With all that being said, I do still believe there is benefit in trying to be specific with manipulation. I, personally and clinically, have experienced many scenarios where a general manipulation helped, but was not as helpful as targeting a specific area. There may just be a stiff area of the spine that needs the proper stimulus of increased mobility. Secondly, I believe we become much more effective with our manipulations if we try to increase our specificity. I have sat in on classes where the instructors emphasized the lack of importance in trying to be specific. The instructions were basically to wind up the patient using long levers and thrust. It is far more difficult to perform a manipulation that way, in my opinion. If you try and "target" a segment and lock them out above and below, sensing for movement at the vertebra, you typically allow the patient to relax more, which permits a more effective thrust. Again I'm not saying that we can actually manipulate that one segment, but I think we can narrow our range of force and provide more effective manipulations by allowing the patient to relax properly.
Huisman PA1, Speksnijder CM, de Wijer A. (2013). The effect of thoracic spine manipulation on pain and disability in patients with non-specific neck pain: a systematic review. Disabil Rehabil. 2013 Sep;35(20):1677-85.
de Oliveira RF1, Liebano RE, Costa Lda C, Rissato LL, Costa LO. (2013). Immediate effects of region-specific and non-region-specific spinal manipulative therapy in patients with chronic low back pain: a randomized controlled trial. Phys Ther. 2013 Jun;93(6):748-56.
Ross JK1, Bereznick DE, McGill SM. (2004). Determining cavitation location during lumbar and thoracic spinal manipulation: is spinal manipulation accurate and specific? Spine (Phila Pa 1976). 2004 Jul 1;29(13):1452-7.
You may have seen some posts earlier on our site about OPTIM Physical Therapy. Several months ago, Chris and Jim joined OPTIM Physical Therapy to create a COMT program based out of Scottsdale, AZ. The mission of the program is to create a residency-like experience for those who are unable to make the financial and location commitment. The program consists of 6 weekend-long courses on-site, in addition to Medbridge courses and online mentoring between classes. Throughout the year, the class as a whole will improve their clinical skills and reasoning while working as a team. Check out www.optimfellowship.com for more information. Only a few spots remain for the year's cohort!