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Manual examination: is pain provocation a major cue for spinal dysfunction?
The Australian Journal of Physiotherapy
|July 16, 2014
Summary
Manual examination reliably detects spinal dysfunction. This study shows physiotherapists can identify painful spinal segments without verbal pain cues, suggesting pain isn't the sole diagnostic factor.
Area of Science:
- Orthopedics
- Neurology
- Physical Therapy
Background:
- Manual examination is considered reliable for detecting spinal dysfunction.
- Clinical decisions often involve assessing abnormal motion, tissue stiffness, and pain provocation.
- Over-reliance on pain as a diagnostic cue may lead to false positive diagnoses of joint dysfunction.
Purpose of the Study:
- To evaluate a manipulative physiotherapist's ability to differentiate between painful and non-painful cervical spinal segments.
- To determine if pain is the sole diagnostic cue in manual spinal examinations.
Main Methods:
- A single-blind study was conducted.
- A manipulative physiotherapist assessed cervical spinal segments.
- The physiotherapist's assessment was compared to the subject's independent nomination of painful and painless segments, without verbal pain cues.
Main Results:
- There was good agreement between the examiner's and the subject's independent nominations of the most painful and painless segments.
- This suggests that factors beyond verbalized pain influence the identification of dysfunctional spinal segments.
Conclusions:
- Pain provocation is an important diagnostic cue in manual spinal examinations.
- However, reliance solely on pain may lead to inaccurate diagnoses.
- Manual examination incorporates additional cues beyond pain for identifying spinal dysfunction.
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