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Thrust Joint Manipulation Skills for the Spine

Speaker: Emilio “Louie” Puentedura- PT, DPT, PhD

This 2-day lab intensive course is designed for physical therapists. It is targeted to those who may have never utilized thrust joint manipulation (TJM) techniques but is also valuable to those who have and wish to improve their skills in delivering safe and effective TJM interventions. It presents the rich history of TJM in the spine and will dispel the notion that it is a relatively new intervention for physical therapists. Short lectures cover the evidence for TJM in the management of low back and neck pain, a discussion on the audible pop or cavitation, evidence on localization of the intervention and discussion on the use of kinematics and coupled motions to achieve better localization and improve patient comfort. A heavy emphasis will be placed on the safety of TJM techniques, the likely causes of serious adverse events and how the use of sound clinical reasoning might mitigate concerns about safety. On the second day, discussion on new thoughts about TJM and how it might have a place in pain neuroscience and the biopsychosocial approach to musculoskeletal pain management is presented, as well as the latest research in and utilization of Thrust Joint Manipulation by physical therapists. Approximately 60% of the time will be spent in labs with a focus on safe and effective delivery of the techniques to each area of the spine as well as transitional regions. Review and round robin events will help in skill refinement and improve the confidence of course participants.

Learning Objectives:

  1. Safely and effectively perform selected manipulation techniques in patients with spinal pain or dysfunction when found justified.
  2. Recognize the current best evidence for the implementation of spinal manipulation in clinical practice
  3. Develop a working knowledge of the safety issues, precautions and contraindications to spinal manipulation and be able to apply them in the course and in clinical practice

Assessment of Learning Objectives:

Course evaluation and skill assessment during lab sections of course.


This activity is provided by the Texas Board of Physical Therapy Examiners Accredited Provider 2207019#TX and meets continuing competence requirements for physical therapist and physical therapist assistant licensure renewal in Texas for 15.0 CCUs.

The assignment of Texas PT CCUs does not imply endorsement of specific course content, products, or clinical procedures by TPTA or TBPTE.

Course participants must complete any & all formal assessments, procedures, and criteria required for credit or certification. As per Memorial Hermann policy, participants must attend the entire course in order to receive CEUs/CCUs and course certificate, no partial credits will be given.

Other Information

Criteria for Course Completion?: Participation in lab sessions and completion of course evaluation

Required Prerequisites?: None

Instructional Level: Intermediate

Target Audience: Physical Therapist that wish to improve spinal manipulation skills.


Date: September 7-8, 2019

Time: Saturday 8 a.m. - 5 p.m (registration starts at 7:30); Sunday 8 a.m. - 4 p.m.

Memorial Hermann Tower, Memorial City
929 Gessner Rd.
12th Floor Orthopedic conference Rooms A and B
Houston, TX 77024

Morning and afternoon light snacks will be provided. Lunch will be on your own.


MH SM&R Employee (PT/PTA/ATC/LAT): $200
MH Non SM&R Employee (PT/PTA/ATC/LAT): $250
Non MH Registrant: $450


Register Here


Refunds will be granted if cancellation notice is received in writing at least 14 calendar days prior to the course start date with Spinal Manipulation in the subject line. If you register and do not attend, or do not fulfill the requirements of the class, your reservations fee will not be refunded. Cancellation of the event by Memorial Hermann will result in a full refund of monies received. Memorial Hermann is not responsible for the refund of travel or hotel expenses under any circumstances. Memorial Hermann reserves the right to cancel or change any programs for due cause. In the event of a cancellation, participants will be notified via contact email and contact phone number submitted in the registration.

Conflicts of Interest

Policy & Procedures exist whereby all speakers must disclose any relationships which may cause a conflict of interest. Any relevant financial and non-financial relationships will be disclosed via speaker agreement, written notification after agreement, and prior to presentation.

Program Schedule

Day 1

8 – 8:15 a.m. Introduction to Thrust Joint Manipulation

8:15 – 8:30 a.m. History of Thrust Joint Manipulation in the Spine

8:30 – 9 a.m. Lab 1: Handling skills and drills

9 – 9:30 a.m. Lab 2: Supine lumbopelvic technique

9:30 – 9:45 a.m. BREAK

9:45 – 10:45 a.m. Evidence for Thrust Joint Manipulation Techniques in the Lumbar Spine

10:45 – 11 a.m. Lab 3: Thoracic supine PA

11 – 11:30 a.m. Evidence for Thrust Joint Manipulation Techniques in the Cervical Spine

11:30 – 12 p.m. Lab 4: Lumbar rotation in Neutral/ Extension

12 – 1 p.m. LUNCH

1 – 1:30 p.m. Audible pop/ Localization

1:30 – 2 p.m. Lab 5: Cervical spine upslope (chin and cradle holds)

2 – 2:15 p.m. Kinematics and coupled motions

2:15 – 2:30 p.m. Lab 6: Thoracic spine prone screw

2:30 – 3:30 p.m. Safety and manipulation

3:30 – 3:45 BREAK

3:45 – 4 p.m. Lab 7: Cervicothoracic junction techniques

4 – 4:30 p.m. Lab 8: Lumbar rotation in flexion

4:30 – 5 p.m. Clinical Reasoning and Thrust Joint Manipulation

5 – 6 p.m. Lab 9: Cervical spine downslope (chin and cradle holds)

Day 2

8 – 8:15 a.m. Review and round robin skills and drills

8:15 – 8:30 a.m. Pain Neuroscience and Thrust Joint Manipulation

8:30 – 9 a.m. Lab 1: Thoracolumbar junction side-lying rotation

9 – 9:30 a.m. Lab 2: Thoracic seated distraction

9:30 – 9:45 a.m. BREAK

9:45 – 10:45 a.m. Research and Education in Thrust Joint Manipulation

10:45 – 11 a.m. Lab 3: Review of cervical upslope techniques

11 – 11:30 a.m. Lab 4: Review of cervical downslope techniques

11:30 – 12 p.m. Lab 5: SI and hip distraction techniques

12 – 1 p.m. LUNCH

1 – 1:30 p.m. Lab 6: Rib techniques

1:30 – 2 p.m. Lab 7: Upper cervical techniques

2 – 2:30 p.m. Utilization of Thrust Joint Manipulation – Opportunities and Barriers

2:30 – 2:45 p.m. BREAK

2:45 – 3:30 p.m. Lab 8: Review and round robin skills and drills

3:30 – 4 p.m. Final Thoughts and Wishful thinking about the future