Dear Editor,
A recent misleading article in the October 9, 1995 issue of Dynamic Chiropractic by Dr. Mark King1 purported to "set the record straight" on misconceptions regarding the "myths" of motion palpation.
He chose my two literature reviews published in the Activator Update as an example to base his arguments about motion palpation, although I made no mention of MP in my writings. My review in the Update is based on fact taken from the articles reviewed, not my opinions, but the expressions of the authors. Dr. King focused his argument from my review of an article on zygapophyseal joint crack sounds in the cervical spine.2 Dr. King attempted to address zygapophyseal joint biomechanics with an anecdotal description of what he believes happened in this study that causes the audible to come from ipsilateral side of head rotation based upon an a priori assumption of a MP set-up.
Of perhaps greater interest was Dr. King's rationalization of MP to research methodology. I found it humorous that King desires to abstain his technique from the scientific method in inter and intra-examiner reliability because he believes that MP initiates reflexogenic changes which would "change the spine" making the study invalid. This is a poor rationalization for failure to do good research. If examiner #1 determines that no fixation is present at a given level, and then examiner #2 determines that there is a fixation present, did examiner #1 cause a subluxation through MP analysis?
Dr. King states: "We re-examine the joint after the adjustment to see if joint function has improved and if so this is an indicator of a successful adjustment." If merely MP analysis of the spine will reduce or remove fixation to be identified by another examiner, how can this reasoning be used to determine if the adjustment was successful? Was it the adjustment or the MP analysis that "changed the spine." Do MPI instructors believe that merely mobilization of the spine through MP analysis will break up fixations or cause fixations for that matter?
Dr. King was dismayed at the discussion of members of the profession questioning the reliability and validity of MP. This is consistent of Dr. Innes' recent emotional comments in the DC.3 Haas and Panzer4 state in Gatterman's 1995 text: "Fifteen studies report original data on the reliability of motion palpation in various regions of the spine and pelvis. The interexaminer reliability of identifying motion or end-feel restriction at specific segmental levels was poor, averaging 0.00 to 0.15. Raters agree little more than would be expected by chance." In further review of these papers, while intraexaminer reliability was found to be better, "the findings must be viewed with caution. ... If two examiners are self-consistent but cannot agree, then at least one rater must be consistently in error."4
Incidentally, Dr. King's "idea" of a model to assess motion (removing the reflexogenic components of the human spine) has already been done numerous times. Jensen et al.5 investigated the ability of 30 student interns and 15 experienced chiropractors to detect the presence or absence of a single and multiple intersegmental motion restrictions in the lumbar spine using a spinal model equipped with artificial segmental fixators. The students were found to detect the fixations more readily than the DCs. The DCs kappa was 0.297 or fair.
The validity of MP was also discussed at the 2nd World Chiropractic Congress. The study concluded: "The best results came from the first year chiropractic students who had never been taught lumbar spine motion palpation."6 Thiel concludes: "Clinical experience does not seem to be of any benefit for correct palpatory identification of fixed segments in a spinal model. This would suggest that the concepts of a fixed joint as a clinical entity and of motion palpation as a diagnostic procedure need to be critically re-evaluated and assessed."6 I am providing other references for the examination of MP by use of a mechanical model to assist Dr. King.7,8
Dr. King justifies that the reason students do not choose MP is because, "They do not want to take the time or put in the effort to learn and master them."1 What he has failed to realize is that students and DCs may not choose MP, not because they don't want to put into the time, but because they have been shown so unreliable that many question their value and utility. Many, like I, adhere to the same philosophy of the great Nikolai Bogduk: "In God we trust; all others bring data."9
I am disappointed in Dr. King's appointment of me as an example for his inconsistent rationalizations for his emotional attachment to his technique. It seems that the overwhelming majority of negative opinions regarding the value of MP analysis could be easily addressed through proper research investigation. Until MP participates in such studies, large numbers of the profession will continue to question its value.
References
1. King M. Myths about Motion Palpation. Dynamic Chiropractic 1995; 13(21):18-9.
2. Colloca CJ. Literature Update. Update: A Bi-Monthly Publication From Activator Methods, Inc. 1995; 10(4):25,29.
3. Innes K. What if... Take Your Best Shot - Please. Dynamic Chiropractic 1995; 13(19):25.
4. Haas M, Panzer DM. Palpatory Diagnosis of Subluxation. In Gatterman MI, ed. Foundations of Chiropractic Subluxation. St. Louis: Mosby, 1995:57-67.
5. Jensen KJ, Gemmell H, Thiel H. Motion palpation accuracy using a mechanical spinal model. Eur J Chir 1993; 41:67-73.
6. Thiel H. Reliability and validity of motion palpation procedures assessed on a mechanical spinal model. Bournemouth, UK: Anglo-European College of Chiropractic. Abstract in: J Manipulative Physiol Ther 1994; 17:290.
7. Harvey D, Byfield D. Preliminary study with a mechanical model for evaluation of spinal motion palpation. Clinical Biomechanics 1991; 6:79-82.
8. Nunn NR. A Study to investigate the reliability of detecting single and multiple motion restriction in the lumbar spine using a mechanical model. Bsc Project, Anglo-European College of Chiropractic, Bournemouth.
9. Bogduk N. Letters. Spine 1995; 20:2173.
Christopher J. Colloca, BS, DC
Marietta, GA
