c IIIKOI'RACTIC HAS A CHRONIC PROBLEM AND MOST OF US aren't even aware how deeply it has embedded itself into our daily practice. Certainly, we all like to think our methods of practice are scientifically sound. But is it really so? Just how good are our most commonly used methods of diagnosis and analysis? In prepping this month's column, 1 reviewed the literature on our profession's most commonly used method of spinal analysis. You might want to read this. Ask a hundred chiropractors how they assess the spine and the most common answer by far will be "palpation" and/or "motion palpation." The ability of chiropractors to skillfully palpate the spine has been one of our most treasured methods of analysis and no small source of professional pride for well over a hundred years. In 2009, Haneline and Young performed an extensive review of the scientific literature pertaining to the reliability of static spinal palpation.' Some of the studies reviewed focused on locating tender points in the spine, some focused on locating various anatomical landmarks, and others looked at the ability to diagnose vertebral position/alignment. For the most part, the levels of inter examiner reliability were unacceptably low (poor agreement). Intraprofes-sional reliability (consistency with self) was somewhat better (moderate agreement). And reliability was also found to be considerably better (good) when examining doctors were focused only upon locating tender/painful points in the spine, as opposed to trying to accurately locate spinal landmarks and/ or determine vertebral positioning. That's a good thing, as we will see in a moment. Two additional reviews by the same lead author on motion palpation studies revealed similar results.:J Intra-examiner reliability is moderate, but interexaminer reliability was poor. And the type of motion palpation used didn't seem to make much difference either. Regardless of whether examiners were palpating for the amount of movement (joint excursion) or quality of move- ment ("end feel"), the results were pretty disappointing. Using the best studies available, 14 out of 15 studies showed poor/ moderate reliability when palpating for joint excursion, while 21 out of 24 studies found poor/moderate agreement when palpat- ing for end feel. Considering that just about every chiropractor on the planet uses palpation to some degree, those stats are pretty discouraging. Lest you think I'm being overly critical of our collective palpation skills, let's consider what all these reliability issues might actually mean in terms of your daily practice. First, keep in mind that spinal adjusting and/or manipulation has been repeatedly shown to be an effective tool for both short and long term pain relief. In short, your adjustments definitely help patients feel better. Secondly, the benefits of adjusting/manipulation appear unrelated to technique, because positive results have been noted using methods ranging from specific instrument adjusting to generalized mobilization and manipulation.4-5-6 So, maybe, just maybe, the shortcomings of palpation as a diagnostic tool are rendered somewhat moot by the efficacy of spinal adjusting/manipulation as a treatment method. At least, it certainly seems that way. In spite of the demonstrated inability of most clinicians to palpate accurately and consistently for joint position/motion, chiropractors are still able to help a large percentage of patients by virtue of the fact that spinal adjusting/manipulation is so effective for dysfunctional spinal joints. Great! Except, of course, all of that still leaves us with one very big problem. Since palpation exhibits poor reliability as a diagnostic tool, we still need valid and reliable methods of analysis. Postural radiographic analysis is a precise and reliable method of obtaining accurate biomechanical information on your patient.7 Better yet, the methods are easily mastered and useful to doctors of all techniques. By adding just this one simple method to your diagnostic tool box, you can dramatically improve both your ability to analyze your patients and intelligently communicate your findings to other interested parties. Dr. Mark Payne is president of Matlin Mfg.. a manufacturer and distributor of postural rehab products since 19SK Interested doctors may CALL I-334-44S-12I0 or email [email protected] for a FREE REPORT. The Best Corrections of Your Career... Measurement of the Lateral Radiographs. A Free Subscription to Postural Rehab is also available at Posturalrehah.com. References: Haneline MT. Young M. A review ofintraexaminer andinterexaminer reliability of static spinal palpation: a literature synthesis. J. Manipulative Physiol Ther. 2009 Jun;32(5):379-86. Haneline MT. Cooperstein R. Young M, Birkeland K. Spinal motion palpation: a comparison of studies that assessed intersegmental end feel vs. excursion. Manipulative Physiol Ther. 2008 Ocl:3l(8):616-26. Haneline M, Cooperstein R, Young M, Birkeland K. An annotated bib liography of spinal motion palpation reliability studies. Can Chiropr Assoc. 2009 Mar:53(l):40-58. Gemmell H. Miller P. Relative effectiveness and adverse effects of cervi cal manipulation, mobilisation and the activator instrument in patients with sub-acute non-specific neck pain: results fivm a stopped randomised trial. Chimpr Osteopat. 2010 Jut 9:18:20. 5. Vernon H. Humphreys K, Hagino C. Chmnic mechanical neck pain in adults treated by manual therapy: a systematic review oj change scores in randomized clinical trials. Manipulative Phvsiol Ther. 2007 Mar- Apr:3U(3):215-27. Lawrence DJ, Meeker W, Branson R, Bivnfort C, Cates JR. Haas M, Haneline M. Micozzi M. Updyke W, Mootz R. Triano JJ, Hawk C. Chiropractic management of low backpain and'low back-related leg complaints: a literature synthesis. J Manipulative Physiol Ther. 2008 Nov-Dec:3l(9):659-74. Harrison DE. Harrison DD. Colloca CJ. BetzJ. Janik TJ. Holland B. Repeatability over time of posture, radiograph positioning, and radiograph line drawing: an analysis of six control groups. J Manipulative Physiol Ther. 2003 Feb:26(2):87-98. Erratum in:.I Manipulative Physiol Ther. 2003 Mar-Apr:2(u3l:2ll. Fig. 1- Palpation appears most reliable for locating painful spinal joints. Fig. 2- Adjusting/manipulation appears effective using a wide range of methods. Fig. 3- Simple geometric X-ray analysis gives accurate information to doctors of all techniques.
