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Chiropractic Research Review

Perfecting the Art of the Adjustment

In any discipline, practice is an important component of perfecting motor skills. As spinal manipulation requires high levels of both sensory and motor coordination, methods to develop and improve adjusting performance are of paramount importance.

This study was designed to "quantify elements of spinal manipulative therapy performance and to test the strategy of combined rehearsal and qualitative feedback as a means of enhancing student skill development for cervical and thoracic manipulative procedures." Researchers quantified performance by 39 students over time (at the beginning, middle and end of a trimester) at a chiropractic college using a manipulation table embedded with a force plate. Students were divided into two groups, with one group receiving standard training and the second group receiving modified training that included a prescribed, self-directed rehearsal program utilizing a training aid instrument.

The instrument allowed the second group of students to rehearse the application of axial forces against proscribed resistance, simulating the coordinated movement of the targeted procedure. The direction of force application was controlled, and failure to maintain a minimum depth of displacement along the axis of the device resulted in an error message. Procedures tested included the single pisiform-transverse applied to T7, and an index maneuver applied to the C2 transverse.

Results showed statistically significant changes between groups in spinal manipulation performance related to some biomechanical parameters, including elements of component amplitude, speed and duration.
"Using quantitative feedback provided from training aids and biomechanical measurement systems, future training programs may be optimized and tested," the authors conclude.

Triano JJ, Rogers CM, Combs S, et al. Quantitative feedback versus standard training for cervical and thoracic manipulation. Journal of Manipulative and Physiological Therapeutics, March/April 2003:26(3), pp. 131-8. www.mosby.com/jmpt

Chiropractic Research Review

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