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1. When testing dynamic stability, the candidate should incorporate a repeat of the static stability test in the presence of inner core and/or segmental muscle contraction.
2. The candidate should be familiar with shoulder quadrants (as well as other joints) as assessment and treatment techniques.
3. The candidate should be familiar with end of range techniques for all shoulder girdle joints, incorporating both physiological and accessory movements.
4. Dynamic wrist manipulations must not emphasize angular wrist motion. Keep the manipulative force in a AP/PA plane. Although the technique is dynamic, the actual thrust must be high velocity, low amplitude. Be sure to include a traction component.
5. The candidate should be prepared to do all reflexes that have the potential to obtain a credible response.
6. When doing end of range techniques at spinal joints, the candidate should incorporate all physiological motions in order to achieve a barrier. Although not necessarily the only choice, candidates should be able to demonstrate locked techniques for end range cervical mobilization.
7. The candidate should be prepared to demonstrate cranial and caudal locking in mid and lower cervical techniques.
8. Subtalar, tarsal and carpal stress tests should incorporate a gap component as well as a shear component.
9. The candidate should be able to discuss all structures involved with joint stability, not just the ligaments.
10. The candidate should be familiar with indirect lumbar techniques.
11. The candidate should demonstrate knowledge of grades of mobilization (please refer to review article in ODR 2009). Passive accessory movements are not just glides at the end of physiological movement range. The candidate should be able to demonstrate an appreciation of the complete range of accessory motion testing from a neutral position of the joint as well as end of range.
12. The candidate needs to ensure that deep transverse frictions are properly localized and effective in depth and breadth.
13. The candidate should demonstrate adequate background knowledge as well as an ability to differentiate proximal from distal interface issues when testing the neuromeningeal system.
14. The candidate should have a complete knowledge of the biomechanics of the TMJ.
15. Candidates must be aware of the components of the extension motion in the cervical spine and incorporate these into testing and treatment techniques, ensuring a posterior/ inferior motion of the superior vertebra, avoiding straight anterior translation (lordosing) to obtain extension.

1. When testing dynamic stability, the candidate should incorporate a repeat of the static stability test in the presence of inner core and/or segmental muscle contraction.
2. The candidate should be familiar with shoulder quadrants as assessment and treatment techniques.
3. The candidate should be familiar with end of range techniques for all shoulder girdle joints, incorporating both physiological and accessory movements.
4. Dynamic wrist manipulations must not emphasize angular wrist motion. Keep the manipulative force in an anterior/posterior - posterior /anterior plane.
5. The candidate should be prepared to do all reflexes that have the potential to obtain a credible response.
6. When doing end of range techniques at spinal joints, the candidate should incorporate all physiological motions in order to achieve a barrier.
7. The candidate should be prepared to demonstrate cranial and caudal locking in mid and lower cervical techniques.
8. When demonstrating subtalar stress tests, the candidate should use not only a shear, but also include a valgus or varus gap force.
9. The candidate should be able to discuss all structures involved with joint stability, not just the ligaments.
10. The candidate should be familiar with indirect lumbar techniques.
11. The candidate should demonstrate knowledge of grades of mobilization (please refer to review article in ODR 2009). Passive accessory movements are not just glides at the end of physiological movement range. The candidate should be able to demonstrate an appreciation of the complete range of accessory motion testing from a neutral position of the joint as well as end of range.
12. The candidate needs to ensure that deep transverse frictions are properly localized and effective in depth and breadth.

1. Candidates should possess and demonstrate detailed knowledge of the anatomy and biomechanics of all costotransverse joints, noting unique features of, for example, the first rib and its articulations.
2. Candidates should demonstrate detailed knowledge of spinal surface anatomy. Review of the midcervical and thoracolumbar junction areas are particularly indicated. Lumbar spine locking must be maintained for effective lumbar manipulation. Attention to positioning the examination models securely near, but not too close to the edge of the table, helps to maintain control of the locked position.
3. Candidates need to ensure they are engaging the motion barrier for manipulations of C1-2.
4. The mid cervical technique, unilateral flexion superior glide (refer to P 112 in Level4/5 manual), requires emphasis on a superior/anterior glide on the affected side.
5. When evaluating the technique of craniovertebral locking, examiners are looking for a series of small side bending/rotation movements of the CV complex, while C2-3 is kept relatively neutral. It is the sequential, incremental nature of the set up that achieves locking without excessive head rotation.
6. Demonstration of detailed knowledge of the blood supply to the cord and brainstem is required. Study this to the point where you could describe it in your sleep. A reminder too that the extension/rotation test manoeuvre requires extension of the entire cervical spine, not just the craniovertebral region.

• Is the lock achieved and maintained? (YES is desirable)
  
• Does your lumbar locking technique facilitate the direction of motion/coupling you are employing when manipulating the lumbar spine (YES is helpful here).
  
• Are you tending to "back off and charge" when manipulating? (work towards a NO)
  
• Are you doing the pre-manipulative test hold at the end of the available range? (Hint....that's what we're looking for).
  

• The manipulations at the thoracolumbar junction are most effective when the side-bending component is emphasized, rather that the rotatory component.
• The indirect technique for the lumbar spine must bias the motion toward flexion or extension at the joint to be treated, not just at the adjacent segments. For example, to restore extension at L3-4 with the stiff side down, the L3-4 segment must be positioned toward extension so that the side bending thrust affects the table side joint and does not induce a flexion/cavitation of the top side joint.
• Rotation stability tests in the lumbar spine need to be specifically performed in a direction of axial rotation, to the end of the range.
• During performance of side lying sacroiliac joint manipulations, ensure that the manipulative force does not produce excessive motion of the leg or pelvis on the opposite side.
• The subject of post manipulation care should include follow up instructions to the patient about self care and expected response to manipulation, pain management as well as exercise or ergonomic advice that is appropriate for the scenario. For example, what advice might you give a sedentary worker versus an athlete?
• In the cervical spine the examiners look for a clear distinction in demonstration of movement in the plane of the z joints versus motion in the plane of the u joint.
• Remember that when mobilizing a spinal joint, grades 3+ and 4+ must push at the R2 barrier of motion.