A novel model for developing thrust joint manipulation skills: a teaching and learning perspective

Spinal and extremity thrust joint manipulation (TJM) has been shown to be an effective intervention when treating patients with various musculoskeletal conditions. Learning skilled TJM requires the proper execution of many discrete tasks. If any of these are missing, effectiveness and safety may be limited. While it is accepted that practice and feedback are important when physical therapists are learning clinical tasks, the best type of practice has not been identified for learning to perform TJM tasks. In this paper, we propose an educational model for instruction of joint manipulation that: 1) standardizes feedback terminology and 2) describes a core set of four discrete tasks (lift, drop, pull, and combination-rotation) that apply to most TJM tasks. The model includes instructing TJM tasks followed by identifying key errors related to the components of setup and thrust. Once these key errors have been identified, intentional practice activities are provided to address the noted positional and movement errors. Finally, reassessment is performed to determine if errors have diminished. This model is similar to the test-retest approach that is commonly used when treating patients. We hope this educational model will provide a framework for teaching TJM and will also foster future research.