MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

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.

15 Responses to Diagnostic tests regularly used by chiropractors and osteopaths are of dubious value

  • The interesting thing is that it probably doesn’t matter. Other research has shown that the adjustments aren’t specific and they probably don’t need to be. That’s probably because the adjustment affects the region, not a specific vertebrae. All those tests need to reveal is if there is a problem in the region and correlate that with history and any other exam findings.

    • very nice attempt to white-wash your quackery!
      alas, it does not wash at all.

    • “a specific vertebra”, surely? “Vertebrae” is the plural of vertebra…..

      That mistake was also made in the script of that otherwise superb docu-drama “The Best of Men” about the work of Dr Ludwig Guttman. It irked me!

    • DC-Forces can be strictly isolated to a particular vertebra but the surrounding soft tissue structures are affected.

        • DC- the mechanical skills and experience of some practioners- using biomechanics, anatomy, physiology, that dreaded palpation! with it’s allied practitioner sensory perceptions, the restored or increased mobility from a previously restricted alignment of two vertebrae, often reduction of pain. Their textbooks are full of how they do it and why. You don’t need a clinical trial to understand the processes.

          • Research has shown that with a manual adjustment one cannot isolate the adjustment to one particular vertebra.

          • DC- your statement may be true for ‘isolate’ but the main force can be exerted on a particular vertebra in relation to another to produce it’s desired effect. This does not exclude simultaneous lesser, non specific movement occurring in adjacent vertebra. There are no rigid immoveable components in any spinal column.

          • First claim: Forces can be strictly isolated to a particular vertebra

            Second claim: the main force can be exerted on a particular vertebra in relation to another

            The first one i rejected, unless you can provide valid evidence.

  • You cite/draw attention to your own blog in 2014 Edzard?
    The replies to your previous blog. “Why is that important?”.
    This previous comment applies to this blog:
    “The article is biased because Prof. Ernst took a recent paper on a orthopaedic test (see above) used by all professions and went on to imply that it is a unique test used by most chiropractors (it is not). He then uses the conclusion from that recent paper to criticize chiropractors for treating conditions which the patient does not have.

    Prof Ernst then must not realise that most orthopaedic test have issues with specificity and sensitivity and is therefore a issue for all professions that use them (i.e. physios, osteos, chiros and orthopaedic surgeons). For him to write the above article criticizing just one profession shows a lack of knowledge on the topic and also a bias against chiropractors.

    However, if he did an article on the neurocalometer, I would agree with him that this is a dubious diagnostic device specifically used by chiropractors. But he didn’t and therefore this article should be criticized for what it is – a poor / misguided attempt to malign a profession by using a recent research paper on a orthopaedic test which is used by all professions.”
    Edzard seems nothing has changed since 2014.

    And this previous comment:
    “The most important part of this post is the praise given to chiropractors (maybe reluctantly) for highlighting the weakness of this test. As others have stated reliance on a single test is inappropriate regardless of your profession.”

    Something has changed. In your 2014 blog you wrote “The authors of this review, chiropractors from Canada, should be praised for tackling this subject.” (Edzard Ernst) This current blog cites a chiropractic paper, the lead author Paul Nolet is Canadian, how ironic that it’s now just “the authors”.

    In the past on this blog over and over I have said that that critics are a valuable resource for reform (both within and without the profession), but that critique has to has to be balanced by support for the researchers and reformers like Paul Nolet. It’s a good paper that questions the status quo for all professions that use this common diagnostic tool. Pity you did not acknowledge and support “the authors”.
    In a nutshell, once again your carpet bombing the profession with sweeping statements and you don’t care who you hit which makes the work of Paul Nolet, researchers and reformers more difficult.

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