Are we on the right level?

5.29=the average error in centimeters from target joint found by Ross et al 2004 for accuracy in spinal manipulation to the lumbar spine (the range of results actually was 0-14 centimeters, quite a bit!).  This is at least one segment or more off of what the practitioners claimed to manipulate and what joint actually manipulated.

So, what does this study actually mean?  Mainly, it shows specificity of joint manipulation is not very high (was only accurate 46% of the time) in the lumbar spine.  It also shows that obtaining more than one cavitation during a thrust can be more beneficial as multiple cavitations could “get the right joint”.  So needless to say, more pops can be better.

This question arose from an intern who understood from her academic education that if we were “off” a joint, then we would make a hypermobile joint surrounding a hypomobile joint worse by manipulating it.  I suggested otherwise, explained this study; but also the higher level evidence of neurophysiological benefits more than biomechanical benefits of manual therapy.  

Does this type of research make us less musculoskeletal specialists?  I don’t think so.  It shows we are informed by the evidence, but I do still strive to be on the joint at question.  If we are off a bit, maybe not that big of a deal…weathermen get paid for being wrong everyday!



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