Questions and Answers

Posted April 8, 1998

The following exchange took place on an online Chiropractic forum. It has been edited in order allow for the confidentiality of those who participated in this exchange other than Dr. Nicholas Spano. Dr. Spano's first message was in response to a post that discussed the lack of inter-examiner reliability of Motion Palpation.

Thank you for this further exposure of Motion Palpation's shortcomings. It comes as no surprise that even the best (presumably) Motion Palpators can not document inter-examiner reliability with Motion Palpation as the coupling patterns of a Functional Spinal Unit would be infinitely too complex to discriminate accurately to begin with, but to then add the changing tensions and reflexes of the overlying tissues as the spine is put through even a seemingly simple range of motion would virtually eliminate any practical value of this method for spinal analysis. Whereas I am finding extremely promising inter-examiner reliability with muscle palpation among novices. Before you ask; I have not yet done a study to demonstrate my claim and so I expect that some will be skeptical and understandably so. I am planning to do an inter-examiner reliability study this summer with Chiropractic students who will be exposed to this method for the first time and as with every other group that I have introduced to this work, we can expect a high number will be in agreement with each other as to not only the spinal level of their positive findings, but the very nature of the finding itself. They will be totally blinded to the conclusions of the other examiners and will not be allowed to have any communication with the examinee. Anyone who is out there who has taken these seminars knows the reliability of this method, but I realize that this is not science and so I hope to bring this method to your attention again when I can finally prove these claims! This of course will only be the beginning as this would not prove validity of the finding; that is, the phenomenon that we are documenting and its consistent relationship to the subluxation. This would prove to be a much bigger hurdle as there is so little agreement on WHAT a subluxation is. If we were to demonstrate that our findings occured concurrently with other objectifiable findings this might satisfy those that regarded the comparitive phenomenon as a legitimate measurement of the subluxation, but be dismissed by others. This is so not only because we have not been able to find a "gold standard" for subluxation measurement, but because we are not even in agreement on "what" the subluxation is. And so we will begin this summer with an inter-examiner reliability study and hope to turn some heads! If we can demonstrate a respectable level of reliability using complete novices this should create interest in this method of muscle palpation and possibly attract the interest of one of you more well trained research Chiros.

Nick Spano, DC

Hi Nick,
Good luck with your study. I believe that that was one of the shortcomings of the motion palpation studies. Most of the subjects were asymptomatic and the palpators were inexperienced students.

I have over the years only kept up with some of the inter-examiner reliability weaknesses of Motion Palpation, but to my knowledge they have not been able to demonstrate reliability except in the S-I articulations. Was every study done using students? This would pose a problem for such a complex system of examination. I do not believe that this will be a problem for our muscle palpation study and then if our results are favorable it should be that much more apparent that a consistently identifiable phenomenon occurs in close relation to the spine. My past experience in teaching this method of analysis to students gives me the confidence to suggest that a significant number of students in every seminar almost immediately demonstrate a relatively high degree of inter-examiner reliability. As for asymptomatic subjects, we have never correlated our findings with pain, tenderness or symptoms, although I could make some anecdotal observations on this point at another time. I do not forsee this posing any problem either though as we discourage the discussion of symptoms in order to not bias our student's findings while they are learning this method and we still observe very strong inter-examiner agreement.

Here's something that I've always wondered about with regards to muscle palpation and what it really means:
When you palpate muscle function/tone, what are you palpating for? HYPERtonicity or HYPOtonicity?

In the method that I teach we are looking for hypertonicity, but not just any hypertonicity. To be a little more specific, we are palpating the small muscles of the spine in order to find any segmental activity.

Is there a difference, and what does it mean? Which is normal? Which is a clinical sign?

I suppose that either would be a clinical sign of something, but I am not the one to ask concerning hypotonicity although I would think that it has multiple origins. Some more valuable in their relationship to any underlying articular dysfunction than others.

Normal is a relative term when we are discussing the theory in question; I will get to that later.

The clinical sign that I am suggesting is paravertebral hypertonicity occurring segmentally in the recumbent spine.

Have you considered the fact that the paraspinal musculature that you palpate are not purely segmentally innervated? Unless you can palpate the deep shunt stabilizers, the paraspinal muscles cross multiple segments. How will you relate that back to joint/segmental dysfunction?

We are in fact palpating the deep muscles of the spine. As only one muscle occupys its unique space between origin and insetion, we are confident that as we palpate activity between these points of attachment we are palpating the muscle that occupys that space or another similarly attached muscle which would convey the same analytical conclusions to the doctor. We virtually eliminate the question of polysynaptic innervation (except in the S-I region) in that we are concerned with segmental activity that must by definition be the result of monosynaptic pathways.

Now to "what it means": we suspect that this phenomenon, if you assume that indeed we are actually on to something here, must be as a result of some form of the stretch reflex as it is the only monosynaptic pathway that innervates the paraspinal muscles. Again here you must assume that we are palpating what we say we are palpating. If this is so then we must be dealing with the stretch reflex and as we are palpating this activity in the resting spine it would seem likely that we are more likely than not observing the result of some form of the static stretch reflex. Also keep in mind that the stretch reflex is under the governance of the gamma efferent system to the muscle spindle whose fibers comprise 31 percent of all motor nerve fibers to the muscle rather than type A alpha motor neurons (Guytons). And so the reflex activity that we observe in the spine is dominated by the stretch reflex, other reflex mechanisms notwithstanding. We will also assume here that this phenomenon is consistently related to segmental dysfunction. At this point we will make a further unsubstantiated, but I think reasonable assumption (maybe for a later discussion), that subluxation is by nature a disrelationship between two vertebrae that includes a slight misalignment of the articular strutures among other possible manifestations. If you have not seen it already then allow me to explain what all this may mean. If this phenomenon of segmental activity is consistently associated with the subluxation and it is representative of the static stretch reflex and the vertebra that we are examining is in fact misaligned and hypomobile; that is a slight mismatch of the articular structures blocked within the normal parameters of physiologic motion, then the muscular activity is likely responding to the vertebral misalignment in an effort to guard proper joint positioning. We would be observing the body's inborn mechanism to regain normal joint mechanics!

Is the muscular activity normal in such a scenario? You may want to answer that for yourself.

Nick Spano, DC

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