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Assessment and reliability of joint mobilizations and manipulations of the cervical, thoracic, lumbar, and sacroiliac joints. Effects of mobilizations and manipulations on the range of motion (ROM), inter- and intra- therapist reliability, force, manipulation grades, types of manips and mobs, and outcomes.

Joint Mobilization and Manipulation: Palpation, Assessment, and Reliability

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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.

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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 :)

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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.

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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.



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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.

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Integrated Manual Therapist

In this course, we cover a topic that has only recently become controversial. Palpation and palpation assessment (passive accessory motion exam) were considered standard components of a physical examination, and they were performed by a variety of healthcare providers. Recently, the reliability and efficacy of these techniques have been critiqued and contrarian therapists on social media claim they are no longer worthy of inclusion in practice. Although healthy skepticism is always encouraged, the research does not support dismissing these techniques. Deep palpation may require more skill and have lower reliability when performed by less experienced therapists, and the efficacy of a technique may be affected by a certain body part being harder to palpate because of its position deep to an internal organ. Further, additional palpation skills may be required to work around a structure carrying critical blood flow, light palpation may be needed when addressing effusion and an increase in joint fluids, and differentiation between tissues may require advanced anatomy knowledge. Despite these factors affecting the reliability and efficacy of palpation, it would be a logical fallacy to dismiss a technique for any presumed flaw. Reliability and efficacy are not binary measures, they are probabilistic measures. Less reliable or effective, does not imply "not reliable or effective".

This course is built from a comprehensive, systematic review of all relevant research, carefully explains the issues involved in interpreting the research, and attempts to develop the nuanced conclusions necessary to make evidence-based recommendations. A couple of examples from the research summary:

 When research investigates a well-differentiated definition of a positive finding, a practically relevant range of agreement, considers therapist confidence in findings (and perhaps therapist skill), good or better inter-therapist and intra-therapist reliability is achievable for joint motion assessment by palpation.

 Range of motion (ROM) assessments and special tests are generally more reliable than joint motion assessment by palpation; however, the addition of joint motion assessment by palpation to a combination of assessments (as is commonly observed in practice) likely increases the reliability of these assessments and the reliability of the evaluation overall.

We hope this course aids in providing clarity for a relatively complex topic and provides simple suggestions for practical application. 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.).

Brookbush Institute's Position Statement 

Good to excellent inter-therapist and intra-therapist reliability may be achieved for the palpation of anatomical landmarks, joint stiffness assessment by palpation, and therapist force during mobilization/manipulation when parameters are well-defined, therapist confidence in findings is considered, and reliability is analyzed using a continuous interval measure and/or practically relevant range of agreement. The reliability, predictive value, and utility of these techniques are likely to improve when integrated into a standard patient evaluation that includes multiple assessments, and/or added to an integrated (multi-modal) intervention plan. Further, adding these techniques to practice reliably and significantly improves mean patient outcomes.

 when these techniques are judged based on how they are commonly used in practice, they demonstrate sufficient reliability to significantly improve patient outcomes.

Joint Mobilization and Manipulation: Introduction

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: Palpation, Assessment, and Reliability

Introduction

Good to excellent inter-therapist and intra-therapist reliability may be achieved for the palpation of anatomical landmarks, joint stiffness assessment by palpation, and therapist force during mobilization/manipulation when parameters are well-defined, therapist confidence in findings is considered, and reliability is analyzed using a continuous interval measure and/or practically relevant range of agreement. The reliability, predictive value, and utility of these techniques are likely to improve when integrated into a normal patient evaluation that includes multiple assessments, and/or added to an integrated (multi-modal) intervention plan. Further, the addition of these techniques to practice reliably and significantly improves mean patient outcomes.

 when these techniques are judged based on the way they are commonly used in practice, they demonstrate sufficient reliability to result in a significant improvement in patient outcomes.

Intra-therapist vs. Inter-therapist Reliability:

 Research suggests that intra-therapist reliability is often good to excellent, and likely better than inter-therapist reliability for these techniques.

This may imply that better inter-therapist reliability is possible if additional research leads to a reliable set of protocols that are widely adopted by the movement professions.

 Imaging may not match the relative location of landmarks found by palpation, and the palpation of anatomical landmarks should be performed knowing that results are a narrow range of probable findings (findings are not discreet values).

 Therapist force during mobilizations exhibits excellent intra-therapist reliability for peak force, mean peak force, amplitude, and oscillatory frequency. Inter-therapist force may exhibit relatively high amounts of variance; however, moderate reliability may be achieved when considering the mean force of grades I and II or grades III and IV together.

As might be expected in any professional setting, the most capable 1/3 of professionals exhibit good to excellent intra-therapist reliability, and the bottom 1/3 exhibit greater variance.

 Mean peak force is likely more critical than mean minimal force during mobilizations and manipulation. Further, a relatively wide range of forces may be effective, with better outcomes correlated with more force or force above a certain low-end threshold.

 Patient characteristics, the rate of force development, and the duration of manipulation should be considered when developing an ideal range for therapist force, and pain intensity, nature of symptoms, and assumptions about factors contributing to comfort should be given less consideration or dismissed from consideration.

Brookbush Institute Evidence-based Recommendations

Palpation and joint stiffness assessment by palpation should be performed knowing that assessment results reflect a narrow range of probable findings (findings are not discreet values).

Joint stiffness assessment by palpation should be performed in conjunction with additional movement assessments (and special tests if necessary) with the intent of improving intervention selection.

It may be ideal to use joint stiffness assessment by palpation as an assessment to determine whether a mobilization or manipulation technique had an acute effect on joint stiffness.

Reliability may be improved for joint motion assessment by incorporating the following into practice: 

Well-differentiated definition of a positive finding (i.e. most stiff)

Although it is not common practice, research suggests a reference device for comparing normal and abnormal amounts of stiffness may improve the reliability of "stiffness assessment".

Mobilizations and manipulations should only be performed on joints exhibiting signs of hypomobility, and should not be used on hypermobile joints.

Professionals should expect that the mean force of grades I and II, and the mean force of grades III and IV will be similar, and greater variance should be expected and potentially promoted during higher amplitude mobilizations (grades II and III).

Peak force likely has a larger impact on outcomes. Professionals should prioritize determining the amount of peak force necessary to improve the arthrokinematic range of joints exhibiting stiffness, and attempt to maintain consistent peak force throughout the duration of the technique (until stiffness/symptoms change).

Professionals performing high-velocity manipulations should practice with the intent to improve the reliability of forces imparted, increase the rate of force development, and decrease the duration of a manipulation technique.

Although it is not common practice, research suggests instrumented manakins and force gauges that visually display the amount of force during a technique can improve reliability when used consistently.

Ignorance Fueled Controversy

Definitions and Word Choice

Course Summary

Palpation of Boney Landmarks

Reliability of Therapist Force during Joint Mobilization/Manipulation

Accuracy of Relative Locations

Physical Factors Affecting Reliability

Inter-therapist Versus Intra-therapist Reliability

Questionable Research Methods

Measurement Issues with Reliability

Section Summary

Reliability of Palpation of Bony Landmarks

Inter-therapist versus Intra-therapists Reliability of Assessment by Palpation

Additional Factors

Reliability of Joint Motion Assessment by Palpation Relative to Other Assessments

Measurement Issues with Studies Investigating the Reliability of Assessing Joint Motion by Palpation

Reliability of Joint Motion Assessment by Palpation Section Summary

Reliability of Joint Motion Assessment by Palpation

Inter-therapist and Intra-therapist Reliability

Factors Affecting Reliability of Therapists Force

Measurement Problems and the Reliability of Therapist Force

Reliability of Therapist Force Section Summary

Outcomes

A few studies have compared outcomes following mobilizations based on random allocation or therapist assessment. Aquino et al. compared changes in pain pressure threshold and pain during active motion for 48 participants with cervical pain following either mobilization of the most painful segment as assessed by palpation, or mobilization of a randomly selected segment. Both groups exhibited similar and significant decreases in pain during palpation, and pain during motion (89). Haas et al. demonstrated that determining a specific segment based on "end play" did not result in better outcomes than selection of a random cervical segment; however, both groups exhibited less pain and stiffness after cervical manipulation and during a follow-up assessment 5-hours later (90). An RCT by Kanlayanaphotporn et al. compared the pain intensity and active range of motion (ROM) of patients with unilateral mechanical neck pain following assessed and random protocols. The level was determined by random allocation or a blinded assessor, and the technique was then randomized to unilateral PA to the painful segment, contralateral PA, or Central PA. All mobilization groups exhibited similar and significant improvements in all outcomes (91). Karas et al. compared the outcomes of 69 patients with cervical spine pain who were randomly assigned to receive a thoracic manipulation that was consistent with the direction of their ROM loss or opposite their ROM loss, demonstrating that both groups exhibited similar improvements in pain, neck disability index, and global rating of change scores at 2-day and 2-week follow-ups (92). Last, an RCT by Donaldson et al. compared outcomes for 63 patients with mechanically reproducible lumbar pain, following mobilization of a therapist-selected segment, or a segment based on a pre-determined lumbar mobilization protocol. At 6-month follow-up there were significant but similar improvements for pain, disability, and patient acceptable symptom state scores; however, there was a significant difference between groups for global rating of change scores favoring the therapist-selected mobilization (93). Studies suggest that segmental assessment may not refine implementation enough to have a significant effect on short-term outcomes; however, significant improvements in long-term outcomes may have been demonstrated. It is worth considering that the assessment and allocation protocols in these studies happened within a few vertebrae (only cervical segments or only lumbar segments), that multiple segments often exhibit altered stiffness in symptomatic individuals, and that mobilizations/manipulations may affect more than one segment. This may have resulted in a large degree of overlap between treatment groups, and imply that studies with larger participants groups are needed to improve study sensitivity enough to identify differences beyond those masked by group overlap. Last, it is worth noting that all participants in all treatment groups demonstrated significant improvements (including when compared to controls), suggesting that knowing the part of the spine to be treated (e.g. cervical, thoracic or lumbar) may be enough to be effective.

Additional studies suggest that assessments may improve outcomes when they aid in narrowing choices between broader categories. Fritz et al. compared outcomes of low back pain patients assessed as hypomobile or hypermobile following treatments of either manipulations or stabilization exercise. Success rates were 23.7% better for hypomobile patients receiving manipulations when compared to patients receiving manipulations who were not hypomobile, and success rates were 36.4% better for hypermobile patients receiving stabilization exercise when compared to patients receiving stabilization exercise who were not hypermobile. Further, failure rates for patients with hypomobility were 26% with manipulation techniques and 74.4% with stabilization exercise, and failure rates for patients with hypermobility were 83.3% for manipulation techniques and 22.2% for stabilization exercises (94). Hidalgo et al. demonstrated that asymptomatic patients assessed with upper cervical hypomobility exhibited greater improvements in cervical range of motion (ROM) following a C0/C1 mobilization (mean 17.64°) when compared to a c7-T1 (mean 5.95°) mobilization. Note, both mobilizations resulted in significant increases in ROM compared to controls (mean 2.45°) (95). And, mentioned above, Venturini et al. demonstrated good inter-therapist reliability between 2 practitioners for maximal force applied during a 30-second, grade III ankle mobilization, poor inter-therapist reliability for minimal force; however, the effects of mobilization were consistent resulting in an increase ankle dorsiflexion ROM for all participants, regardless of which therapist performed the technique (69). These studies suggest that differentiating between hypermobility and hypomobility, upper and lower cervical spine, and/or ensuring adequate maximal force during mobilization may be sufficiently accurate to significantly improve outcomes.

 Segmental assessment may not refine implementation enough to have a significant effect on short-term outcomes; however, segmental assessment may result in improvements in long-term outcomes. Further, mobilizations/manipulations improved both short-term and long-term outcomes when compared to controls, following both random and assessed allocations.

 - It is worth considering that the assessment and allocation protocols in these studies happened within a few vertebrae (only cervical segments or only lumbar segments), that multiple segments often exhibit altered stiffness in symptomatic individuals, and that mobilizations/manipulations may affect more than one segment. This may have resulted in a large degree of overlap between treatment groups, and imply that studies with larger participants groups are needed to improve study sensitivity enough to identify differences beyond those masked by group overlap.

 - Differentiating between hypermobility and hypomobility, upper and lower cervical spine, and/or ensuring adequate maximal force during mobilization may be sufficiently accurate to significantly improve outcomes.

Chakraverty, R., Pynsent, P., & Isaacs, K. (2007). Which spinal levels are identified by palpation of the iliac crests and the posterior superior iliac spines?. 

Póvoa, L. C., Ferreira, A. P., Zanier, J. F., & Silva, J. G. (2018). Accuracy of Motion Palpation Flexion-Extension Test in Identifying the Seventh Cervical Spinal Process. 

Haneline, M. T., Cooperstein, R., Young, M. D., & Ross, J. (2008). Determining spinal level using the inferior angle of the scapula as a reference landmark: a retrospective analysis of 50 radiographs. 

The Journal of the Canadian Chiropractic Association

Cooperstein, R., Haneline, M. T., & Young, M. D. (2009). The location of the inferior angle of the scapula in relation to the spinal level of prone patients. 

Palpation: Factors affecting accuracy (and 2)

Simmonds, M. J., & Kumar, S. (1993). Health care ergonomics Part II: Location of body structures by palpation-A reliability study. International Journal of Industrial Ergonomics, 11(2), 145-151.

Harlick, J. C., Milosavljevic, S., & Milburn, P. D. (2007). Palpation identification of spinous processes in the lumbar spine. 

Pagé, I., Descarreaux, M., & Sobczak, S. (2017). Development of a new palpation method using alternative landmarks for the determination of thoracic transverse processes: an in vitro study. 

Billis, E. V., Foster, N. E., & Wright, C. C. (2003). Reproducibility and repeatability: errors of three groups of physiotherapists in locating spinal levels by palpation. 

McKenzie, A. M., & Taylor, N. F. (1997). Can physiotherapists locate lumbar spinal levels by palpation?. 

Pattyn, E., & Rajendran, D. (2014). Anatomical landmark position–can we trust what we see? Results from an online reliability and validity study of osteopaths. Manual therapy, 19(2), 158-164.

Robinson, R., Robinson, H. S., Bjørke, G., & Kvale, A. (2009). Reliability and validity of a palpation technique for identifying the spinous processes of C7 and L5. 

Rossettini, G., Rondoni, A., Lovato, T., Strobe, M., Verzè, E., Vicentini, M., & Testa, M. (2017). Intra-and inter-rater reliability of 3D passive intervertebral motion in subjects with non-specific neck pain assessed by physical therapy students: A pilot study. 

Journal of back and musculoskeletal rehabilitation

Smedmark, V., Wallin, M., & Arvidsson, I. (2000). Inter-examiner reliability in assessing passive intervertebral motion of the cervical spine. 

Potter, L., McCarthy, C., & Oldham, J. (2006). Intraexaminer reliability of identifying a dysfunctional segment in the thoracic and lumbar spine. 

Journal of manipulative and physiological therapeutics

Ghoukassian, M., Nicholls, B., & McLaughlin, P. (2001). Inter-examiner reliability of the Johnson and Friedman percussion scan of the thoracic spine. 

Cooperstein, R. (2012). Interexaminer reliability of the Johnston and Friedman percussion scan of the thoracic spine: secondary data analysis using modified methods. 

Christensen, H. W., Vach, W., Vach, K., Manniche, C., Haghfelt, T., Hartvigsen, L., & Høilund-Carlsen, P. F. (2002). Palpation of the upper thoracic spine: an observer reliability study. 

Journal of Manipulative and Physiological Therapeutics

Lynette Inscoe, E., Witt, P. L., Gross, M. T., & Mitchell, R. U. (1995). Reliability in Evaluating Passive Intervertebral Motion of the Lumber Spine. 

Mootz, R. D., Keating Jr, J. C., Kontz, H. P., Milus, T. B., & Jacobs, G. E. (1989). Intra-and interobserver reliability of passive motion palpation of the lumbar spine. 

Gonnella, C., Paris, S. V., & Kutner, M. (1982). Reliability in evaluating passive intervertebral motion. 

Owens Jr, E. F., DeVocht, J. W., Gudavalli, M. R., Wilder, D. G., & Meeker, W. C. (2007). Comparison of posteroanterior spinal stiffness measures to clinical and demographic findings at baseline in patients enrolled in a clinical study of spinal manipulation for low back pain. Journal of manipulative and physiological therapeutics, 30(7), 493-500.

van Duijn, A. J., & Jensen, R. H. (2001). Reliability of inferior glide mobility testing of the glenohumeral joint. Journal of Manual & Manipulative Therapy, 9(2), 109-114.

Lin, H. T., Hsu, A. T., An, K. N., Chien, J. R. C., Kuan, T. S., & Chang, G. L. (2008). Reliability of stiffness measured in glenohumeral joint and its application to assess the effect of end-range mobilization in subjects with adhesive capsulitis. 

Hayes, K. W., & Petersen, C. M. (2001). Reliability of assessing end-feel and pain and resistance sequence in subjects with painful shoulders and knees. Journal of Orthopaedic & Sports Physical Therapy, 31(8), 432-445.

Staes, F. F., Banks, K. J., De Smet, L., Daniels, K. J., & Carels, P. (2009). Reliability of accessory motion testing at the carpal joints. Manual Therapy, 14(3), 292-298.

Schneider, G. M., Jull, G., Thomas, K., Smith, A., Emery, C., Faris, P., … & Salo, P. (2013). Intrarater and interrater reliability of select clinical tests in patients referred for diagnostic facet joint blocks in the cervical spine. 

Archives of physical medicine and rehabilitation

Cleland, J. A., Childs, J. D., Fritz, J. M., & Whitman, J. M. (2006). Interrater reliability of the history and physical examination in patients with mechanical neck pain. 

Hubka, M. J., & Phelan, S. P. (1994). Interexaminer reliability of palpation for cervical spine tenderness. 

Fjellner, A., Bexander, C., Faleij, R., & Strender, L. E. (1999). Interexaminer reliability in physical examination of the cervical spine. 

Maher, C., & Adams, R. (1994). Reliability of pain and stiffness assessments in clinical manual lumbar spine examination. 

Binkley J, Stratford PW, Gill C. Interrater reliability of lumbar accessory motion mobility testing. Phys Ther. 1995;75(9):786–792; discussion 793–5

Lakhani, E., Nook, B., Haas, M., & Docrat, A. (2009). Motion palpation used as a postmanipulation assessment tool for monitoring end-feel improvement: a randomized controlled trial of test responsiveness. 

Haas, M., Panzer, D., Peterson, D., & Raphael, R. (1995). Short-term responsiveness of manual thoracic end-play assessment to spinal manipulation: a randomized controlled trial of construct validity. 

Cook, C., Turney, L., Ramirez, L., Miles, A., Haas, S., & Karakostas, T. (2002). Predictive factors in poor inter-rater reliability among physical therapists. Journal of Manual & Manipulative Therapy, 10(4), 200-205.

Cook, C., Brismée, J. M., & Sizer, P. S. (2005). Factors associated with physiotherapists' confidence during assessment of clinical cervical and lumbar spine instability. Physiotherapy Research International, 10(2), 59-71.

Downey, B., Taylor, N., & Niere, K. (2003). Can manipulative physiotherapists agree on which lumbar level to treat based on palpation?. 

Cook, C., & Showalter, C. (2004). A survey on the importance of lumbar coupling biomechanics in physiotherapy practice. 

Keating, L., Lubke, C., Powell, V., Young, T., Souvlis, T., & Jull, G. (2001). Mid-thoracic tenderness: a comparison of pressure pain threshold between spinal regions, in asymptomatic subjects. 

Chiradejnant, A., Maher, C. G., & Latimer, J. (2003). Objective manual assessment of lumbar posteroanterior stiffness is now possible. Journal of manipulative and physiological therapeutics, 26(1), 34-39.

Maher, C. G., & Adams, R. D. (1996). Stiffness judgments are affected by visual occlusion. Journal of Manipulative and Physiological Therapeutics, 19(4), 250-256.

Maher, C., & Adams, R. (1996). A comparison of pisiform and thumb grips in stiffness assessment. Physical therapy, 76(1), 41-48.

Assessment: Palpation Compared to other Assessments

Fraser, J. J., Koldenhoven, R. M., Saliba, S. A., & Hertel, J. (2017). Reliability of ankle-foot morphology, mobility, strength, and motor performance measures. International Journal of Sports Physical Therapy, 12(7), 1134.

Schneider, M., Erhard, R., Brach, J., Tellin, W., Imbarlina, F., & Delitto, A. (2008). Spinal palpation for lumbar segmental mobility and pain provocation: an interexaminer reliability study. 

Maigne, J. Y., Chantelot, F., & Chatellier, G. (2009). Interexaminer agreement of clinical examination of the neck in manual medicine. Annals of physical and rehabilitation medicine, 52(1), 41-48.

Viikari-Juntura, E. (1987). Interexaminer reliability of observations in physical examinations of the neck. 

Piva, S. R., Erhard, R. E., Childs, J. D., & Browder, D. A. (2006). Inter-tester reliability of passive intervertebral and active movements of the cervical spine. Manual therapy, 11(4), 321-330.

Aartun, E., Degerfalk, A., Kentsdotter, L., & Hestbaek, L. (2014). Screening of the spine in adolescents: inter-and intra-rater reliability and measurement error of commonly used clinical tests. 

Pool, J. J., Hoving, J. L., De Vet, H. C., Van Mameren, H., & Bouter, L. M. (2004). The interexaminer reproducibility of physical examination of the cervical spine. Journal of Manipulative and Physiological Therapeutics, 27(2), 84-90.

Bertilson, B. C., Grunnesjö, M., & Strender, L. E. (2003). Reliability of clinical tests in the assessment of patients with neck/shoulder problems—impact of history. 

Hanten, W. P., Olson, S. L., & Ludwig, G. M. (2002). Reliability of manual mobility testing of the upper cervical spine in subjects with cervicogenic headache. Journal of Manual & Manipulative Therapy, 10(2), 76-82.

Jull, G., Zito, G., Trott, P., Potter, H., Shirley, D., & Richardson, C. (1997). Inter-examiner reliability to detect painful upper cervical joint dysfunction. Australian Journal of Physiotherapy, 43(2), 125-129.

Measurement Issues with Reliability of Assessing Joint Motion by Palpation

Marcotte, J., Normand, M. C., & Black, P. (2005). Measurement of the pressure applied during motion palpation and reliability for cervical spine rotation. 

Cooperstein, R., Haneline, M., & Young, M. (2010). Interexaminer reliability of thoracic motion palpation using confidence ratings and continuous analysis. 

Cooperstein, R., & Young, M. (2016). The reliability of lumbar motion palpation using continuous analysis and confidence ratings: choosing a relevant index of agreement. 

Humphreys, B. K., Delahaye, M., & Peterson, C. K. (2004). An investigation into the validity of cervical spine motion palpation using subjects with congenital block vertebrae as a'gold standard'. 

Walker, B. F., Koppenhaver, S. L., Stomski, N. J., & Hebert, J. J. (2015). Interrater reliability of motion palpation in the thoracic spine. 

Evidence-Based Complementary and Alternative Medicine

Snodgrass, S. J., Rivett, D. A., & Robertson, V. J. (2007). Manual forces applied during cervical mobilization. 

Snodgrass, S. J., Rivett, D. A., Robertson, V. J., & Stojanovski, E. (2009). Forces applied to the cervical spine during posteroanterior mobilization. 

An, H. J., Heo, S. Y., Choi, J. H., & Choi, W. S. (2017). Quantification of Mobilization Grade for Mean Peak Force During Central Posteroanterior Mobilization of C3-C5 in Asymptomatic College Students. 

Journal of International Academy of Physical Therapy Research

Forand, D., Drover, J., Suleman, Z., Symons, B., & Herzog, W. (2004). The forces applied by female and male chiropractors during thoracic spinal manipulation. Journal of manipulative and physiological therapeutics, 27(1), 49-56.

Pasquier, M., Barbier-Cazorla, F., Audo, Y., Descarreaux, M., & Lardon, A. (2019). Learning spinal manipulation: Gender and expertise differences in biomechanical parameters, accuracy, and variability. Journal of Chiropractic Education, 33(1), 1-7.

Cambridge, E. D., Triano, J. J., Ross, J. K., & Abbott, M. S. (2012). Comparison of force development strategies of spinal manipulation used for thoracic pain. 

Gagnon, D. H., Longtin, C., Berbiche, D., & Gaudreault, N. (2016). Do experienced physiotherapists and final year physiotherapy trainees apply similar force during posterior-to-anterior lumbar mobilization techniques?. 

Harms, M. C., & Bader, D. L. (1997). Variability of forces applied by experienced therapists during spinal mobilization. 

Choi, W. S., Heo, S. Y., Moon, O. K., Kim, B. K., & San Wang, J. (2017). Effects of Mobilization Grade on Maximum Pressure Force During Central Posteroanterior Movement of Lumbar Spine in Healthy Person. 

Chester, R., Swift, L., & Watson, M. J. (2003). An evaluation of therapist's ability to perform graded mobilization on a simulated spine. Physiotherapy Theory and Practice, 19(1), 23-34.

Silvernail, J. L., Gill, N. W., Teyhen, D. S., & Allison, S. C. (2011). Biomechanical measures of knee joint mobilization. 

Tragord, B. S., Gill, N. W., Silvernail, J. L., Teyhen, D. S., & Allison, S. C. (2013). Joint mobilization forces and therapist reliability in subjects with knee osteoarthritis. Journal of Manual & Manipulative Therapy, 21(4), 196-206.

Venturini, C., Penedo, M. M., Peixoto, G. H., Chagas, M. H., Ferreira, M. L., & de Resende, M. A. (2007). Study of the force applied during anteroposterior articular mobilization of the talus and its effect on the dorsiflexion range of motion. 

vS de Souza, M., Venturini, C., Teixeira, L. M., Chagas, M. H., & de Resende, M. A. (2008). Force-displacement relationship during anteroposterior mobilization of the ankle joint. 

Snodgrass, S. J., Rivett, D. A., Robertson, V. J., & Stojanovski, E. (2010). Cervical spine mobilisation forces applied by physiotherapy students. Physiotherapy, 96(2), 120-129.

Snodgrass, S. J., Rivett, D. A., Robertson, V. J., & Stojanovski, E. (2010). A comparison of cervical spine mobilization forces applied by experienced and novice physiotherapists. journal of orthopaedic & sports physical therapy, 40(7), 392-401.

Derian, J. M., Smith, J. A., Wang, Y., Lam, W., & Kulig, K. (2020). Biomechanical characteristics of lumbar manipulation performed by expert, resident, and student physical therapists. Musculoskeletal Science and Practice, 102150.

Loranger, M., Treboz, J., Boucher, J. A., Nougarou, F., Dugas, C., & Descarreaux, M. (2016). Correlation of expertise with error detection skills of force application during spinal manipulation learning. 

Unexpected Influences (and 56, 57, 35, 36)

Maher, C. G., Latimer, J., & Holland, M. J. (1999). Plinth padding confounds measures of posteroanterior spinal stiffness. Manual therapy, 4(3), 145-150.

Improved Reliability with Instrumented Manakins and Force Gauges

Björnsdóttir, S. V., & Kumar, S. (2003). Posteroanterior motion test of a lumbar vertebra: accuracy of perception. 

Triano, J. J., Giuliano, D., Kanga, I., Starmer, D., Brazeau, J., Screaton, C. E., & Semple, C. (2015). Consistency and malleability of manipulation performance in experienced clinicians: a pre-post experimental design. Journal of manipulative and physiological therapeutics, 38(6), 407-415.

Kope, R., O’Brien, J., Sadi, J., Walton, D. M., & Ferreira, L. M. (2018). Quantifying performance metrics of cervical spine mobilization for improved education and clinical outcomes: Early experience with a novel wearable device. 

Journal of rehabilitation and assistive technologies engineering

Measurement Problems with the Reliability of Therapist Force

Owens Jr, E. F., Hosek, R. S., Sullivan, S. G., Russell, B. S., Mullin, L. E., & Dever, L. L. (2016). Establishing force and speed training targets for lumbar spine high-velocity, low-amplitude chiropractic adjustments. 

Petersen, E. J., Thurmond, S. M., Shaw, C. A., Miller, K. N., Lee, T. W., & Koborsi, J. A. (2020). Reliability and accuracy of an expert physical therapist as a reference standard for a manual therapy joint mobilization trial. 

Snodgrass, S. J., Rivett, D. A., Sterling, M., & Vicenzino, B. (2014). Dose optimization for spinal treatment effectiveness: a randomized controlled trial investigating the effects of high and low mobilization forces in patients with neck pain. 

Joint Mobilization and Manipulation: Palpation, Assessment, and Reliability

Related Courses:

Course Description: Palpation, Assessment, and Reliability

Introduction
2 Sub Sections

Course Summary
2 Sub Sections

Reliability of Palpation of Bony Landmarks
6 Sub Sections

Reliability of Joint Motion Assessment by Palpation
5 Sub Sections

Reliability of Therapist Force during Joint Mobilization/Manipulation
4 Sub Sections

Outcomes

Bibliography

Related Courses:

Comments

Guest

Joint Mobilization and Manipulation: Palpation, Assessment, and Reliability

Related Courses:

Course Description: Palpation, Assessment, and Reliability

Introduction2 Sub Sections

Course Summary2 Sub Sections

Reliability of Palpation of Bony Landmarks6 Sub Sections

Reliability of Joint Motion Assessment by Palpation5 Sub Sections

Reliability of Therapist Force during Joint Mobilization/Manipulation4 Sub Sections

Outcomes

Bibliography

Related Courses:

Comments

Guest

Introduction
2 Sub Sections

Course Summary
2 Sub Sections

Reliability of Palpation of Bony Landmarks
6 Sub Sections

Reliability of Joint Motion Assessment by Palpation
5 Sub Sections

Reliability of Therapist Force during Joint Mobilization/Manipulation
4 Sub Sections