Procedural Skills in Spinal Manipulation: Do Prerequisites Matter?

Spinal manipulation is frequently considered as a treatment for back pain (especially by doctors of chiropractic). However, there are many different training methods for those pursuing spinal manipulation as part of their health care practice.

It is of course assumed that the more in-depth training an individual receives, the better he or she will be at performing the spinal manipulation procedures. This article discusses a study that looked into the validity of that assumption, and assessed the best approach in the early stages of preparation for performing spinal manipulation procedures.

Spinal Manipulation Training Study

Training for performing spinal manipulation ranges from full professional degree programs to weekend seminars. As a result, health professionals can end up with widely varying levels of skill, ranging from incompetent, to safe, to masterful. This study was undertaken to try to determine what kind of training best prepares someone to perform spinal manipulation. Once this information is known, patients will be able to ask potential care-providers about what type of education they received and decide if they want to be treated by that individual.

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The authors of the study chose a certain high velocity, low-amplitude (HVLA) spinal manipulation procedure, the L4 mamillary push, to use as the basis of their comparison. This form of spinal manipulation is one of the most widely used methods of treatment for the lower back pain and lumbar spine problems.

Three groups of people were studied. One was a group of eight internationally known experts chosen for their reputation, with a range of 8 to 30 years of clinical experience. All of the experts use the procedure in question, and are very familiar with it. The other two groups were college students, at two different colleges, who were completing prerequisite courses that were required prior to beginning their specific training for HVLA spinal manipulation procedures.

The prerequisite requirements at the two colleges were different: one college focused on hands-on practice more than laboratory study, and the other college reversed that, focusing more on the preparatory lab courses than the hands-on, clinical application. All of the students had completed pre-med and were enrolled in 2nd year professional training.

Several parameters were chosen for comparison of the groups, and each person was then observed performing the procedure from initial positioning of the patient through completion of the spinal manipulation procedure. The group of experts was used to set the standards of how this type of spinal manipulation should be done, and the performance of each student was compared to those standards.

Spinal Manipulation Study Results

The results of the study were very clear. Students who were given a great deal of informative instruction in the laboratory setting, before actually performing any hands-on training, were much better prepared to complete this HVLA spinal manipulation procedure. Every comparison parameter was shown to favor the students who had the more extensive laboratory preparation. The authors observed that the most distinct difference in the groups was in the pre-positioning of the patients.

The results suggest that extensive training before ever performing a first spinal manipulation procedure is an important component in the teaching and learning of this type of skill. Additionally, it appears that condensed learning sessions, without adequate preparatory training, are inappropriate and could be dangerous to patients.

From this study, the authors concluded that prerequisite courses for spinal manipulation should emphasize laboratory training, and then build slowly into rehearsal experience, including prepositioning of the patient. Spinal manipulation procedures performed by health care professionals with this type of early training are likely to be safest and most effective.