To palpate or not to palpate the cervical spine to determine restricted levels? To use palpation to help assist in making a clinical diagnosis? Should I even perform a joint feel assessment? These are questions that may arise in a newbie joining the ranks. As you may know, the answer depends on who you ask. If you have high level research on speed dial, then the answer is a big no.
If you are evidenced-based, you will get cut off quickly. For example, a few recent systematic reviews lead you no where (Sefinger et al 2004, van Trijffell et al 2005, and Hollerwager D 2006). They tell us that “interexaminer reliability of passive assessment of segmental intervertebral motion in the cervical …spine ranged from poor to substantial” and “The majority of spinal palpatory diagnostic procedures are unreliable.” In short, we fail at this and are poor examiners, bottom line.
I hope we don’t take these too seriously. If we do, we might as well get off of the high road to musculoskeletal specialists and get in line behind manage therapists and chiropractors. I can tell you they aren’t sweeping this major tool under the rug. We will get left behind.
Let’s not allow ourselves to abandon our palpation. If we get rusty, full of cobwebs and just not get our hands dirty; then a systematic review 10 years from now will probably end with conclusion of ‘atrocious and horrible’ reliability instead of just “fair to poor”. If we don’t use it, we will lose it. Let’s reverse the data and get better at it!
Don’t we need to turn this around and get conclusions to say fair to good, maybe even excellent reliability? Yes, the research is clear currently, but if our palpation blows away with the wind, we might as well say goodbye to our respect from consumers too.