Static or motion manual palpation tests of the spine are commonly used by chiropractors and osteopaths to assess pain location and reproduction in low back pain (LBP) patients. But how reliable are they?
The purpose of this review was to evaluate the reliability and validity of manual palpation used for the assessment of LBP in adults. The authors systematically searched five databases from 2000 to 2019 and critically appraised the internal validity of studies using QAREL and QUADAS-2 instruments.
A total of 2023 eligible articles were identified, of which 14 were at low risk of bias. Evidence suggests that reliability of soft tissue structures palpation is inconsistent, and reliability of bony structures and joint mobility palpation is poor. Preliminary evidence was found to suggest that gluteal muscle palpation for tenderness may be valid in differentiating LBP patients with and without radiculopathy.
The authors concluded that the reliability of manual palpation tests in the assessment of LBP patients varies greatly. This is problematic because these tests are commonly used by manual therapists and clinicians. Little is known about the validity of these tests; therefore, their clinical utility is uncertain. High quality validity studies are needed to inform the clinical use of manual palpation tests.
I have repeatedly drawn attention to the fact that the diagnostic methods used by chiropractors and osteopaths are of uncertain or disproven validity (see for instance here, or here). Why is that important?
Imagine you consult a chiropractor or osteopath. Simply put, this is what is likely to happen:
- They listen to your complaint.
- They do a few tests which are of dubious validity.
- They give you a diagnosis that is meaningless.
- They treat you with manual therapies that are neither effective nor safe.
- You pay.
- They persuade you that you need many more sessions.
- You pay regularly.
- When eventually your pain has gone away, they persuade you to have useless maintenance treatment.
- You pay regularly.
In a nutshell, they have very little to offer … which explains why they attack everyone who dares to disclose this.