title: Manipulation Peak Forces Across Spinal Regions for Children Using Mannequin Simulators.
abstract: The purpose of this work was to create an exploratory database of manipulation treatment force variability as a function of the intent of an experienced clinician sub-specializing in the care of children to match treatment to childhood category. Data of this type are necessary for realistic planning of dose-response and safety studies on therapeutic benefit.
  
  
  
  The project evaluated the transmitted peak forces of procedures applied to mannequins of different stature for younger and older children. Common procedures for the cervical, thoracic, and lumbar spine and sacroiliac joint were administered to estimate variability by a single experienced practitioner and educator in pediatric manipulation attempting to modulate for childhood category. Results described for peak components in the cardinal axes and for peak total forces were cataloged and compared with consensus estimates of force from the literature.
  
  
  
  Mean force values for both components and total force peaks monotonically increased with childhood category analogous to consensus expectations. However, a mismatch was observed between peak values measured and consensus predictions that ranged by a factor of 2 to 3.5, particularly in the upper categories. Quantitative data permit a first estimate of effect size for future clinical studies.
  
  
  
  The findings of this study indicate that recalibration of spinal manipulation performance of experienced clinicians toward arbitrary target values similar to consensus estimates is feasible. What is unclear from the literature or these results is the identity of legitimate target values that are both safe and clinically effective based on childhood categories in actual practice.
authors.affiliation: Graduate Education and Research, Canadian Memorial Chiropractic College, Toronto, ON, Canada. Electronic address: jtriano@cmcc.ca.
authors.forename: John J
authors.initials: JJ
authors.lastname: Triano
authors.affiliation: Undergraduate Education, Canadian Memorial Chiropractic College, Toronto, ON, Canada.
authors.forename: Steven
authors.initials: S
authors.lastname: Lester
authors.affiliation: Simulation Lab, Canadian Memorial Chiropractic College, Toronto, ON, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Starmer
authors.affiliation: Adjunct Faculty, University of Western States, Portland, OR.
authors.forename: Elise G
authors.initials: EG
authors.lastname: Hewitt
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D008348:Manikins; D026882:Manipulation, Chiropractic / Q000592:standards; D020393:Manipulation, Spinal / Q000379:methods* / Q000592:standards; D013131:Spine / Q000502:physiology* / Q000503:physiopathology*; D055815:Young Adult
keywords: Biomechanics; Chiropractic; Manipulation; Pediatrics; Simulation