The science of spinal motion palpation: a review and update with implications for assessment and intervention

Abstract

Spinal motion palpation (SMP) is a standard component of a manual therapy examination despite questionable reliability. The present research is inconclusive as to the relevance of the findings from SMP, with respect to the patient's pain complaints. Differences in the testing methods and interpretation of spinal mobility testing are problematic. If SMP is to be a meaningful component of a spinal examination, the methods for testing and interpretation must be carefully scrutinized. The intent of this narrative review is to facilitate a better understanding of how SMP should provide the examiner with relevant information for assessment and treatment of patients with spinal pain disorders. The concept of just noticeable difference is presented and applied to SMP as a suggestion for determining the neutral zone behavior of a spinal segment. In addition, the use of a lighter, or more passive receptive palpation technique, is considered as a means for increasing tactile discrimination of spinal movement behavior. Further understanding of the scientific basis of testing SMP may improve intra-and inter-examiner reliability. The significance of the findings from SMP should be considered in context of the patient's functional problem. Methodological changes may be indicated for the performance of SMP techniques, such as central posterior-anterior (PA) pressure and passive intervertebral motion tests, in order to improve reliability. Instructors of manual therapy involved in teaching SMP should be knowledgeable of the neurophysiological processes of touch sensation so as to best advise students in the application of the various testing techniques.

Spinal PA movements behave ‘as if’ there are limitations of local segmental mobility and are large enough to be perceivable by manual palpation: A synthesis of the literature

“…Additionally, the design of several studies failed to consider that the repeated application of passive movement to the spines of the individuals receiving PIVMs could change the test conditions across subjects conducting the examinations; the testing, in effect, becoming treatment and reducing or eliminating the basis for comparison across subjects [42,44,[47][48][49][50][51]. Finally, it is probably reasonable to not expect a higher level of agreement from PIVM movements than other assessment procedures as, for example, few cervical spine examination procedures in isolation demonstrate high repeatability [52].…”

Effective teaching of manual skills to physiotherapy students: a randomised clinical trial

“…Specific improvements were noted in fine characteristics of manual skills (e.g. identification and fixation of cervical spine level) that require high levels of sensory and motor coordination . However, in neither group did participants achieve completely correct performance during the skills laboratories, possibly because joint mobilisation is not included among the learning outcomes expected at undergraduate level and the participating students were being exposed to the acquisition of this complex competence for the first time …”

“…To date, no study has compared these two approaches in the education of other health care professionals, such as that of physiotherapists. Physiotherapists, among others, are required to demonstrate a high level of performance in technical skills that also implies the continuing acquisition of clinical data, which informs them how to apply and regulate the procedure on the basis of the individual patient's specific needs . Therefore, the main aim of this study was to evaluate the effectiveness of each of these approaches in physiotherapy education.…”

The short and mid-term effects of Mulligan concept in patients with chronic mechanical neck pain

“…As clinicians, we use manual contact techniques like joint-play and end-feel, in evaluation of manual therapy effect, but these methods still lacks of evidence based support [36]. External validity is negatively affected from many possible confounding factors in highly controlled research settings investigating motion palpation and manual contact [37].…”