Differences between Experienced Physiotherapists and Physiotherapy Students in Force Applied During Sacrum Mobilization Techniques
Keywords:
Mobilization, sacrum, pelvic, manual therapy, joint mobilizationAbstract
Manual physical therapy is always used in treating sacroiliac joint pain, with joint mobilization
frequently used for joint stiffness treatment. Physical therapy students must learn how to apply
the appropriate quantity of force on the sacrum. A reliable physical therapy force display table may
be useful for accurate and fast learning. The purpose of this study was to compare the difference
between experienced physiotherapists and physiotherapy students in the force applied when using
posterior-to-anterior sacrum mobilization techniques. Research methods used 3 healthy female
volunteers lying prone on a force display table, 3 physical therapists who applied posteroanterior
direction on the sacrum on grades 1, 2, 3, and 4, and 3 physical therapy students who applied the
same procedure to the same volunteers. The display panel was closed between test periods by
another, blinded physical therapist. The Wilcoxon signed-rank test was used to analyze the data.
Results showed that physical therapy students applied an average force on the sacrum
grade 1 = 7.7 kilograms, grade 2 = 8.1 kilograms, grade 3 = 9.2 kilograms, and grade 4 = 10.8 kilograms.
Physical therapists applied an average force on the sacrum grade 1 = 6 kilograms, grade 2 = 7 kilograms,
grade 3 = 8.8 kilograms, grade 4 = 10.3 kilograms. The difference in average force in grade 1 = 1.7
kilograms, grade 2 = 1.1 kilograms, grade 1 = 0.4 kilograms, and grade 4 = 0.5 kilograms. There was
no statistically signifcant difference between groups (p > .05), but a clinically meaningful difference
between groups was noted for grades 1 and 2. The study concluded that physical therapy students
applied more force than did the physical therapists. Some differences in force to reduce pain (grade
1 = 1.7 kilograms, grade 2 = 1.1 kilograms) were large enough to require caution and further training
for students in clinical settings, since more force raises the risk of increased pain. The display force
panel of the physical therapy force display table can promote the learning process.
References
Bronfort, G., Haas, M., Evans, R, L., & Bouter, L, M. (2004). Efficacy of spinal manipulation and mobilization for low back pain and neck pain: a systematic review and best evidence synthesis. Spine J, 4(3), 335–356.
Crosbie, J., Gass, E., Jull, G., Morris, M., Rivett, D., Ruston, S., et al. (2002). Sustainable undergraduate education and professional compentency. Aust J Physiother, 48(2): 5–7.
Flynn, T, W., Wainner, R, S., & Fritz, J, M. (2006). Spinal manipulation in physical therapist professional degree education: a model for teaching and integration into clinical practice. J Orthop Sports Phys Ther, 36(8), 577–887.
Grieve, G. P. (1991). Mobilisation of the spine. (5th ed.) Edinburgh: Churchill Livingstone.
Magarey, M, E., Rebbeck, T., Coughlan, B., Grimmer, K., Rivett, D, A., & Refshauge, K. (2004). Pre-manipulative testing of the cervical spine: review, revision and new clinical guidelines. Man Ther, 9(2), 95–108.
Maitland, G, D., Banks, K., English, K., Hengeveld, E. (2005). Maitland’s vertebral manipulation. (7th ed.) Oxford: Butterworth-Heinemann.
Smith, E., Conradie, M., Wessels, J., Witbooi, I., & Otto. R. (2003). Measurement of the magnitude of force applied by students when learning a mobilization technique. S Afr J Physiother, 59(4), 3–8.
Snodgrass, S., Rivett, D., Robertson, V., & Stojanovski, E. (2010). Cervical spine mobilisation
forces applied by physiotherapy students. Physiotherapy, 96(2), 120–129.
Vannajak K., & Vannajak, P, T. (2020). Validity and reliability of force plate table. Burapha Journal Medicine, 7(2), 14-22. [ In Thai ]
