Publications

The force sensing technology used in our FSTT® system has been around for a long time. Several research papers have been published using the hardware incorporated into our system, or our system directly.

Please see below for a reference list of studies related to force sensing technology in manual therapies to better understand the impact this technology has had on the profession, and opportunities for the future.


  • Cambridge ED, Triano JJ, Ross JK, Abbott MS. Comparison of force development strategies of spinal manipulation used for thoracic pain. Man Ther. (2012) 17:241–5. doi: 10.1016/j.math.2012.02.003

  • Chiradejnant A, Latimer J, Maher CG. Forces applied during manual therapy to patients with low back pain. J Manipul Physiol Ther. (2002) 25:362–9. doi: 10.1067/mmt.2002.126131

  • Chiradejnant A, Maher CG, Latimer J. Development of an instrumented couch to measure forces during manual physiotherapy treatment. Man Ther. (2001) 6:229–34. doi: 10.1054/math.2001.0418

  • Conradie M, Smit E, Louw M, Prinsloow M, Loubser L, Wilsdorf A. Do experienced physiotherapists apply equal magnitude of force during a grade I central pa on the cervical spine? South Afr J Physiother. (2004) 60:18. doi: 10.4102/sajp.v60i4.191

  • Conway P, Herzog W, Zhang Y, Hasler E, Ladly K. Forces required to cause cavitation during spinal manipulation of the thoracic spine. Clin Biomech. (1993) 8:210–4. doi: 10.1016/0268-0033(93)90016-B

  • Downie AS, Vemulpad S, Bull PW. Quantifying the high-velocity, low[1]amplitude spinal manipulative thrust: a systematic review. J Manipul Physiol Ther. (2010) 33:542–53. doi: 10.1016/j.jmpt.2010.08.001

  • Funabashi M, Nougarou F, Descarreaux M, Prasad N, Kawchuk GN. Does the application site of spinal manipulative therapy alter spinal tissues loading? Spine J. (2018) 18:1041–52. doi: 10.1016/j.spinee.2018.01.008

  • Funabashi M, Nougarou F, Descarreaux M, Prasad N, Kawchuk GN. Spinal tissue loading created by different methods of Spinal Manipulative Therapy (SMT) Application. Spine. (2017) 42:635–43. doi: 10.1097/BRS.0000000000002096

  • Goodsell M, Lee M, Latimer J. Short-term effects of lumbar posteroanterior mobilization in individuals with low-back pain. J Manipul Physiol Ther. (2000) 23:332–42. doi: 10.1016/S0161-4754(00)90208-2

  • Gorgos, Kara S., Nicole T. Wasylyk, Bonnie L. Van Lunen, and Matthew C. Hoch. Inter-clinician and intra-clinician reliability of force application during joint mobilization: a systematic review. Manual therapy 19, no. 2 (2014): 90-96. doi.org/10.1016/j.math.2013.12.003

  • Gudavalli M, Rowell R. Three-dimensional chiropractor-patient contact loads during side posture lumbar spinal manipulation: a pilot study. Chiropr Man Ther. (2014) 22:1–13. doi: 10.1186/s12998-014-0029-4

  • Gudavalli MR, Cox JM. Real-time force feedback during flexion-distraction procedure for low back pain: a pilot study. J Can Chiropr Assoc. (2014) 58:193–200.

  • Gudavalli MR, Devocht J, Tayh A, Xia T. Effect of sampling rates on the quantification of forces, durations, and rates of loading of simulated side posture high-velocity, low-amplitude lumbar spine manipulation. J Manipul Physiol Ther. (2013) 36:261–6. doi: 10.1016/j.jmpt.2013. 05.010

  • Gudavalli MR. Instantaneous rate of loading during manual high-velocity, low-amplitude spinal manipulations. J Manipul Physiol Ther. (2014) 37:294–9. doi: 10.1016/j.jmpt.2014.01.006

  • Harms MC, Bader DL. Variability of forces applied by experienced therapists during spinal mobilization. Clin Biomech. (1997) 12:393–9. doi: 10.1016/S0268-0033(97)00023-5

  • Harms MC, Cusick G, Bader DL. Measurement of spinal mobilisation forces. Physiotherapy. (1995) 81:599–604. doi: 10.1016/S0031-9406(05)66642-4

  • Harms MC, Innes SM, Bader DL. Forces measured during spinal manipulative procedures in two age groups. Rheumatology. (1999) 38:267–74. doi: 10.1093/rheumatology/38.3.267

  • Herzog W, Kats M, Symons B, Herzog W, Kats M, Symons B. The effective forces transmitted by high-speed, low-amplitude thoracic manipulation including commentary by Swenson RS. Spine. (2001) 26:2105– 11. doi: 10.1097/00007632-200110010-00012

  • Hessell BW, Herzog W, Conway PJ, Mcewen MC. Experimental measurement of the force exerted during spinal manipulation using the Thompson technique. J Manipul Physiol Ther. (1990) 13:448–53.

  • Howarth SJ, D’angelo K, Triano JJ. Development of a linked segment model to derive patient low back reaction forces and moments during high-velocity low-amplitude spinal manipulation. J Manipul Physiol Ther. (2016) 39:176–84. doi: 10.1016/j.jmpt.2016.02.009

  • Kawchuk GN, Herzog W. Biomechanical characterization (fingerprinting) of five novel methods of cervical spine manipulation. J Manipul Physiol Ther. (1993) 16:573–7.

  • Kirstukas SJ, Backman JA. Physician-applied contact pressure and table force response during unilateral thoracic manipulation. J Manipul Physiol Ther. (1999) 22:269–79. doi: 10.1016/S0161-4754(99)70059-X

  • Mercier, Marie-Andrée, Philippe Rousseau, Martha Funabashi, Martin Descarreaux, and Isabelle Pagé. Devices used to measure force-time characteristics of spinal manipulations and mobilizations: A mixed-methods scoping review on metrologic properties and factors influencing use. Frontiers in Pain Research 2 (2021). doi : 10.3389/fpain.2021.755877

  • Mikhail J, Funabashi M, Descarreaux M, Pagé I. Assessing forces during spinal manipulation and mobilization: factors influencing the difference between forces at the patient-table and clinician-patient interfaces. Chiropract Manual Ther. (2020) 28:1–10. doi: 10.1186/s12998-020-00346-1

  • Pasquier M, Daneau C, Marchand AA, Lardon A, Descarreaux M. Spinal manipulation frequency and dosage effects on clinical and physiological outcomes: a scoping review. Chiropr Man Therap. (2019) 27:23. doi: 10.1186/s12998-019-0244-0

  • Petersen EJ, Thurmond SM, Shaw CA, Miller KN, Lee TW, Koborsi JA. Reliability and accuracy of an expert physical therapist as a reference standard for a manual therapy joint mobilization trial. J Man Manip Ther. (2021) 29:189–95. doi: 10.1080/10669817.2020.1844853

  • Rogers CM, Triano JJ. Biomechanical measure validation for spinal manipulation in clinical settings. J Manipul Physiol Ther. (2003) 26:539–48. doi: 10.1016/j.jmpt.2003.08.008

  • Snodgrass SJ, Rivett DA, Robertson VJ, Stojanovski E. Forces applied to the cervical spine during posteroanterior mobilization. J Manipul Physiol Ther. (2009) 32:72–83. doi: 10.1016/j.jmpt.2008.09.012

  • Snodgrass SJ, Rivett DA, Robertson VJ. Calibration of an instrumented treatment table for measuring manual therapy forces applied to the cervical spine. Man Ther. (2008) 13:171–9. doi: 10.1016/j.math.2007.04.002

  • Snodgrass SJ, Rivett DA, Robertson VJ. Manual forces applied during cervical mobilization. J Manipul Physiol Ther. (2007) 30:17–25. doi: 10.1016/j.jmpt.2006.11.008

  • Snodgrass SJ, Rivett DA, Robertson VJ. Manual forces applied during posterior-to-anterior spinal mobilization: a review of the evidence. J Manipul Physiol Ther. (2006) 29:316–29. doi: 10.1016/j.jmpt.2006.03.006

  • Todd AJ, Carroll MT, Mitchell EK. Forces of commonly used chiropractic techniques for children: a review of the literature. J Manipul Physiol Ther. (2016) 39:401–10. doi: 10.1016/j.jmpt.2016.05.006

  • Triano J, Schultz AB. Loads transmitted during lumbosacral spinal manipulative therapy. Spine. (1997) 22:1955–64. doi: 10.1097/00007632-199709010-00003

  • Triano JJ, Lester S, Starmer D, Hewitt EG. Manipulation peak forces across spinal regions for children using mannequin simulators. J Manipul Physiol Ther. (2017) 40:139–46. doi: 10.1016/j.jmpt.2017.01.001

  • Triano JJ. Biomechanics of spinal manipulative therapy. Spine J. (2001) 1:121–30. doi: 10.1016/S1529-9430(01)00007-9

  • Tuttle N, Jacuinde G. Design and construction of a novel low-cost device to provide feedback on manually applied forces. J Orthopaedic Sports Phys Ther. (2011) 41:174–9. doi: 10.2519/jospt.2011.3461

  • Van Zoest G, Gosselin G. Three-dimensionality of direct contact forces in chiropractic spinal manipulative therapy. J Manipul Physiol Ther. (2003) 26:549–56. doi: 10.1016/j.jmpt.2003.08.001

  • Van Zoest GGJM, Van Den Berg HTCM, Holtkamp FC. Three[1]dimensionality of contact forces during clinical manual examination and treatment: a new measuring system. Clin Biomech. (2002) 17:719–22. doi: 10.1016/S0268-0033(02)00132-8

  • Waddington G, Diong J, Adams R. Development of a hand dynamometer for the control of manually applied forces. J Manipul Physiol Ther. (2006) 29:297–304. doi: 10.1016/j.jmpt.2006.03.007

  • Waddington GS, Adams RD. Initial development of a device for controlling manually applied forces. Man Ther. (2007) 12:133–8. doi: 10.1016/j.math.2006.06.009

  • Descarreaux M, Dugas C, Lalanne K, Vincelette M, Normand MC. Learning spinal manipulation: the importance of augmented feedback relating to various kinetic parameters. Spine J. (2006) 6:138–45. doi: 10.1016/j.spinee.2005.07.001

  • Kope R, O’brien J, Sadi J, Walton DM, Ferreira LM. Quantifying performance metrics of cervical spine mobilization for improved education and clinical outcomes: early experience with a novel wearable device. J Rehabil Assistive Technol Eng. (2018) 5:2055668318765396. doi: 10.1177/2055668318765396

  • Lardon A, Pasquier M, Audo Y, Barbier-Cazorla F, Descarreaux M. Effects of an 8-week physical exercise program on spinal manipulation biomechanical parameters in a group of 1st-year chiropractic students. J Chiropract Educ. (2019) 33:118–24. doi: 10.7899/JCE-18-15

  • Pasquier, Mégane, Charlène Chéron, Gaëtan Barbier, Claude Dugas, Arnaud Lardon, and Martin Descarreaux. "Learning spinal manipulation: objective and subjective assessment of performance." Journal of Manipulative and Physiological Therapeutics 43, no. 3 (2020): 189-196. doi:10.1019/j.jmpt.2019.12.010

  • Petersen EJ, Thurmond SM, Buchanan SI, Chun DH, Richey AM, Nealon LP. The effect of real-time feedback on learning lumbar spine joint mobilization by entry-level doctor of physical therapy students: a randomized, controlled, crossover trial. J Man Manip Ther. (2019) 1–11. doi: 10.1080/10669817.2019.1673953

  • Petersen EJ, Thurmond SM, Shaw CA, Miller KN, Lee TW, Koborsi JA. Reliability and accuracy of an expert physical therapist as a reference standard for a manual therapy joint mobilization trial. J Man Manip Ther. (2021) 29:189–95. doi: 10.1080/10669817.2020.1844853

  • Sheaves EG, Snodgrass SJ, Rivett DA. Learning lumbar spine mobilization: the effects of frequency and self-control of feedback. J Orthopaedic Sports Phys Ther. (2012) 42:114–24. doi: 10.2519/jospt.2012. 3691

  • Snodgrass SJ, Rivett DA, Robertson VJ, Stojanovski E. A comparison of cervical spine mobilization forces applied by experienced and novice physiotherapists. J Orthopaedic Sports Phys Ther. (2010) 40:392–401. doi: 10.2519/jospt.2010.3274

  • Snodgrass SJ, Rivett DA, Robertson VJ, Stojanovski E. Real-time feedback improves accuracy of manually applied forces during cervical spine mobilisation. Man Ther. (2010) 15:19–25. doi: 10.1016/j.math.2009. 05.011
  • Stainsby BE, Clarke MCS, Egonia JR. Learning spinal manipulation: a best evidence synthesis of teaching methods. J Chiropract Educ. (2016) 30:138–51. doi: 10.7899/JCE-15-8

  • Starmer DJ, Guist BP, Tuff TR, Warren SC, Williams MGR. Changes in manipulative peak force modulation and time to peak thrust among first-year chiropractic students following a 12-week detraining period. J Manipul Physiol Ther. (2016) 39:311–7. doi: 10.1016/j.jmpt.2016.02.010

  • Triano J, Descarreaux M, Dugas C. Biomechanics–review of approaches for performance training in spinal manipulation. J Electromyogr Kinesiol. (2012) 22:732–9. doi: 10.1016/j.jelekin.2012.03.011

  • Triano JJ, Gissler T, Forgie M, Milwid D. Maturation in rate of high[1]velocity, low-amplitude force development. J Manipulative Physiol Ther. (2011) 34:173–80. doi: 10.1016/j.jmpt.2011.02.007

  • Triano JJ, Rogers CM, Combs S, Potts D, Sorrels K. Developing skilled performance of lumbar spine manipulation [randomized controlled Frontiers in Pain Research | www.frontiersin.org 12 October 2021| Volume 2 | Article 755877 Mercier et al. Manual Therapy Force-Time Characteristics Measurement trial]. J Manipul Physiol Ther. (2002) 25:353–61. doi: 10.1067/mmt.2002. 126132

  • Van Zoest GGJ, Staes FFG, Stappaerts KH. Three-dimensional manual contact force evaluation of graded perpendicular push force delivery by second-year physiotherapy students during simple feedback training. J Manipul Physiol Ther. (2007) 30:438–49. doi: 10.1016/j.jmpt.2007.06.001

  • Aguirrebena IL, Newham D, Critchley DJ. Mechanism of action of spinal mobilizations: a systematic review. Spine. (2016) 159–72. doi: 10.1097/BRS.0000000000001151

  • Bialosky JE, Bishop MD, Price DD, Robinson ME, George SZ. The mechanisms of manual therapy in the treatment of musculoskeletal pain: a comprehensive model. Man Ther. (2009) 14:531–8. doi: 10.1016/j.math.2008.09.001

  • Conradie M, Smit E, Louw M, Prinsloow M, Loubser L, Wilsdorf A. Do experienced physiotherapists apply equal magnitude of force during a grade I central pa on the cervical spine? South Afr J Physiother. (2004) 60:18. doi: 10.4102/sajp.v60i4.191

  • Conway P, Herzog W, Zhang Y, Hasler E, Ladly K. Forces required to cause cavitation during spinal manipulation of the thoracic spine. Clin Biomech. (1993) 8:210–4. doi: 10.1016/0268-0033(93)90016-B

  • Goodsell M, Lee M, Latimer J. Short-term effects of lumbar posteroanterior mobilization in individuals with low-back pain. J Manipul Physiol Ther. (2000) 23:332–42. doi: 10.1016/S0161-4754(00)90208-2

  • Pasquier M, Daneau C, Marchand AA, Lardon A, Descarreaux M. Spinal manipulation frequency and dosage effects on clinical and physiological outcomes: a scoping review. Chiropr Man Therap. (2019) 27:23. doi: 10.1186/s12998-019-0244-0

  • Waddington G, Lau G, Adams R. Manual application of controlled forces to thoracic and lumbar spine with a device: rated comfort for the receiver’s back and the applier’s hands. J Manipul Physiol Ther. (2007) 30:365–73. doi: 10.1016/j.jmpt.2007.04.006