes’ symmetry: a prospective randomized study. 

Anuario Jurídico y Económico Escurialense

The immediate effect of lumbar spine manipulation, thoracic spine manipulation, combination lumbar and thoracic spine manipulation and sham laser on bowling speed in action cricket fast bowlers

Zhang, J., Wang, F., Liu, Q., Zhang, H., Sun, P., Liang, D., & Zhao, P. (2016). Conduction characteristics of human lumbar facet joint pressures during simulated spinal manipulationversusspinal mobilization. 

Chinese Journal of Tissue Engineering Research

Cramer, G. D., Gregerson, D. M., Knudsen, J. T., Hubbard, B. B., Ustas, L. M., & Cantu, J. A. (2002). The effects of side-posture positioning and spinal adjusting on the lumbar Z joints: a randomized controlled trial with sixty-four subjects. 

Xu, H. T., Xu, D. C., Li, Y. G., Zhang, M. C., Li, Y. K., & Wang, G. L. (2007). Analyses of intra-stress and displacement of degenerate lumbar disc during simulating rotatory manipulation by finite element. 

Haussler, K. K., Hill, A. E., Puttlitz, C. M., & McIlwraith, C. W. (2007). Effects of vertebral mobilization and manipulation on kinematics of the thoracolumbar region. 

Xia, T., Long, C. R., Vining, R. D., Gudavalli, M. R., DeVocht, J. W., Kawchuk, G. N., … & Goertz, C. M. (2017). Association of lumbar spine stiffness and flexion-relaxation phenomenon with patient-reported outcomes in adults with chronic low back pain–a single-arm clinical trial investigating the effects of thrust spinal manipulation. 

BMC complementary and alternative medicine

Stamos-Papastamos, N., Petty, N. J., & Williams, J. M. (2011). Changes in bending stiffness and lumbar spine range of movement following lumbar mobilization and manipulation. 

Panjabi, M. M. (1992). The stabilizing system of the spine. Part I. Function, dysfunction, adaptation, and enhancement. 

Panjabi, M. M. (1992). The stabilizing system of the spine. Part II. Neutral zone and instability hypothesis. 

Dorron, S. L., Losco, B. E., Drummond, P. D., & Walker, B. F. (2016). Effect of lumbar spinal manipulation on local and remote pressure pain threshold and pinprick sensitivity in asymptomatic individuals: a randomised trial. 

George, S. Z., Bishop, M. D., Bialosky, J. E., Zeppieri, G., & Robinson, M. E. (2006). Immediate effects of spinal manipulation on thermal pain sensitivity: an experimental study. 

Bialosky, J. E., Bishop, M. D., Robinson, M. E., Zeppieri Jr, G., & George, S. Z. (2009). Spinal manipulative therapy has an immediate effect on thermal pain sensitivity in people with low back pain: a randomized controlled trial. 

Penza, C. W., Horn, M. E., George, S. Z., & Bishop, M. D. (2017). Comparison of 2 lumbar manual therapies on temporal summation of pain in healthy volunteers. 

Bialosky, J. E., Bishop, M. D., Robinson, M. E., Barabas, J. A., & George, S. Z. (2008). The influence of expectation on spinal manipulation induced hypoalgesia: an experimental study in normal subjects. 

Aspinall, S. L., Jacques, A., Leboeuf-Yde, C., Etherington, S. J., & Walker, B. F. (2019). No difference in pressure pain threshold and temporal summation after lumbar spinal manipulation compared to sham: A randomised controlled trial in adults with low back pain. 

Dishman, J. D., & Bulbulian, R. (2000). Spinal reflex attenuation associated with spinal manipulation. 

Dishman, J. D., Burke, J. R., & Dougherty, P. (2018). Motor Neuron Excitability Attenuation as a Sequel to Lumbosacral Manipulation in Subacute Low Back Pain Patients and Asymptomatic Adults: A Cross-Sectional H-Reflex Study. 

Dishman, J. D., Dougherty, P. E., & Burke, J. R. (2005). Evaluation of the effect of postural perturbation on motoneuronal activity following various methods of lumbar spinal manipulation. 

Dishman, J. D., Cunningham, B. M., & Burke, J. (2002). Comparison of tibial nerve H-reflex excitability after cervical and lumbar spine manipulation. 

Dishman, J. D., & Burke, J. (2003). Spinal reflex excitability changes after cervical and lumbar spinal manipulation: a comparative study. 

Colloca, C. J., Keller, T. S., & Gunzburg, R. (2004). Biomechanical and neurophysiological responses to spinal manipulation in patients with lumbar radiculopathy. 

Cao, D. Y., Reed, W. R., Long, C. R., Kawchuk, G. N., & Pickar, J. G. (2013). Effects of thrust amplitude and duration of high-velocity, low-amplitude spinal manipulation on lumbar muscle spindle responses to vertebral position and movement. 

Sung, P. S., Kang, Y. M., & Pickar, J. G. (2005). Effect of spinal manipulation duration on low threshold mechanoreceptors in lumbar paraspinal muscles: a preliminary report. 

Pickar, J. G., & Kang, Y. M. (2006). Paraspinal muscle spindle responses to the duration of a spinal manipulation under force control. 

Floman, Y., Liram, N., & Gilai, A. N. (1997). Spinal manipulation results in immediate H-reflex changes in patients with unilateral disc herniation. 

Bibliography

Questions, comments and critiques welcomed and encouraged

Joint Manipulation: Lumbar Spine, Sacroiliac Joint and Pubic Symphysis

Related Courses:

Course Description: Lumbar Spine, Sacroiliac Joint, and Pubic Symphysis Joint Manipulation

Introduction

Research Summary

Research Corner: Lumbar Spine Manipulation
7 Sub Sections

Research Corner: Sacroiliac Joint
6 Sub Sections

Pubic Symphysis Manipulation

Video Demonstration
3 Sub Sections

Bibliography

Related Courses:

Comments

Guest

Joint Manipulation: Lumbar Spine, Sacroiliac Joint and Pubic Symphysis

Related Courses:

Course Description: Lumbar Spine, Sacroiliac Joint, and Pubic Symphysis Joint Manipulation

Introduction

Research Summary

Research Corner: Lumbar Spine Manipulation7 Sub Sections

Research Corner: Sacroiliac Joint 6 Sub Sections

Pubic Symphysis Manipulation

Video Demonstration3 Sub Sections

Bibliography

Related Courses:

Comments

Guest

Research Corner: Lumbar Spine Manipulation
7 Sub Sections

Research Corner: Sacroiliac Joint
6 Sub Sections

Video Demonstration
3 Sub Sections