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Spinal Manipulation: Lack of Precision Doesn’t Mean Lack of Skill

August 15, 2025 / Leave a comment

By: Mark Shepherd, PT, DPT, DSc Spinal thrust manipulation has been used for centuries, with evidence supporting its inclusion in neck and low back guidelines.1,2 Yet, how it’s taught and applied varies widely across and within professions, sparking debate among educators, clinicians, and researchers.3,4 Nim et al.’s recent systematic review5 and JOSPT blog6 challenge us […]

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Manual Therapy: Manipulation of the Brain?

August 25, 2023 / 1 Comment on Manual Therapy: Manipulation of the Brain?

By: Tara Winters PT, DPT When a person walks into the clinic with low back pain with primary nociplastic pain mechanisms, I’m armed and ready with a number of treatment ideas. This is thanks to the leaps and bounds made in the last 20 to 30 years in the world of pain science. “Let’s see […]

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When the Numbers Don’t Move: Understanding Ceiling Effects, Floor Effects, and Limited Score Spread in MSK Patient‑Reported Outcomes
By: Chad Cook PT, PhD, FAPTA Introduction: I recently responded to a very supportive post on Linked-In that discussed a study we published two years…
Why Individualized Treatment Effects Matter More Than Averages in Musculoskeletal Care
By: Chad Cook PT, PhD, FAPTA Introduction: Imagine being able to say: “Based on your profile, you’re likely to respond better to graded activity than…
Spinal Manipulation: Lack of Precision Doesn’t Mean Lack of Skill
By: Mark Shepherd, PT, DPT, DSc Spinal thrust manipulation has been used for centuries, with evidence supporting its inclusion in neck and low back guidelines.1,2…
Advantages and Disadvantages of Research Metrics used to Evaluate a Researcher’s Impact or Influence
By: Chad E Cook PT, PhD, FAPTA Background: Each year, in Duke University’s Division of Physical Therapy, I teach a class on research methodology. One…
“It’s Not You, It’s Us…”: Heterogeneity of Treatment Effects as a Challenge to Effectiveness Trials.
By: Damian L Keter, PT, DPT, PhD Background: Comparative effectiveness studies are the cornerstone of medicine and health sciences research. They have a goal of…
Is Myofascial Pain Syndrome a Legitimate Primary Diagnosis?
By: Chad E Cook, Damian Keter, Ken Learman Background: Myofascial Pain Syndrome (MPS) is hypothesized to be both a primary and/or a secondary chronic pain…