Stéphane Pletain, DC

Dr Plétain is a 1973 graduate of the Anglo-European College of Chiropractic, who is in private practice in Brussels. He has served as secretary of the Scientific Committee of the Belgian Chiropractor’s Union. He has also been a member of the postgraduate faculty of AECC and Life Chiropractic College. Dr Pletain has lectured at numerous European and international conferences and at various chiropractic colleges on the subject of motion palpation

Presentation:

Motion Palpation : where do we stand?


Motion Palpation is an examination method to detect spinal fixations by passively mobilising the patient through the different ranges of motion. Gillet describes a fixation as ‘the possibility of a vertebra to be restricted, or hindered by some abnormal factors, from being passively put through its range of motion’. For many years MP was used by chiropractors throughout the profession based on these principles. In the 80's MP became the subject of several studies to control its reliability. At the time the profession started to be investigated by a new breed of scientifically minded chiropractors. The result of these investigations seems to indicate that the inter-examiner reliability of MP is poor. Consequently some practitioners even suggest to abandon the procedure altogether.

Having use this diagnostic tool for more than 30 years I may have a few objection to this proposal. As far as I am concerned the research done on MP is not satisfactory. In some cases the studies are flawed from the start because the chosen examiners had no MP experience, or in another instance the straight leg raising test of Gillet ,under investigation, was badly performed by the palpators. But beyond those obvious mistakes some fundamental questions must be answered before attempting to research MP.

For example. How much force do we need to enhance our palpation? How many times do we need to palpate a joint to achieve the best perception? What is the optimal position to palpate a patient (standing, sitting, supine, prone)? When we palpate our patients we passively mobilise their spine, has this a therapeutic effect or is it an aggravating factor? Other issues like the experience of the examiners comes into play and also the effect of simply touching the patient. Answering these basic questions should be the next task for the people scrutinising our profession.

As we have seen earlier, the inter-examiner reliability of MP seems to be poor, but oddly enough the intra-examiner is good. Why this discrepancy? In all the investigations done so far on MP a common factor seems to appear. As I mentioned earlier the purpose of MP is to find fixations and apparently none of the investigators utilise this word but rather use a more ‘sophisticated’ terminology like: dysfunction, dyskinesia, functional spinal lesion, joint movement restriction, lost of joint play, coupled motions, pathomechanical patterns, etc… These terms are used loosely by investigators to describe what Gillet calls a fixation. But do they mean the same thing? Are the authors of the different articles on MP confuse as to the type of lesion MP is suppose to detect? It seems that this confusion exists even between individual practitioners. No wonder their palpatory findings are different. It is necessary for our profession to arrive to a consensus concerning the terminology to be used when investigating the efficacy of MP. If we don’t we will end up with the inextricable situation the profession is now facing with the word ‘subluxation’