Open Access Research article

Inertial sensor real-time feedback enhances the learning of cervical spine manipulation: a prospective study

Antonio I Cuesta-Vargas12* and Jonathan Williams3

Author Affiliations

1 Departamento de Psiquiatría y Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Málaga, Andalucia Tech, Cátedra de Fisioterapia y Discapacidad, Instituto de Biomedicina de Málaga (IBIMA), Grupo de Clinimetria (AE-14), Malaga, Spain

2 School of Clinical Science, Faculty of Health, Queensland University of Technology, Brisbane, Australia

3 School of Health and Social Care, Bournemouth University, Bournemouth, UK

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BMC Medical Education 2014, 14:120  doi:10.1186/1472-6920-14-120

Published: 19 June 2014



Cervical Spinal Manipulation (CSM) is considered a high-level skill of the central nervous system because it requires bimanual coordinated rhythmical movements therefore necessitating training to achieve proficiency. The objective of the present study was to investigate the effect of real-time feedback on the performance of CSM.


Six postgraduate physiotherapy students attending a training workshop on Cervical Spine Manipulation Technique (CSMT) using inertial sensor derived real-time feedback participated in this study. The key variables were pre-manipulative position, angular displacement of the thrust and angular velocity of the thrust. Differences between variables before and after training were investigated using t-tests.


There were no significant differences after training for the pre-manipulative position (rotation p = 0.549; side bending p = 0.312) or for thrust displacement (rotation p = 0.247; side bending p = 0.314). Thrust angular velocity demonstrated a significant difference following training for rotation (pre-training mean (sd) 48.9°/s (35.1); post-training mean (sd) 96.9°/s (53.9); p = 0.027) but not for side bending (p = 0.521).


Real-time feedback using an inertial sensor may be valuable in the development of specific manipulative skill. Future studies investigating manipulation could consider a randomized controlled trial using inertial sensor real time feedback compared to traditional training.

Medical education; Manipulation; Cervical; Kinematics; Inertial sensor