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Chiropractic Research Review

Physician-Applied Contact Pressure during Manipulation

It can be difficult to accurately discuss and compare biomechanical components of treatment protocols because of the natural differences in manipulative force between practitioners. However, quantifying manipulative technique is crucial to comparing different techniques, addressing concerns of patient risk, and understanding the fundamental mechanical events that occur during a manipulative thrust.

Seven healthy male chiropractic students (age 24-47 and with no reports of pain, thoracic spinal fractures, use of muscle relaxants or surgeries) served as the subjects for a study that measured applied loading during a reinforced pisiform unilateral thoracic manipulation.

The subjects each received six manipulative maneuvers over two test sessions (two days apart), delivered to the left transverse process at the peak of kyphosis.

A sensor system attached to the manipulation table measured support force magnitude and various biomechanical parameters.

The researchers analyzed the data and concluded that in the application of a reinforced unilateral manipulation, the practitioner establishes contact and applies a near-static preload force of 250- 350 N. The dynamic portion of the typical thrust is preceded by a 22% decrease in force magnitude, with peak thrust magnitude linearly related to preload force magnitude. The peak contact pressure beneath the chiropractors pisiform is estimated to exceed 1000 Kpa.

This paper presents the first reports of simultaneous measurements of physician-applied loading and table-force response during chiropractic manipulation. The authors hope that their findings will lead to a better understanding of doctor-applied forces and resulting load response in the clinical setting.

Kirstukas SJ, Backman JA. Physician-applied contact pressure and table force response during unilateral thoracic manipulation. Journal of Manipulative and Physiological Therapeutics, June 1999:22(5), pp269-79.
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Chiropractic Research Review

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