THE ASSOCIATION OF COMPUTER-CONTROLLED POSTERIOR-TO-ANTERIOR VERTEBRAL STIFFNESS WITH MANUAL POSTERIOR-TO-ANTERIOR ACCESSORY MOVEMENT TEST IN PATIENTS WITH THORACIC SPINE PAIN

J. Harju¹, M. Hirvimäki², P. Rytkönen², J. Takatalo^3,2,4

Background: Thoracic spine is neglected in the spine research. Oher regions of the spine are studied more thoroughly, but the results on reliability and validity of examination by palpation have been controversial. In this study, manual posterior-to-anterior (PA) vertebral stiffness was compared to computer-controlled (CC) PA stiffness of vertebral in subjects with thoracic spine pain.

Purpose: The main purpose of the current study was to evaluate the association of manual PA movement palpation with CC PA pressure in subjects with TSP. Secondly, the aim was to increase understanding whether manually found stiffness is uni- or multisegmental problem.

Methods: Participants were recruited to the study and physical therapist (PT) performed CC and manual PA stiffness examination for thoracic spine in one session. CC was performed in Th3, Th5, Th7 and Th10 segments with 30N, 50N and 70N forces at each level. Distance and time were recorded on CC PA stiffness. PA stiffness was examined manually for every thoracic spine segmentand they were graded as normal or hypomobile. Three independent PT assessors analyzed the CC data and after the consensus the most relevant time-force angulation change was decided for each segment (Th3, Th5, Th7 and Th10). The regression analysis was used to investigate the associations between manual and CC PA stiffness examinations and model was adjusted for body mass index (BMI), age and gender.

Results: Manual examination for 34 participants (22 females; mean age 30) of Th3 area was associated with CC at Th3 with 70N force in crude and adjusted models when four to five hypomobile segments was found manually (OR 0.76 and OR 0.69, respectively). In addition, CC at Th3 and manually hypomobile four to five segments in the Th3 area were associated with each other in crude and adjusted model (OR 0.87 and OR 0.89, respectively). Moreover, 50N pressure was associated with manually found four to five hypomobile segments in crude and adjusted model (OR 0.93 and OR 0.93, respectively). All forces and segments in CC PA stiffness was associated with four to five hypomobile segments at each level tested manually in crude and adjusted model (OR 0.95 and OR 0.92, respectively).

Conclusion(s): Manually palpated hypomobility is more reliable at Th3 than lower thoracic spine. Nevertheless, the reliability is higher in the whole thoracic spine, when four to five hypomobile segments is found by using 50N PA force.

Implications: Our results challenge the paradigm of manual segmental examination at least in TS region. According to our results it seems to be difficult to find specifically hypomobile segment in TS in clinical practice. However, the area of several hypomobile segments can be found manually.

Funding, acknowledgements: Finnish Association of Physiotherapists, Finnish Association of Orthopaedic Manual Therapy

Keywords: thoracic spine, manual examination, palpation

Topic: Musculoskeletal: spine

Did this work require ethics approval? Yes

Institution: Oulu University Hospital

Committee: Ethical Committee of Northern Ostrobothnia

Ethics number: 234/2009