SMT-1: High-Velocity Low-Amplitude Thrust Manipulation of the Cervical, Thoracic, Lumbar & Sacroiliac Joints


This two-day seminar includes 70% hands-on practical training and 30% didactic lecture instruction. The content of the seminar focuses on the practical hands-on skills required to perform high-velocity low-amplitude (HVLA) thrust manipulation techniques in a competent and safe manner for all of the spinal regions.

Participants will learn HVLA thrust manipulation techniques for the following articulations: C0-1 (occipito-atlantal joint), C1-2 (atlanto-axial joint), C2-7 (mid and lower cervical segments), C7-T3 (cervicothoracic junction), upper ribs 1, 2 and 3 (costotransverse & costovertebral joints), T4-9 (mid-thoracic facet articulations), T10-L1 (thoracolumbar junction), L2-4 (mid-lumbar spine facets), L5-S1 (lumbosacral junction), and the SI (sacroiliac) joint.

Current evidence will also be presented that underpins the use of spinal manipulation for cervicogenic headaches, cervicothoracic dysfunction, shoulder pain and upper rib syndromes, acute and chronic low back pain, sacroiliac joint dysfunction, and mechanical neck pain.

Course Objectives

  1. Describe the indications, precautions and contra-indications (relative and absolute) of high-velocity low-amplitude thrust manipulation.  Demonstrate pre-manipulative screening tests for cervical artery dysfunction (Vertebro-Basilar-Insufficiency) and upper cervical instability and understand their limitations.
  2. Improve the use of body and posture in application of high-velocity low-amplitude thrust, making them an integral part of technique delivery.
  3. Start combining leverages using multiple components in order to focus forces and build “mechanical barriers” at target motion segments.
  4. Develop the psychomotor skills necessary to appreciate the pre-manipulative barrier (end-feel) utilized in minimal leverage or momentum induced manipulative technique by concentrating on combining multiple leverages in order to minimize the overall amplitude and force required to achieve cavitation.
  5. Facilitate sound clinical reasoning processes behind the choice (or not) of high-velocity low-amplitude techniques and an appreciation of the current evidence base behind their application.
  6. Demystify the delivery of high-velocity low-amplitude thrust manipulation and develop an appreciation of its merits and limitations in every day clinical practice.
  7. Utilize clinical reasoning skills in the selection of high-velocity low-amplitude thrust manipulation techniques for a variety of neuromusculoskeletal dysfunctions.
  8. Demonstrate safe, competent and proficient performance of HVLA thrust manipulation techniques, including pre-thrust positioning and actual thrust application of mid and lower cervical, thoracic, rib, lumbar and sacro-iliac regions.
  9. Describe and demonstrate HVLA thrust manipulation for the junctional zones:  upper cervical, cervicothoracic, thoracolumbar and lumbosacral regions.
  10. Learn how to effectively diagnose and treat upper, mid, and lower cervical joint dysfunction, sacro-iliac joint dysfunction, lumbar spine facet syndromes, second and third rib syndromes, and cervicothoracic joint dysfunction.
Course Outline - Day 1
 7:45 am  Registration
 8:00  Indications, precautions, contraindications for use of HVLAT manipulation
 9:00  Cervical (C2-7) rotatory HVLA thrust manipulation technique
 10:00  Break
 10:15  Cervicothoracic junction (C7-T3) HVLA thrust manipulation technique
 11:00  Evidence based diagnosis and management of cervicogenic headaches
 12:00 pm  Lunch (on own)
 1:00  Upper cervical HVLA thrust manipulation of Atlanto-Axial (C1-2) joint
 2:00  Evidence for use of HVLA thrust manipulation in acute and chronic LBP
 3:00  Break
 3:15  Mid-lumbar (L2-4) HVLA thrust manipulation technique
 4:00  1st rib HVLA thrust manipulation technique
 4:30  2nd & 3rd rib HVLA thrust manipulation technique
 5:00  Conclusion of day one
Course Outline - Day 2
 7:45 am  Sign-in
 8:00  Upper thoracic (T1-3) HVLA thrust manipulation technique
 9:00  Cervical (C2-7) lateral-flexion translatory HVLA thrust manipulation technique
 10:00  Break
 10:15  Lumbo-sacral junction (L5/S1) HVLA thrust manipulation technique
 11:00  Mid-thoracic (T4-9) HVLA thrust manipulation technique
 12:00 pm  Lunch (on own)
 1:00  Upper cervical HVLA thrust manipulation of Occipito-Atlantal (C0-1) joint
 2:00  Evidence based diagnosis of sacro-iliac dysfunction
 3:00  Break
 3:15  Sacro-iliac joint HVLA thrust manipulation technique
 4:00  Thoraco-lumbar junction (T11-L1) HVLA thrust manipulation technique
 4:30  Rib 4-8 HVLA thrust manipulation technique
 5:00  Conclusion of course & issue of certificates

Course registrations should be completed online; however, if you prefer to mail your registration form, please print and mail the COURSE REGISTRATION FORM with payment by check (made out to Spinal Manipulation Institute) or credit card to:

Spinal Manipulation Institute
1036 Old Breckenridge Lane
Montgomery, AL 36117

Registration & Cancellation Policy

Early bird registration (e.g. $625 for SMT-1; $795 for DN-1) applies only to participants who register more than 20 days before the listed course start date; regular registration ($660 for SMT-1) applies to participants who register less than 20 days before the listed course start date. A full refund of course tuition may be obtained with cancellations that occur more than 21 days prior to the course start date; however, cancellations with less than 21 days notice only qualify for a 50% refund or 50% transfer to another course.

Attention: Participants for the osteopractic spinal manipulation and dry needling courses in Italy must be a licensed physiotherapist or medical doctor. Osteopaths may only participate if they are also a licensed PT or MD. Proof of licensure will need to be provided via email 2 weeks prior to the course start date. If a registrant is not able to provide proof of license as a physiotherapist or medical doctor, the registration will be cancelled and refunded; however, AAMT will not be responsible for any travel or accommodation bookings.

La registrazione anticipata ($625 per SMT-1) si applica solo ai partecipanti che si registrano più di 20 giorni prima della data di inizio del corso; la registrazione regolare ($660 per SMT-1) si applica ai partecipanti che si registrano meno di 20 giorni prima della data di inizio del corso. Sarà concesso un rimborso della completo quota di registrazione per richieste di cancellazione pervenute più di 21 giorni prima della data di inizio del corso; tuttavia, per le cancellazioni con meno di 21 giorni di preavviso sarà concesso un rimborso del solo 50% della cifra, oppure il trasferimento del 50% della somma per la registrazione di ad un’altro corso.

Attenzione: In Italia i destinatari dei corsi di osteopractic spinal manipulation e dry needling sono Fisioterapisti (o studenti del III anno del corso di Laurea) e Medici. Possono partecipare ai corsi anche Osteopati solo se medici o in possesso del titolo di fisioterapia. Sarà richiesta copia del titolo via email prima della data del corso. In caso il partecipante non fosse in grado di dimostrare il possesso del titolo richiesto, la registrazione verrà cancellata e rimborsata fino a 21 giorni prima dell’inizio del corso (qualsiasi spesa o commissione bancaria sarà a carico del richiedente del rimborso). In tal caso, l’AAMT non è responsabile di eventuali prenotazioni di viaggio o alloggio.

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