Palpation: The Art and Science of Chiropractic Diagnosis

Patient Case:

A 39-year-old amateur weekend gardener has pulled one too many weeds and experiences painful spasms across the low back with debilitating stiffness. After two days of persistent pain, she makes an appointment to see her chiropractor. The chiropractor takes her history, finds that standard neurological findings are normal, and x-ray studies show no fracture. There is no evidence of a bulging disc or any unusual complications.

The chiropractor proceeds to use a number of chiropractic diagnostic procedures to determine what went wrong with the gardener. Having developed the analogy of the moving picture in explaining the dynamic spine, we can say that the chiropractor is comparing that picture with a new dynamic model: the unhealthy and injured spine that the patient presents.

Some of the indicators the chiropractor uses to build the new picture include the location and character of the patient's pain, gait and posture, general range of motion, muscle tone, muscle strength and balance. Especially important is a chiropractic diagnostic procedure called spinal palpation.

Spinal Palpation
Palpation is the process of examining by means of touch. The art of spinal palpation is the first procedure a chiropractor learns in school. It is an art the chiropractor continues to perfect throughout his or her career. Palpation is not the only way a chiropractor determines where and how to adjust or manipulate the spine. It is however, the chiropractor's central diagnostic technique.

Static and Motion Palpation
Static palpation involves the palpation of tissue surrounding the spine for pain or tenderness, as well as feeling for lack of tissue compliance or tightness. With experience, a chiropractor can gain vital information through direct touch.

In motion palpation, the chiropractor examines each complex spinal joint to analyze the degree to which it may lack proper motion. This highly-skilled maneuver requires the examiner to have a mental picture and tactile knowledge of a spinal joint's normal motion. Normal motion is compared with the feel of the joint being examined as it is moved through its range of motion.

As a joint goes through its range of motion, there is extra play to that motion called the end play. An easy way to illustrate end play is to demonstrate using wrist motion.

For example, straighten your wrist with the palm up. Draw your hand forward to flex the hand toward the wrist. At about 90 degrees, you will reach a normal stopping point. Now make the wrist move just a little more toward you. You will reach an absolute stopping point where the wrist cannot move any farther. That little extra distance you have made your wrist move is called the joint's end play.

When the muscles of your wrist work to bring the hand toward you, they depend on end play in the joint. If your wrist was locked or fixated, the muscles would tug against the fixed joint and become inflamed.

Spinal Joint Subluxation
In examining the amateur gardener with low back pain, the chiropractor has asked the patient to sit on the adjusting table. Standing behind the patient and using both hands in a series of gentle motions, the chiropractor examines the low back joints one by one, taking each joint through its five ranges of motion to determine if any joint has become locked or fixated. Specific lack of spinal joint motion is one important aspect of what chiropractors call a subluxation.

If you have been to a chiropractor, you have probably heard the term subluxation. When the chiropractor reports his findings to the patient, he explains an injury or lack of proper function to a particular spinal joint as a subluxation of the spine.

A subluxation is a disturbance in the spinal joint's function. The term subluxation describes a set of abnormal spinal joint inter-relationships that is not yet fully understood. These inter-relationships include the structural, mechanical, chemical, neurological, hormonal, and circulatory spinal joint components. While not an identifiable 'thing' like a fracture or a wound, it is a useful organizing principle for chiropractic research and clinical practice.

Determining the Chiropractic Listing
Returning to the examination of the amateur gardener's lumbar spine, the chiropractor finds a locked joint in the low spine. Let's say it is the spinal joint formed by the 4th and 5th lumbar vertebra (L4-L5) and the joint is locked on the right-side in a range of motion called extension.

When the chiropractor moves the L4-L5 joint into extension on the right-side using motion palpation, there is no endplay in the joint. The chiropractor determines from the character of endplay, as well as other diagnostic indicators, that the fixation is caused by injury to a muscle. The specific lesion in this case is at the L4-L5 joint and its specific characteristics make up what is referred to as the listing.

To continue this article, please click on Part 3, Part 4 or return to Part 1.

Part 3: Understanding Chiropractic and Low Back Injury

Part 4: Chiropractic Spinal Adjustment: What Was That Pop?

Part 1: Chiropractic Care and Back Pain: An Overview of Diagnostic Principles and Treatment