Last year, I invited Dr. Leonard Faye to conduct a chiropractic technique seminar for the 70+ doctors in my organization. He is a pioneer in motion palpation and studied under Dr. Henri Gillet in Europe. The seminar was a great fit for my doctors who practice at The Joint locations throughout Southern California and we are always seeking ways to provide faster, safer, and more effective care. Dr. Faye referred me to a 2016 study that provides a measure of redemption for the very commonly used motion palpation techniques. I hope you find my short review of this study helpful!
Double blind studies of motion palpation have shown poor interexaminer reliability in the assessment vertebral subluxation. Simply stated, researchers had 2 experienced chiropractors examine the same patients at each of the 26 spinal levels using motion palpation; the 2 chiropractors could not reliably agree on which spinal levels were stiff or not stiff. This has been a thorn in the side of motion palpation and chiropractic in general as most chiropractors use some sort of motion palpation in the spinal analysis of their patients. The implications of poor interexaminer reliability are that patients visiting multiple chiropractors would probably receive a different diagnosis at each one they visited. The chiropractor claims to offer diagnosis and correction of vertebral subluxation, the location of which no two chiropractors can agree upon! This lack of consistency is problematic for a profession that has struggled to gain respect in the healthcare industry.
There is good news though. Cooperstein and Young (2016) recently revisited some of those studies and asked a different question. Instead of asking if two examiners could agree if each specific spinal level was stiff or not stiff, they asked if two examiners could simply agree on the “stiffest spinal site” or “SSS” within the sections of the spine. For example, they asked themselves if the chiropractors could agree upon the stiffest site in the cervical region, the stiffest site in the thoracic region, and the stiffest site in the lumbar region. They found that the chiropractors could in fact reliably agree on the the stiffest site in each of the three regions. Furthermore, they found that when the examiners were more confident in their findings, they had a greater the level of agreement. Keep in mind that each examiner was blinded from the other’s results.
What does this mean for the practicing chiropractor? When examining a patient, the chiropractor using motion palpation might ask the same amended question the researchers asked. Abandon the level by level method of stiff or not stiff, moving or not moving, fixated or not fixated, out or in, and instead ask, “Is this the stiffest spinal site in the region?”; direct the force of the adjustment to those areas. When chiropractors use techniques that have good interexaminer reliability, consistency of care is improved, greater results can be expected, and the validity of chiropractic is strengthened.
Cooperstein, R., & Young, M. (2016) The reliability of spinal motion palpation determination of the location of the stiffest spinal site is influenced by confidence ratings: a secondary analysis of three studies. Chiropractic & Manual Therapies. 24:50