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Dr. Puentedura discussed his research into spinal manipulation, particularly in the cervical spine. He talked about his preliminary studies into a clinical prediction rule for manipulation of the cervical spine. We also talked about the importance of pain science education utilizing the biopsychosocial approach in accordance with manual therapy and exercise. Dr. Puentedura stressed the importance of the physical therapist to integrate the “package deal” into their treatment of patients: manual therapy, exercise, and pain neuroscience education.