17/05/2026
This is a skill many current physiotherapists are loosing from their skill set, as so many others since I joined this profession in 1988.
I am glad that I took my basic training a step further and trained in advanced manual & OMT. 👏
Can you really adjust one vertebra?
It’s one of the first things students get taught:
Find the segment.
Set the line of drive.
Deliver the thrust.
But the literature paints a more complicated picture.
• Cavitations can occur up to 14 cm from the intended target (Ross 2004)
• 92% of unilateral C1-C2 manipulations produced bilateral cavitations (Dunning 2013)
• The skin-fascia interface is essentially frictionless, meaning you can’t reliably “hook” onto bone through skin tension alone (Bereznick 2002)
• Manipulation does not appear to create sustained positional change at the SI joint (Tullberg 1998)
That doesn’t mean manipulation doesn’t work.
It means the effects are likely neurophysiological:
Pain modulation.
Hypoalgesia.
Motor effects.
Contextual and sensory input.
Line of drive still matters for practitioner biomechanics and force delivery.
But probably not as a precision segmental targeting system in the way many of us were originally taught.
We cover this in much more depth in our free spinal manipulation theory course on the OMT Online platform:
online.omttraining.co.uk/course/free-spinal-manipulation-theory
Where do you think the specificity model still holds up clinically?