Force-Time Profile Differences in the Delivery of Simulated Toggle-Recoil Spinal Manipulation by Students, Instructors, and Field Doctors of Chiropractic

ObjectivesThe objectives of this study were to examine the force-time profiles of toggle recoil using an instrumented simulator to objectively measure and evaluate students' skill to determine if they become quicker and use less force during the course of their training and to compare them to course instructors and to field doctors of chiropractic (DCs) who use this specific technique in their practices.MethodsA load cell was placed within a toggle recoil training device. The preload, speed, and magnitude of the toggle recoil thrusts were measured from 60 students, 2 instructors, and 77 DCs (ie, who use the toggle recoil technique in their regular practice). Student data were collected 3 times during their toggle course (after first exposure, at midterm, and at course end.)ResultsThrusts showed a dual-peak force-time profile not previously described in other forms of spinal manipulation. There was a wide range of values for each quantity measured within and between all 3 subject groups. The median peak load for students decreased over the course of their class, but they became slower. Field doctors were faster than students or instructors and delivered higher peak loads.ConclusionToggle recoil thrusts into a dropping mechanism varied based upon subject and amount of time practicing the task. As students progressed through the class, speed reduced as they increased control to lower peak loads. In the group studies, field DCs applied higher forces and were faster than both students and instructors. There appears to be a unique 2-peak feature of the force-time plot that is unique to toggle recoil manipulation with a drop mechanism.