Why I choose the ‘simple’ patient classification of Compression vs. Motion disorder

Reliability of chiropractic methods commonly used to detect manipulable lesions in cLBP

French SD et al. JMPT May; 23(4) 2001

Intraexaminer and interexaminerreliability of static spinal palpation: a literature synthesis

Naneline MT, Young M. JMPT Jun;32(5) 2009

Results: Commonly used chiropractic diagnostic methods in patients with LBP to detect manipulable lesions are NOT reproducible. These procedures do not provide reliable information concerning where to direct manipulative procedures.

Results: Reported indices of agreement were generally low. Pain palpation reported more acceptable levels, although no one method could be deemed superior.

Comment: many of the tried & true procedures we utilize for finding the ‘right/specific adjustment’ area have come under increasing pressure in the last decades. Static palpation assessing motion has no reliability and in the face of ‘force closure’ tests and shear instability testing likely assesses “hyper” not “hypo” mobile segments. Motion palpation has remained unreliable and likely invalid in at least 10 studies. Short legs, though showing good interexaminer reliability are likely invalid. With 90 degree leg-bending the reliability drops to ‘below-chance’. Even instrument adjustment proponents like Dr. Colloca have publicly excoriated the Activator “tests” as non-sensical.  

So…since axial-traction/decompression need not require or rely on inter-segmental analysis or specificity (even IF you knew the exact disc-level you can’t get to it with any precision)…we assess for the simple differential of “compression” vs. non-compression i.e. motion disorder (inappropriate muscle activation patterns or motion control perturbations). We get much more reliable and valid findings and can be less reliant on spurious or dubious procedures to ‘fix’ things that can’t be determined with any degree of reproducibility. Decompression “gets at” compression sensibly, safely intuitively and reproducibly.