Correlating motion palpation with functional x-ray findings in patients with low back pain

Objectives: To determine whether a correlation between motion palpation findings and abnormal coupling patterns, as viewed in lumbar functional X-rays, can be demonstrated in low back pain (LBP) patients.Design: A prospective observational study of patients who present to a chiropractic clinic for assessment of low back pain.Subjects: The sample population consisted of 27 consecutive patients presenting with LBP between the ages of 20-50 year old and who were capable of pain free lateral lumbar flexion.Intervention: All subjects underwent motion palpation to determine whether a "fixation" at the L4/5 existed. All had lumbar spine X-rays in an anterior-posterior (AP) and bilateral AP lateral flexion position. X-rays were then analyzed to determine whether the coupling pattern at L4/5 was considered abnormal.Results: In those patients with a perceived L4/5 motion restriction no coupling patterns where found in 6 cases (22.4%) and normal coupling patterns in 13 cases (48%). In those patients who presented with LBP and no motion findings at L4/5 no coupling was observed in 4 cases (14.8%) and normal coupling in another 4 cases (14.8%). The chi-squared test demonstrated no statistical differences (p>0.05) between the motion fixation at L4/5 and coupling patterns from lateral flexion X-rays.Conclusion: It is of particular interest to note that the presence of the L4/5 fixation was not associated with abnormal coupling but conversely was frequently observed to be associated with normal coupling patterns. A simple correlation between a single motion palpation finding of a restriction at a L4/5 facet and an alteration in coupling patterns could not be supported.