A Comparison of Cervical Spine Mobilization Forces Applied by Experienced and Novice Physiotherapists

Abstract

t MethoDs: One hundred sixteen practicing physiotherapists and 120 physiotherapy students without clinical experience applied grades I through IV posteroanterior mobilization to the premarked C2 and C7 spinous and articular processes of 1 of 67 asymptomatic subjects. An instrumented table recorded applied forces (N), force amplitudes (N), and oscillation frequencies (Hz), and a custom device measured subjects' spinal stiffness (N/mm). Independent t tests were used to compare the forces applied by therapists and students, intraclass correlation coefficients were used to determine variability, and linear regression was used to establish factors associated with applied forces.t resUlts: Students' forces were generally lower (mean difference, 15.7 N for grades III and IV; P.001) and applied with slower oscillation frequencies (0.12 Hz; P.001) than therapists' forces. Similar factors were associated with applied forces for both groups: male gender and greater subject body weight were associated with higher applied forces, and greater C2 stiffness with lower forces. Having thumb pain was associated with lower applied forces for therapists but higher ones for students.t ConClUsions: Students apply lower forces than therapists. Similar factors appear to affect applied forces regardless of clinical experience.

Identification of the forces developed by upper limbs in various forms of human physical activity and in manual techniques used by physiotherapists – a brief review

“…Podkreśla się, że wartości sił, które fizjoterapeuci dozują intuicyjnie, mogą być nie tylko nieodpowiednie, ale i niebezpieczne dla pacjenta [38]. Dotychczas nie opracowano jeszcze metody bezpośredniego pomiaru sił, z jakimi fizjoterapeuta oddziałuje na ciało pacjenta, dlatego też stosuje się metody pośrednie, umożliwiające rejestrację sił reakcji dzięki wykorzystaniu specjalnego stołu pomiarowego lub manekina [39][40][41][42][43][44], symulatora kręgosłupa [45], czy analizy matematycznej z wykorzystaniem różnych modeli mięśni [38]. Inni autorzy zwrócili uwagę na wpływ manipulacji na reakcje mięśni kręgosłupa w EMG [46].…”

Learning Lumbar Spine Mobilization: The Effects of Frequency and Self-Control of Feedback

“…Research shows that this form of feedback is less accurate than objective feedback on manual forces. This is highlighted by the wide variation in manual forces applied by students 47,58 and physiotherapists 12,22,48,49 when performing spinal mobilization. Better feedback methods for learning spinal mobilization techniques are necessary.…”

Dose Optimization for Spinal Treatment Effectiveness: A Randomized Controlled Trial Investigating the Effects of High and Low Mobilization Forces in Patients With Neck Pain

“…58,59 Registered physiotherapists who regularly use PA mobilizations apply grade III techniques to the lower cervical spine using a mean peak force of 64.2  28.6 N (range, 6.0-133.4 N, excluding 5 outliers confirmed using the Grubbs test). 52 A low force of 30 N and high force of 90 N were selected, being approximately 1 standard deviation below and above the mean peak force applied to C7 by the 116 practicing physiotherapists in a previous study.…”