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Updated: Aug 18, 2025

Subject-specific Musculoskeletal Model for Studying Bone Strain During Dynamic Motion
Published on: April 11, 2018
Why is the prevailing model of joint manipulation (still) incorrect?
1Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK. dwe@backpainclinic.co.uk.
This study reveals flaws in the prevailing Sandoz model of joint manipulation, which originated from misinterpreted research. A corrected model aligns with data and addresses criticisms, necessitating an empirically derived definition for therapeutic manipulation.
Area of Science:
- Physiotherapy
- Biomechanics
- Clinical Practice
Background:
- The Sandoz model is the prevailing explanation for joint manipulation.
- This model is based on early research into 'joint cracking' that has been misinterpreted.
- The flawed model has led to concerning clinical predictions and criticism.
Purpose of the Study:
- To present and critique the prevailing Sandoz model of joint manipulation.
- To explain the origins and flaws of the Sandoz model.
- To introduce and support a corrected model of joint manipulation.
Main Methods:
- Chronological review of early research on joint manipulation.
- Analysis of misinterpretations leading to the Sandoz model's flaw.
- Presentation and explanation of the corrected Evans and Breen model.
Main Results:
- The Sandoz model is fundamentally flawed due to misinterpretation of early research.
- The flawed model's predictions are inconsistent with empirical data and raise safety concerns.
- The corrected model aligns with empirical data and addresses criticisms of manipulation.
Conclusions:
- A corrected model of joint manipulation, proposed by Evans and Breen, is empirically supported.
- Current definitions of manipulation often retain the flaw from the Sandoz model.
- An empirically derived definition consistent with the corrected model is needed for therapeutic manipulation.
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