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Introduction to joint mobilizations and manipulations. The efficacy, on goniometry and joint stiffness, the best use, long-term outcomes, risk of adverse events, and assessments of joint manips and mobs of the cervical, thoracic, and lumbar spine. Differences between active, passive, and self-administered joint mobilizations and manipulations. And what makes the cavitation sound (joint pop)?

Joint Mobilization and Manipulation: Introduction

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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.

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Integrated Manual Therapist

Joint mobilization treatment and joint manipulation treatment have literally been developing for thousands of years, with early depictions of these techniques found in Thailand (2000 BC) and depicted by Hippocrates (500 BC). However, a more organized approach to mobilizations did not begin until the practice of "bone setting" appeared in England in the 1650s. Two hundred years later, schools were created for osteopaths (Still, 1876) and chiropractors (Palmer, 1895), aiding in formalizing education and advancing these techniques as a practice within a trade. Over the last 100 years, the advancement of these techniques, and their inclusion in the medical model, can be largely attributed to individuals such as Cyriax, Maitland, Kaltenborn, McKenzie, Mulligan, and Paris. In the last 20 years, the focus has shifted from individual innovators and "schools of thought" toward evidence-based practice. The Brookbush Institute will continue the trend toward an evidence-based refinement of mobilization and manipulation techniques; including the development of an evidence-based, systematic, integrated, patient-centered, and outcome-driven approach, refined by a comprehensive review of all relevant original research.

Joint mobilization and joint manipulation strategies are relatively well-researched topics in sports medicine. These techniques are among the few modalities benefiting from 100s of comparative randomized control trials, including the efficacy of these techniques relative to other manual therapy techniques, self-administered techniques, and exercise interventions. The addition of joint mobilizations and manipulations to other effective methods, as part of an integrated approach to treatment, has demonstrated superior efficacy for hand pain (e.g. joint issues), sports injury (e.g. muscle sprains), altered recruitment patterns (e.g. muscle weakness resulting from inhibition), chronic pain of the low back (e.g. loss of lumbar mobility), etc.

We hope this course aids in providing clarity about a topic that has benefited from a very large body of research and rich history of comparing joint mobilization strategies. Further, this course is pre-approved for credits toward the Integrated Manual Therapist (IMT) Certification, and pre-approved for continuing education credits for sports medicine professionals and health care providers (physical therapists, athletic trainers, massage therapists, chiropractors, occupational therapists, etc.).

Effects of Joint Mobilizations and Manipulations

Joint Mobilizations and Manipulations: Risk of Adverse Events

Joint Mobilizations and Manipulations: Evidenced-based Teaching and Learning

Course Description: Introduction to Joint Mobilization and Manipulation

Introduction

Practical Applications

Arthrokinematic Motion and Osteokinematic Motion

Definitions and Protocols

Research Summary

Active versus Passive: Comparing Mobilization and Manipulation Techniques to Exercise

Combined Interventions: An Integrated Approach

Comparing Mobilizations and Manipulations  

Best Practice Recommendations

Long-term Outcomes following Mobilizations and Manipulations

Several hundred studies have demonstrated that mobilizations and manipulations have positive effects on long-term patient outcomes. Rather than review all of these studies, which are already discussed in other courses, this section will only review randomized controlled trials (RCTs) with follow-ups of 12-weeks (3-months) or longer.

 Mobilizations/manipulations result in superior long-term outcomes when compared to a variety of conventional interventions; however, the largest benefits are likely achieved when mobilizations/manipulations are combined with additional effective interventions, in every session of an integrated treatment plan, as indicated by movement assessment,

 Cervical mobilizations and manipulations result in superior short-term and long-term improvements in pain, dysfunction, quality of life, speed of recovery, and rate of recovery when compared to massage, acupuncture, conventional physical therapy (exercise and modalities), and conventional physician care. Further, the addition of cervical mobilizations/manipulations to an integrated program results in better long-term outcomes, and the combination of cervical mobilizations/manipulations and exercise results in better outcomes than either technique alone.

 Thoracic manipulations are likely to result in superior short and long-term outcomes for function, ROM, and rate of recovery when compared to, or added to, conventional physician care, conventional therapeutic exercise, or infrared radiation therapy,

 The treatment of low back pain with lumbar manipulations or mobilizations, when compared to analgesics, lumbar corsets, chemonucleolysis, electrotherapy, acupuncture or conventional exercise, exhibits superior efficacy during short-term follow-up, and equal or superior efficacy during long-term follow-up.

 Lumbar manipulations and mobilizations exhibit superior short-term and long-term outcomes when compared to general exercise programs and home exercise programs, but may result in similar outcomes when compared to supervised, specific exercise programs. Further, the combination of lumbar mobilizations/manipulations and exercise has demonstrated superior long-term efficacy when compared to any exercise program performed alone, exercise and patient education, exercise and NSAIDs, and physician care and patient education.

 Based on long-term outcomes, manipulations are likely more effective than mobilizations, manipulations/mobilizations alone may not be sufficient to improve outcomes, the addition of 5 sessions of mobilizations/manipulations may not be sufficient to improve outcomes, and the addition of lumbar manipulations to an intervention plan for extremity joints may be beneficial but have a smaller effect size than techniques intended for the symptomatic joint.

Research investigating the long-term efficacy of lower extremity mobilizations and manipulations reports findings similar to research investigating the long-term efficacy of spine mobilizations and manipulations. Based on both short-term and long-term pain, ROM, function, and disability outcomes measures, mobilizations/manipulations alone exhibit superior efficacy to exercise alone, the combination of mobilizations/manipulations and exercises exhibit superior long-term efficacy when compared to either intervention alone, and mobilizations/manipulations, with or without the addition of exercise, exhibit superior efficacy to conventional medical care.

 An integrated approach including thoracic spine and/or shoulder mobilizations, may improve short and long-term outcomes for shoulder dysfunction; however, shoulder mobilizations are likely more beneficial for individuals exhibiting signs of shoulder joint movement restriction.

 For the treatment of lateral epicondylitis, injections may be more beneficial initially; however, success rates and long-term outcomes are likely superior when elbow mobilizations/manipulations are added to an integrated approach that may include ultrasound, transverse friction massage, radial nerve mobilization, and/or wrist extensor exercise.

 The gross majority of RCTs have demonstrated improvements in long-term patient outcomes when mobilizations or manipulation are added to an intervention plan, and no studies have demonstrated that these techniques resulted in worse patient outcomes. It is likely reasonable to conclude that mobilizations and manipulations have significant potential to improve long-term patient outcomes, and far less potential to have no effect at all.

 The body of research implies that mobilizations and manipulations may be slightly more effective than exercise for improving long-term outcomes; however, exercise and mobilizations/manipulations likely result in some intervention-specific benefits, and the combination of the two interventions is more effective than either alone.

 More than 5 sessions of mobilizations or manipulations may be necessary to reliably increase long-term patient outcomes. However, rather than implying a specific number of sessions, a more practical recommendation may be the use of an integrated approach that considers the inclusion of mobilizations or manipulations as part of every treatment session.

 Mobilizations/manipulations of the spine may provide additional benefits for patients with extremity dysfunction; however, it is likely these techniques alone will not have the same magnitude of effect as techniques performed on the dysfunctional extremity.

 The reduction of significant differences in research should be expected when comparing various interventions, and short-term outcomes to long-term outcomes. As patients improve, and treatment duration approaches the mean (average) recovery time for a diagnosis, the potential for improvements decreases, and the magnitude of improvement made in each session decreases.

Joint Mobilization and Manipulation: Introduction

Related Courses:

Course Description: Introduction to Joint Mobilization and Manipulation

Introduction
4 Sub Sections

Best Practice Recommendations
3 Sub Sections

Long-term Outcomes following Mobilizations and Manipulations
8 Sub Sections

Assessment, Effects and Risks (Summaries from Additional Courses)
4 Sub Sections

Related Courses:

Comments

Guest

Joint Mobilization and Manipulation: Introduction

Related Courses:

Course Description: Introduction to Joint Mobilization and Manipulation

Introduction4 Sub Sections

Best Practice Recommendations3 Sub Sections

Long-term Outcomes following Mobilizations and Manipulations8 Sub Sections

Assessment, Effects and Risks (Summaries from Additional Courses)4 Sub Sections

Related Courses:

Comments

Guest

Introduction
4 Sub Sections

Best Practice Recommendations
3 Sub Sections

Long-term Outcomes following Mobilizations and Manipulations
8 Sub Sections

Assessment, Effects and Risks (Summaries from Additional Courses)
4 Sub Sections