As I’m working on presentation to 3rd year students in a few weeks on manipulation, I am always floored to see this picture for lumbopelvic manipulation as the cornerstone of decision making for clinicians to implement a procedure of manipulation for low back pain. This is the essential treatment, based on clinical prediction rule from Flynn 2002, for individuals who will respond favorably.
Now I know regional manipulation may not always be necessary (see recent study here in Phys Ther 2013 by de Oliveira RF), but does this really is good picture of the definition of manipulation, which is according to the Guide to PT;
skilled, passive movement of joints and soft tissue, etc.
This doesn’t look very skilled to me.
Nothing against the study or the authors, as this research study is a milestone in our profession, as well as overall treatment of LBP. Many other studies have been proposed based on this research but as the foundation for manipulation? What do you think?