Physical Therapy Continuing Education: What’s the Best Way to Learn Spinal Manipulation?

A common question is what is the best way to learn spinal manipulation. Some say it should be taught in PT school, some say it is best to learn as a Physical Therapy continuing education course, others recommend a residency? We asked a spinal manipulation expert his opinion, here is what he said.

Interviewer: Now manipulation is definitely a skill. Definitely something that requires some practice to become proficient in. What is your recommendation for the best way to learn manipulation?

Spinal Manipulation Expert: I think that’s a great question. I’ve taught through a continuum. I’ve taught DOs, MDs, in various stages of their careers. Physical Therapists end of career, mid-career, and a lot of my teaching has been early career. I can say without a doubt that technical skill of manipulation is easier to learn the younger you are in the profession. In other words, students within a professional program can get very skilled very quickly because they haven’t been contaminated with a lot of the different models that many of us got contaminated with that make us actually fearful of certain types of procedures.

The other thing is the younger you are – it’s a motor skill, so usually your motor system is more adaptable and you can move your body in ways – you haven’t developed motor habits that kind of feel awkward when you put patients in certain positions. So, the best way to learn it is early on in your career. Now that doesn’t mean that you’re 65 and you’re learning some new skills that you can’t learn manipulation and be very proficient at it. It just takes a little bit more work training your body how to do it.

So, my first point is learning it early in your career. Hopefully there’s at least a reasonable proficiency coming out of professional training, but then what happens is folks do not have the clinical reasoning or the confidence often to use this. And often they’re confronted with clincicals and clinical instructors and fellow clinicians that are not as proficient or comfortable, so they tend to lose that skill sometimes when they enter the professional world.

That’s where it’s helpful to then really work with colleagues of a like mindset. What I’ve found is a variety of training is the most effective. For example, we teach a lot of manipulation in traditional continuing medical education, but where we find that therapists tend to really get more proficient is when it’s coupled in an environment where there’s some ongoing training. So, that’s why we’ve moved to residencies and fellowship training along with we’ve started a certification program both in manual therapy and upper quarter-lower quarter management. What’s interesting, what’s consistent across those programs is that people are learning the technical skills during weekend intensives but they’re online for about eight weeks studying a particular topic and they finally kind of get to that point “ah-ha”. There’s a lot of ah-ha moments where as therapists are sharing their patient cases during the course of their time together that they really become competent in doing it. You can know technically how to do something, but that’s just one component of actually performing. Often what happens is they say, “Yeah I think I should do it, but I’m just not confident doing it and I don’t have anybody to really kind of bounce ideas off of to gain that confidence.”

Interviewer: Absolutely.

Spinal Manipulation Expert: So, I think manipulation technically can be learned. I think practice, a motor skill requires a lot of practice with good feedback during that practice time, and then coupling it with the cognitive or the thought process. That takes a while to change the mindset of a therapist to really become proficient that they think, “Oh, this is no big deal, I do this frequently in my management of musculoskeletal care.”

Interviewer: Yes, speaking from personal experience I can say learning spinal manipulation was more difficult than I expected. It is definitely a skill and I would definitely recommend attending multiple physical therapy continuing education courses, not just a single weekend course; or do a residency or fellowship.