Biomechanical characteristics of lumbar manipulation performed by expert, resident, and student physical therapists.

BACKGROUND: Lumbar manipulation is a commonly used treatment for low back pain, but little research evidence exists regarding practitioner biomechanics during manipulation. Most existing evidence describes rate of force production through the hands into instrumented manikins and it is unclear how the practitioner moves their body and legs to generate this force. OBJECTIVES: To identify and characterize important kinetic and kinematic factors in practitioners of varying experience performing lumbar manipulation in order to identify which factors distinguish experts from less experienced practitioners. STUDY DESIGN: This was a cohort observational laboratory study. METHODS: 43 male physical therapists (PT) and PT students (4 experts, 11 residents, 13 third year, and 15 first year students) performed 4 manipulations each on asymptomatic patient models. Angular and linear kinematics of the pelvis were measured using motion capture, and ground reaction forces were measured with force plates under the practitioner's feet. RESULTS: Peak pelvic angular velocity was greater and in the opposite direction in experts compared to other groups in the frontal plane (p = 0.020) and transverse plane (p = 0.000). Experts had greater downward pelvic linear velocity than third year students and first year students (p = 0.000). Experts also demonstrated faster rate of vertical ground reaction force unloading during the manipulation (p = 0.002). CONCLUSIONS: Expert performance of manipulation was characterized by increased speed of linear and angular pelvic motion, and increased modulation of vertical ground reaction force. These results help to inform educators and practitioners that teach and use this complex manual skill.

The ATLAS project: The effects of a constructionist digital laboratory project on undergraduate laboratory performance.

Anatomical education is a dynamic field where developments in the implementation of constructive, situated-learning show promise in improving student achievement. The purpose of this study was to examine the effectiveness of an individualized, technology heavy project in promoting student performance in a combined anatomy and physiology laboratory course. Mixed-methods research was used to compare two cohorts of anatomy laboratories separated by the adoption of a new laboratory atlas project, which were defined as preceding (PRE) and following the adoption of the Anatomical Teaching and Learning Assessment Study (ATLAS; POST). The ATLAS project required the creation of a student-generated, photographic atlas via acquisition of specimen images taken with tablet technology and digital microscope cameras throughout the semester. Images were transferred to laptops, digitally labeled and photo edited weekly, and compiled into a digital book using Internet publishing freeware for final project submission. An analysis of covariance confirmed that student final examination scores were improved (P < 0.05) following the implementation of the laboratory atlas project (PRE, n = 75; POST, n = 90; means ± SE; 74.9 ± 0.9 versus 78.1 ± 0.8, respectively) after controlling for cumulative student grade point average. Analysis of questionnaires collected (n = 68) from the post group suggested students identified with atlas objectives, appreciated the comprehensive value in final examination preparation, and the constructionism involved, but recommended alterations in assignment logistics and the format of the final version. Constructionist, comprehensive term-projects utilizing student-preferred technologies could be used to improve performance toward student learning outcomes.