The relationship between palpation of thoracic tissues and deep paraspinal muscle thickness

A review of force and resonance sensors used in the clinical study of tissue properties

Tactile sensing is commonly carried out by humans using their fingers or hands to estimate the physical properties of an object. A large body of literature covers a range of applications of these methods in clinical situations. The objective of this work is to show the breadth of application areas explored and the achievements that have been made in the measurement of physical variables of interest to physicians using tactile force and resonance sensors. Although a broad spectrum of applications has been considered, of particular interest is the application of these methods to determine tissue properties in vivo. Progress in this direction has been made by various groups particularly with respect to piezoelectric and capacitance sensors. Also described are the findings of a preliminary study of a tactile system designed to examine the abdomen of the clinically super-obese patient.

Establishing the content validity of palpatory examination for the assessment of the lumbar spine using ultrasonography: a pilot study

CONTEXT

Practitioners of manipulative medicine have long sought to prove the intra- and interexaminer reliability of palpatory examinations in assessing somatic dysfunction. However, decades of research have yet to achieve the level of reproducibility needed to satisfy evidence-based criteria.

OBJECTIVES

To examine the content validity of segmental motion evaluations using ultrasonographic measurements and to investigate the implication of these results for understanding the effects of an osteopathic manipulative treatment technique--high-velocity, low-amplitude (HVLA)--applied to somatic dysfunction in the lumbar spine.

METHODS

A repeated-measures design was used, with the ultrasonographer blinded to the findings for each participant. The study was divided into 2 phases: (1) palpatory and ultrasonographic examination with no treatment and (2) palpatory and ultrasonographic examination with HVLA treatment. During phase 1, measurements were taken of tissue depth corresponding to bony landmarks of the dysfunctional vertebrae. Dysfunction was identified by means of palpatory examination and captured in sequential (ie, test-retest) ultrasonographic images. Content validity of somatic dysfunction was addressed by comparing palpatory examination with ultrasonographic data. During phase 2, the same protocol for tissue depth measurements was applied to the pre- and posttreatment images for comparison.

RESULTS

Twelve young, healthy, asymptomatic students with no contraindications to HVLA treatment were recruited at Kansas City University of Medicine and Biosciences. The test-retest reliability, as determined by a Pearson correlation coefficient, was 0.997. For all participants, objectively identified side of dysfunction correlated with palpatory evaluation of segmental motion. A within-subjects analysis of variance was performed on the raw data, corrected for lumbar lordosis, showing statistical significance for main effect for side of measurement (P<.001) and interaction of side and time (P<.001), and showed no statistically significant effect for time (P=.259).

CONCLUSION

Ultrasonography is a reliable instrument for the assessment of somatic dysfunction of the lumbar spine. The data also establish the content validity of palpatory examinations. In addition, this study provides the first objective evidence, to our knowledge, of the effect of a thrusting manipulative treatment on dysfunctional lumbar vertebrae.

The immediate effects of sigmoid colon manipulation on pressure pain thresholds in the lumbar spine

Visceral manual therapy is increasingly used by UK osteopaths and manual therapists, but there is a paucity of research investigating its underlying mechanisms, and in particular in relation to hypoalgesia. The aim of this study was to investigate the immediate effects of osteopathic visceral mobilisation on pressure pain thresholds. A single-blinded, randomised, within subjects, repeated measures design was conducted on 15 asymptomatic subjects. Pressure pain thresholds were measured at the L1 paraspinal musculature and 1st dorsal interossei before and after osteopathic visceral mobilisation of the sigmoid colon. The results demonstrated a statistically significant improvement in pressure pain thresholds immediately after the intervention (P<0.001). This effect was not observed to be systemic, affecting only the L1 paraspinal musculature. This novel study provides new experimental evidence that visceral manual therapy can produce immediate hypoalgesia in somatic structures segmentally related to the organ being mobilised, in asymptomatic subjects.

The Electromyographic Activity of Thoracic Paraspinal Muscles Identified as Abnormal With Palpation

OBJECTIVE

The aim of this study was to compare the electromyographic (EMG) activity of deep muscles in the thoracic paravertebral gutter (PVG) detected as abnormal to palpation (AbPT) and reported as tender by the subject with muscles underlying nontender (NT), normal to palpation sites under various experimental conditions.

METHODS

Twelve subjects (mean age, 25.42 years; range, 22-43 years) participated in this study. Fine-wire, bipolar intramuscular electrodes were inserted, under real-time ultrasonic guidance, into the deep paravertebral muscle mass underlying 1 AbPT and 2 NT sites (1 segment above and below the AbPT site) in the thoracic PVG regions. Electromyographic activity was recorded under the following conditions: resting prone, prone active trunk extension, application of pressure (300 kPa) to adjacent spinous processes, resting seated, passive and active seated trunk rotation, and supporting 2-kg weights in outstretched arms.

RESULTS

Mean EMG activity was highest at the AbPT site, relative to NT sites, under all conditions, with a significant between-group effect of site (F2,31 = 4.13, P = .03) and large between-group effect size (eta2 = 0.21). There was also a trend for lower percentage change from baseline resting at the AbPT sites, relative to the NT sites, in response to the demand of other conditions. There were large variations in EMG activity within and between individuals, and large SDs accompanied the mean values of EMG activity in all cases.

CONCLUSION

Increased motor activity may be a contributing factor to tissue changes in the PVG detected with palpation. However, caution must be used when interpreting these results because of the large variations, small sample size, and issues associated with EMG normalization.