Manual examination: is pain provocation a major cue for spinal dysfunction?

Evidence suggests that manual examination is reliable in the detection of dysfunctioned spinal segments. Clinical decisions are considered to relate to the presence of abnormal motion and tissue stiffness along with provocation of pain but there have been suggestions that pain is the major diagnostic cue. Pain provocation is important but reliance on pain could cause false positive joint dysfunction diagnoses. A single blind study was undertaken to test a manipulative physiotherapist's ability to differentiate painful and non painful cervical segments without the subject's verbal pain cues. Results indicated good agreement between the examiner and subjects for their independent nomination of most painful and painless segments, suggesting pain is not the only cue.