An exploratory study of provocation testing with padded wedges: can prone blocking demonstrate a directional preference?
Anthony J Lisi1, Robert Cooperstein, Elaine Morschhauser
1University of Bridgeport College of Chiropractic, Conn. 06601, USA. alisi@bridgeport.edu
Background:
Currently, no traditional chiropractic examination method to determine a spinal listing offers demonstrated guidance in treatment decisions for low back pain (LBP) patients. Development of an examination that bypasses the difficulty of accurately and reliably identifying a listing, yet provides guidance on manipulative vectors, could be very valuable to clinicians and patients.
Objective:
To explore 2 potential protocols for provocation testing and assessment of directional preference using padded wedges.
Methods:
Two groups of 20 subjects were examined while lying prone on various positions of padded wedges. In the first group, pain pressure threshold (PPT) was measured at 4 anatomic points; in the second group, tenderness was measured at 1 anatomic point. We investigated whether either method could demonstrate a directional preference response.
Results:
When tenderness was measured at 1 anatomic point, 70% of subjects demonstrated a directional response, and only 1 subject exhibited an increase in baseline tenderness at the end of the procedure. When PPT was measured at 4 anatomic points, 40% of subjects demonstrated a directional response, but 12 subjects exhibited decreased PPT at the end of the procedure.
Conclusion:
Measuring changes in tenderness at 1 anatomic point in response to various padded wedge patterns appears promising as an examination procedure to determine directional preference.
