Table 2.

Manual intervention algorithm for treatment selection.

Assessment	Treatment
Clinicians assess cervical spine mobility and range of motion, including overpressure and repeated movements, if indicated	If hypomobility or limited range of motion is identified in the cervical spine, the therapist will utilize cervical thrust manipulation or nonthrust mobilizations; this may include central and unilateral posterior-anterior, side glides, and occipito-atlanto joint (C0-1)
	Thrust manipulations may be repeated up to two times if reassessment of the patient shows improvements in range of motion, mobility, and/or pain
	Nonthrust mobilizations generally performed two to three times ×30 repetitions at each hypomobile level and may be repeated again (two to three times ×30 repetitions) if the patient shows improvements in range of motion, mobility, and/or pain
Clinicians assess thoracic spine mobility and range of motion	If hypomobility or limited range of motion is identified in the thoracic spine, the therapist will utilize thoracic thrust manipulation and/or nonthrust manipulation (may include central and unilateral posterior-anterior techniques to the thoracic spine and ribs)
	Thrust manipulation will be used unless contraindications noted (history or self-report of osteopenia/osteoporosis, etc)
	Thrust manipulations may be repeated up to two times if reassessment of the patient shows improvements in range of motion, mobility, and/or pain
	Nonthrust manipulations generally performed two to three times ×30 repetitions at each hypomobile level and may be repeated again (two to three times ×30 repetitions) if the patient shows improvements in range of motion, mobility, and/or pain