To Thrust or Not to Thrust, That is the Question!

Laurie Hartman, an osteopath who teaches spinal manipulation states one of the indications for thrust manipulation versus mobilization is that it is a shortcut. If your patient has an acutely locked facet, whether it is cervical, thoracic, or lumbar spine, and it is uncomplicated with no neural signs, they will respond fastest to a thrust manipulation. Your outcomes may be similarly successful with mobilization, but I and Hartman would argue, why bother? You could do it faster and most likely much more comfortable with a thrust manipulation. Even recent research shows that cervical thrust manipulation improves patient's complaints and ROM faster for the first 2-3 visits, even though in the long run, both are good treatment choices. When I present the choice of hammering away at a painful restriction with a grade 3-4 mobilization for minutes at a time versus one quick thrust that may or not even be painful for more than 1 second, many patients choose the thrust. If you were given the choice, and told the research shows both are valid treatment options, which would you choose? The only thing stopping you should be relative skill of the clinician, one of my soft contraindications.