Increasing evidence against the diagnosis value of ‘orthopedic’ tests
Facet joints are a common “assumed source” of back pain however NO evidence exists that any test for facet joints is ultimately confirmatory. Kemps-type testing has been proposed to have good sensitivity but that knowledge per se affords no diagnostic prevalence. The effectiveness of common tests is at best “moderate” (Bogduk, Twomey) and only so when multiple tests are used and properly adjudicated (which is still dubious). No one-test can be relied upon. The Slump and SLR do offer insight though both offer confusion thru false-positive & negative results. And confirmation against a “gold-standard” is lacking. Hancock et al (Eur Spine 07) adds: “conventional investigations do not reveal the cause of LBP”. Even provocative discography has been given a thumbs-down by the American Pain Society official guidelines. Pain researcher Lorimer Moseley on a TED lecture: “You walk into any clinic and see disc models with discs so far out they are sitting on their own…what is your brain to make of that? If you’ve ever seen a cadaver, you CAN’T slip the suckers…they are immobile, they don’t slip…but that’s our language, and it messes with your brain. It cannot NOT mess with your brain”.
An ominous and prophetic conclusory statement has been proffered by numerous researchers: “You (the patient in pain) cannot generally trust professionals to identify a structural origin for your pain…even if you have one, which you probably don’t”.