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Paul Wanlass
Amber McCallum
Oscar Alvarado
Rhiannon Hutton


Healthcare Education, Spinal Manipulation, Motor Skills, Psychomotor Skills, Sensorimotor Learning


Objective: To evaluate if changing the sequence in which students learn the complex psychomotor skill of spinal manipulation of the pelvis and lumbar spine in a chiropractic technique course would help to improve performance on practical exams.

Methods: This is a retrospective study of data collected for practical examinations. In order to assess the results of this change, the midterm and final practical exam scores for the 2 cohorts before the experiment were compared to the scores of the cohorts after the change. The students’ gender and cumulative grade point average were examined to determine if they were mediating factors.

Results: The experimental cohort scored lower in their technique exams compared to the control cohort (p = .001), although the difference between the medians was small (184.0 versus 180.0).

Conclusion: The results of this study reveal no improvement in practical exam scores after the sequencing of the pelvis and lumbar spine adjustive technique class instruction was changed from the traditional specific adjustments first and then psychomotor skills vs. teaching the psychomotor skills first followed by teaching specific adjustments. Further research is needed to determine the optimum sequence of teaching chiropractic psychomotor skills to maximize the students’ learning experience and clinical performance.


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1. Downie AS, Vemulpad S, Bull PW. Quantifying the high-velocity, low-amplitude spinal manipulative thrust: a systematic review. J Manipulative Physiol Ther 2010;33(7):542–553

2. Descarreaux M, Dugas C, Lalanne K, Vincelette M, Normand MC. Learning spinal manipulation: the importance of augmented feedback relating to various kinetic parameters. Spine J 2006;6(2):138–145

3. Triano JJ, Bougie J, Rogers C, et al. Procedural skills in spinal manipulation: do prerequisites matter? Spine J 2004;4(5):557–563

4. Triano JJ, Descarreaux M, Dugas C. Biomechanics--review of approaches for performance training in spinal manipulation. J Electromyogr Kinesiol 2012;22(5):732–739

5. Elliott D, Grierson LEM, Hayes SJ, Lyons J. Action representations in perception, motor control and learning: implications for medical education. Med Educ 2011;45(2):119–131

6. Harvey MP, Wynd S, Richardson L, Dugas C, Descarreaux M. Learning spinal manipulation: a comparison of two teaching models. J Chiropr Educ 2011;25(2):125–131

7. Dunphy BC, Williamson SL. In pursuit of expertise. Toward an educational model for expertise development. Adv Health Sci Educ Theory Pract 2004;9(2):107–127

8. Delacruz GC, Chung GKWK, Bewley WL. Characterizing trainees in the cognitive phase using the human performance knowledge mapping tool (HPKMT) and microgenetic analysis. (CSE Report 699). Los Angeles: University of California, Los Angeles, National Center for Research on Evaluation, Standards, and Student Testing (CRESST). 2006

9. Stainsby BE, Clarke MCS, Egonia JR. Learning spinal manipulation: A best-evidence synthesis of teaching methods. J Chiropr Educ 2016;30(2):138–151. Available from:

10. Palmgren PJ, Laksov KB. Exploring chiropractic students’ experiences of the educational environment in healthcare professional training: a qualitative study. BMC Med Educ 2015;15:128

11. Kühnast C, Neuhäuser M. A note on the use of the non-parametric Wilcoxon-Mann-Whitney test in the analysis of medical studies. Ger Med Sci 2008;6:Doc02

12. Lydersen S, Fagerland MW, Laake P. Pearson’s chi-squared test. Tidsskr Nor Laegeforen. 2019;139(12)

13. Pasquier M, Barbier-Cazorla F, Audo Y, Descarreaux M, Lardon A. Learning spinal manipulation: gender and expertise differences in biomechanical parameters, accuracy, and variability. J Chiropr Educ 2019;33(1):1–7. Available from:

14. Gleberzon BJ, Cooperstein R, Good C, Roecker C, Blum C. Developing a standardized curriculum for teaching chiropractic technique. J Chiropr Educ 2021;35(2):249–257

15. Watson TA, Radwan H. Comparison of three teaching methods for learning spinal manipulation skill: a pilot study. J Manipulative Physiol Ther 2001;9(1):48–52. Available from:

16. Wulf G, Shea C, Lewthwaite R. Motor skill learning and performance: a review of influential factors: motor skill learning and performance. Med Educ 2010;44(1):75–84. Available from:

17. Chang I, Rivera MJ, Eberman LE. The effect of feedback on manual therapy skill acquisition: a systematic review. Athl Train Educ J 2020;15(3):224–234. Available from:

18. Adams NE. Bloom’s taxonomy of cognitive learning objectives. J Med Libr Assoc 2015;103(3):152–153. Available from:

19. Clark D. Bloom’s taxonomy of learning domains.1999. Available from:

20. Cannon HM, Feinstein AH, Friesen DP. Managing complexity: applying the conscious-competence model to experiential learning. In developments in business simulation and experiential learning: proceedings of the annual ABSEL conference. 2010

21. Howell WC, Fleishman EA. Human performance and productivity: Information processing and decision making. Vol. 2. Hillsdale, NJ: Erlbaum; 1982:29–33

22. Busan AM. Learning styles of medical students - implications in education. Curr Hlth Sci J 2014;(2):104–110. Available from:

23. Hernandez JE, Vasan N, Huff S, Melovitz-Vasan C. Learning styles/preferences among medical students: kinesthetic learner’s multimodal approach to learning anatomy. Med Sci Educ 2020;30(4):1633–1638. Available from:

24. Whillier S, Lystad RP, Abi-Arrage D, et al. The learning style preferences of chiropractic students: a cross-sectional study. J Chiropr Educ 2014;28(1):21–27

25. Wise CH, Schenk RJ, Lattanzi JB. A model for teaching and learning spinal thrust manipulation and its effect on participant confidence in technique performance. J Man Manip Ther 2016;24(3):141–150. Available from:

26. Lardon A, Cheron C, Pagé I, Dugas C, Descarreaux M. Systematic augmented feedback and dependency in spinal manipulation learning: a randomized comparative study. J Manipulative Physiol Ther 2016;39(3):185–191. Available from:

27. Schmidt RA, Lee TD. Motor control and learning: a behavioral emphasis. 3rd ed. Champaign, IL: Human Kinetics 1999.

28. Pasquier M, Cheron C, Dugas C, Lardon A, Descarreaux M. The effect of augmented feedback and expertise on spinal manipulation skills: an experimental study. J Manipulative Physiol Ther 2017;40(6):404–410. Available from:

29. Duquette SA, Starmer DJ, Plener JB, BSc DAG. A pilot study to determine the consistency of peak forces during cervical spine manipulation utilizing mannequins. J Chiropr Educ 2021;35(1):8–13. Available from: