Can Manipulative Physiotherapists Agree on which Lumbar Level to Treat Based on Palpation?

Abstract

Summary Background and Purpose Assessment of intervertebral movement through palpation forms the basis for mobilisation techniques used to treat patients with vertebral disorders. There is contradictory evidence on whether clinicians can reliably choose which spinal level to treat based on palpation. In general, it appears that the reliability of palpation has been less than moderate when practised by clinicians without specialist training and when evaluated on people without symptoms. This study therefore aimed to determine whether physiotherapists with specialist training in manipulative physiotherapy could agree in locating and naming the lumbar level to treat in people with sub-acute low back pain in a clinical setting. Method Three pairs of physiotherapists with postgraduate qualifications in manipulative physiotherapy palpated the lumbar spines of 20 people presenting to their clinics for treatment of low back pain. Based on central posterior-anterior pressures, each therapist located the level that was considered to be most likely to be contributing to symptoms (the comparable level). Each therapist marked the skin overlying the spinous process of the comparable level with an ultraviolet pen and these marks were transcribed on to transparencies for analysis. Results Therapists demonstrated only fair agreement for palpating the location of a comparable spinal level (k = 0.37). In addition, when asked to name the located comparable level the overall agreement (k = 0.09) was not greater than due to chance alone. The mean distance between marks was 27.8 mm, which was greater than the measured dimensions of any lumbar spinous process. Conclusion These results suggest that the therapists were frequently palpating different lumbar spinous processes as the most comparable level. Therapists who use central posterior-anterior palpation pressures in the management of people with low back pain should be aware that this technique may not be reliable and should not base treatment decisions on these palpatory findings alone.