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Adjunctive Treatments, Pathophysiology of Lower Back Pain with Anatomy Overview.

It is estimated that up to 84 percent of adults have low back pain at some time in their lives and many clinicians and patients are seeking nonpharmacologic treatments for pain management. Spinal manipulation is taught in medical schools for Osteopathic Physicians but for most medical doctors and nurse practitioners they have not been trained in these adjunctive procedures.

Empire Medical Training’s Spinal Manipulation Therapy Training is an evidence-based program created for all physician practices using an osteopathic approach for treatment for certain pain conditions unresponsive to conventional medical treatments. Empire’s hands-on spinal manipulation course focuses on the technical and practical hands-on skills required to successfully perform high-velocity low-amplitude (HVLA) spinal manipulation. The course emphasis is for treatment of lower back pain but will teach manipulation techniques for the following articulations; T10-L1 (thoracolumbar junction), L2-L5 and SI (sacroiliac) joint for acute and chronic lower back pain.

Empire has developed this course to enhance our other pain courses and give additional tools for a practitioner to diagnose, treat patients portraying pain for a variety of lower back pain. This is a 1-Day Course which will include didactic for each indication and a “hands-on” element immediately thereafter including protocols associated with the procedure as well as “standard of care” considerations.

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Aesthetics/Anti-Aging Curriculum

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Pain Management Curriculum

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The course is taught by Board Certified Physicians who have incorporated these procedures within their practice and will share their results in addition to reviewing the numerous evidenced-based studies on the topic including peer to peer articles that will give the attendee the insights to deliver these procedures safely and effectively. A full color manual and instructional videos illustrating the procedures are included through our Physician Portal.

Pain is associated with inflammation and many of these manipulation techniques will involve increase blood circulation of the areas, reduce inflammation, and flexibility techniques for strength and increased ROM to manage pain. Back pain is typically generated from (3) major structures:

  • Muscles can be spasm, MFTP, or strain due to acute injury or after injuries are poorly or inappropriately healed.
  • Joint lumbar facets degenerate in relationship to chronic pain arthritis responsible for up to 80% of lower back pain affecting the vertebral body (i.e., compression fracture, Schmorels node) including the Sacrum and Ilium (SI Joint).
  • Nerve pain such as radiculopathies, nerve entrapment or RSD.

The Empire Medical Training Spinal Manipulation (HVLA) Therapies training will give you a better understanding of pain and will review pertinent anatomy and techniques to help diagnose and create a proper treatment plan for managing pain for patients.

Within the course study, you will learn how to perform a proper history and physical based on the latest standard of care. Learn how to perform various functional tests to confirm the initial diagnosis for numerous conditions including:

  • MRI disc pathology and ligament damage
  • Xrays
  • Functional testing
    • Seated straight raise
    • Supine SLR
    • Kemp’s Extension Test (Rotate and Lateral Flux)
  • DTR
    • Patellar
    • Achilles
  • Lower Back Pain with or without leg pain
  • SI Joint Testing
    • Fortin finger test
    • FABER
    • SI Compression
  • Muscle Testing
    • Hallux
    • Eversion/Inversion Testing
spinal manipulation by medical professional
winning consultation x ray exam

What Conditions can be Treated with Spinal Manipulation (HVLA)?

Conditions treated by perineural injection therapy (PIT) include, but are not necessarily limited to:

  • Sacro-iliac Dysfunction
  • Palpable somatic dysfunction of a joint | thoracic spine.
  • Firm distinct restrictive barrier.
  • Range of Motion Loss
  • Lumbar Pain
  • Sacrum Related Pain

Empire Medical Training has created the Spinal Manipulation (HVLA) Therapy Training course for all physicians to enhance patient care for medical practices that encounter lower back pain within their clinical setting. These are very safe procedures to perform with no real complications associated with the proper training while offering long-term or permanent relief for patients and can be easily integrated within a practice setting.

Join the thousands of physicians who have entrusted Empire Medical Training for the past 23 years and have used our programs to integrate new medical procedures within their practice to enhance patient care.


Upon completion of this program, attendees will have a thorough understanding of the following concepts:

  • Acquire the necessary knowledge to identify potential patients who would substantially benefit from these therapies.
  • Identify the indications, precautions and contra-indications (relative and absolute) of spinal manipulation.
  • Learn and develop proper body positioning and biomechanics needed in the delivery of high-velocity low-amplitude manipulation.
  • Implementing combination leverages so as to focus forces and create concentrated physiologic forces at target dysfunctional joint(s).
  • Develop the psychomotor skills necessary to appreciate the pre-manipulative physiologic end feel in order to minimize the overall amplitude and force required to achieve audible joint release (cavitation).
  • Develop and incorporate sound clinical reasoning influencing the choice (or not) of manipulation reviewing current evidence based literature.
  • Developing a sound comprehension of spinal manipulation and develop a sound fundamental appreciation of the appropriate use as well as the inherent limitations to spinal manipulation in every day clinical practice.
  • Develop and increase the clinical reasoning skills in the selection of spinal manipulation techniques for a variety of low back and neuromusculoskeletal dysfunctions.
  • Demonstrate safe, competent and proficient performance of spinal manipulation techniques, including pre-manipulative positioning and actual thrust application to the lumbar and sacro-iliac regions.
  • Learn effective diagnose and treatment strategies for sacro-iliac joint dysfunction, lumbar spine facet syndromes and lumbar disc lesions.
  • Learn Pricing and Packaging for the procedures and marketing pearls to incorporate within your present practice.
spinal manipulation hlva

Frequently Asked Questions

This training caters to MDs, DOs, DMDs, DDS, NPs, RNs and other licensed healthcare professionals.

A board-certified physician expert will teach this course, with other licensed healthcare professionals assisting where needed.

Certainly! For those outside the United States, injections on anatomical models are an option; however, you will not be allowed to inject on a live patient.

Each state has its own regulations concerning live patient injections. Kindly consult your licensing board to determine if you’re permitted to administer injections.

In-Person Course Agenda

Day 1

Agenda Training - Agenda
8:30am-9:00am Registration
  • Intro and Pathophysiology of low back pain with anatomy overview
  • H&P low back and SI with imaging review
11:00am-11:15am Break
  • Evidence based diagnosis and management of low back (lumbar) pain with and without sciatica
  • Evidence based diagnosis of sacro-iliac dysfunction
12:30pm-1:30pm Lunch
Agenda Training - Injection
  • Indications, precautions, contraindications for HVLAT manipulation
  • Hands-On Lumbar manipulation technique
3:30pm-3:45pm Break

Hands-On Lumbar manipulation technique

Day 2

Agenda Training - Agenda
8:30am-9:00am Registration
  • Intro Exercise and rehab strategies for low back pain
  • Sacro-iliac joint manipulation technique
11:00am-12:00pm Lunch
  • Soft tissue effects on LBP acupressure MFTP treatments injections
  • Lumbar and SI manipulation technique continuing practice session
Agenda Training - Injection
  • Adjunct therapies and techniques pharmaceutical options
  • Assessment of techniques

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*All courses are conducted by Physicians and other Specialists in Aesthetics, Pain, Surgery, and Medicine. Not by less qualified Instructors

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