Kinematic measures to objectify head and neck motions in palpatory diagnosis: a pilot study.

Abstract

Physicians typically combine the use of palpation and objective measures, as evidence-based medicine dictates, to improve patient diagnosis and care. Practitioners also use palpatory examination in manual medicine to diagnose musculoskeletal impairment; however, there are no commonly accepted objective measures to complement palpatory findings. To evaluate coupled vertebral motion as a parameter to complement palpatory findings from a standard clinical diagnostic test of cervical function. Two examiners performed a blind screening of volunteer subjects for the presence of palpable symmetry or asymmetry in motions of the head and neck. In cases of interexaminer agreement, subjects then participated in kinematic assessment of cervical motion patterns. Neck angles were recorded, plotted, and evaluated for amounts of vertebral coupling. Interexaminer agreement was reached with 18 of the 34 subjects screened. Seven subjects with symmetric responses constituted the control group. Experimental subjects consisted of an asymmetric-asymptomatic (pain-free) group (n=6) and an asymmetric-symptomatic (pain) group (n=5). Control subjects exhibited the smallest average linear slope (-0.32) for the least amount of coupled motion. The average linear slopes for asymmetric subjects was -0.42 (asymptomatic) and -0.50 (symptomatic). Data analysis revealed that statistically significant differences among groups will be detected with a larger sample size. Objective, kinematic parameters can be generated, measured, and evaluated relative to palpatory findings of musculoskeletal impairment by identifying trends in ratios of cervical lateral flexion and axial rotation.