I want to follow-up on the last post with further thoughts on the topic.

The post was not to undermine any of our skills but just relay the facts. I did not want to debunk use of palpation because it is a skill that we all possess.  A great skill in that!  I have to wonder alot of times what our patients think when we go right in and touch the injured body part.  Not a lot of professions just jump right in!

I do feel, however, when it comes to diagnosing the injured segment or just plain old educating our patients, we should be a little more careful.  We may think as clinicians, we need to be MORE exact, MORE detailed and in turn, MORE accurate but is it necessary?

Does not defining strict defects not make us DOCTORS of physical therapy?

Are we making it harder than it really needs to be?

Is it inappropriate to just say there is a dysfunctional joint at C5-C6 or sacroiliac joint fault on the right side?

-This can be done simply by palpation and provocation tests.  (See past post on SIJ Diagnosis using provocation tests, not static testing).

– This doesn’t have to necessarily be by PROM, AROM, PPIVMS/PPAVMS, subluxations here and there, rotated & side-bent here and there.   JUST, simply by pain provocation testing over zygopophyseal joints.  How many times has the patient asked you HOW did you know where my pain was when you performed the latter, rather than your guesstimate of the former.

Is it evidenced-based?  A few examples for the cervical spine.

-It has been shown that even novice clinicians can find the presence of intersegmental fixation of the cervical spine using palpation on congenitally-fused vertebrae. 1

-Lateral glide test for C3-7 was “as good as a radiological assessment for the diagnosis of intervertebral dysfunction in the cervical spine”.  This simple clinical test can diagnose zygapophyseal joint dysfunction. 2

Bottom line, should we just say, “you have a dysfunctional joint at C5-6 or sacroiliac joint fault on the right side?

Do we really need the other “stuff”?  Let me know your thoughts.

1. Humphreys BK, Delahaye M, Peterson CK.  An investigation into the validity of cervical spine motion palpation using subjects with congenitally-fused vertebrae as a ‘gold-standard’. BMC Musculoskel Disorders. 2004, 5: 19.

2. Fernandez-de-las-Penas C, Downey, C, Miangolarra-Page J.  Validity of the lateral gliding test as tool for the diagnosis of intervertebral joint dysfunction in the lower cervical spine. Journal of Manipulative and Physiological Therapeutics. 2005, 28 (8) 610-616.


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