Abstract
Coupling behavior has been described as fundamental to the theory of lumbar biomechanics. Different manual therapy approaches use discrepant coupling biomechanical models. Despite these inconsistencies, coupling models have been frequently used in the management of low back pain. The purpose of this paper is to investigate evidence for the use of coupling biomechanical modeling in manual therapy assessment and treatment. The findings of this paper suggest that use of a single dogmatic lumbar spinal coupling approach utilizing a side-bend initiation may not be appropriate and could lead to unreliable findings. The use of rotation initiation needs further consideration. Coupling behavior may be more consistent if rotation is initiated first, however there is insufficient evidence to substantiate this view.
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