PainSci summary of Maigne 2012?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided at the bottom of the page, as often as possible. ★★★☆☆3-star ratings are for typical studies with no more (or less) than the usual common problems. Ratings are a highly subjective opinion, and subject to revision at any time. If you think this paper has been incorrectly rated, please let me know.
Researchers tested two physicians with training in manual medicine to see if they could detect the painful side of the neck or back by touch alone, feeling for tension in the spinal muscles. In almost two hundred patients, they identified the correct side of 65% of lower back pain and 59% of neck pain — only slightly better than chance.
An odd anomaly occurred in the difference between the left and right side: the examiners were more accurate on the right side with back pain, but better on the left side with neck pain.
The results are underwhelming. Although they did a little better than just guessing, the results suggest that it’s difficult even for expert examiners to detect the location of neck and back pain by feel. As well, they were only attempting to detect the side of pain. Imagine how much worse their performance would have been if they had had to identify the location more precisely, or if the pain could have been anywhere or nowhere. So they barely passed the easiest possible test, and probably would have failed a harder one and done no better than guessing.
An obvious weakness of the study is that only two examiners (of uncertain skill) were tested, and so the results are inconclusive. One would still hope for a better detection, though, even from professionals with only average examination skills.
original abstract†Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.
OBJECTIVES: Back pain is often attributed to increased tension in the back muscles, regardless of whether the tension is primary or related to a disc/facet pathology. We hypothesized that when either lower back pain or neck pain is unilateral, the muscle tension would be more pronounced on the painful side and could be detected by palpation alone (i.e., without the need to apply pain-triggering manoeuvres).
METHODS: Patients with unilateral neck or lower back pain were enrolled in the study. Participants with scoliosis, obesity, a history of spinal surgery or pain radiating below the knee or the elbow were excluded. The patients were examined by comparative muscle palpation only. The examiner was unaware of which body side was painful and the patient was told to remain still and silent. The spinal muscles were examined bilaterally, with superficial and deep palpation. The examiner had to determine on which side the tension was greater. The patients' age, body mass index, time since onset of symptoms and Rolland Morris (lower back pain) and INDIC (neck pain) functional disability questionnaire scores were recorded.
RESULTS: Ninety-one patients with unilateral lower back pain (35 males, 56 females; mean±SD age: 45.2±15 yrs) and 94 patients with unilateral neck pain (26 males, 68 females, 49.1±15 yrs) were enrolled in the study. The lower back pain and neck pain were right-sided in 50 (54.9%) and 53 (56.4%) of cases, respectively. The examiners correctly identified the painful side in 64.8% of the cases of lower back pain (a significantly better percentage than chance alone (i.e. 50%), P=0.02) and 58.5% (P=0.10) of the cases of neck pain. In lower back pain patients, the results were better for right-side pain than for left-side pain (70.0% and 58.5% of correct answers, respectively, ns). In neck pain patients, the results were better for left-side pain than right-side pain (61% and 56.6%, respectively, ns). There were no significant differences between the two examiners' respective performance levels. The patients' clinical parameters did not appear to influence successful detection of the painful side.
CONCLUSION: Our findings suggest that palpation can detect increased muscle tension in a limited proportion of cases.
These six articles on PainScience.com cite Maigne 2012 as a source:
- PS Does Massage Therapy Work? — A review of the science of massage therapy … such as it is
- PS Save Yourself from Low Back Pain! — Low back pain myths debunked and all your treatment options reviewed
- PS Save Yourself from Neck Pain! — A complete guide to chronic neck pain and the disturbing sensation of a “crick”
- PS You’re Really Tight — The three most common words in massage therapy are pointless
- PS Palpatory Pareidolia & Diagnosis by Touch — Tactile illusions, wishful thinking, and the belief in advanced diagnostic palpation skills in massage and other touchy health care
- PS Cramps, Spasms, Tremors & Twitches — The biology and treatment of unwanted muscle contractions
This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights:
- A Bayesian model-averaged meta-analysis of the power pose effect with informed and default priors: the case of felt power. Gronau 2017 Comprehensive Results in Social Psychology.
- The neck and headaches. Bogduk 2014 Neurol Clin.
- Agreement of self-reported items and clinically assessed nerve root involvement (or sciatica) in a primary care setting. Konstantinou 2012 Eur Spine J.
- Effect of NSAIDs on Recovery From Acute Skeletal Muscle Injury: A Systematic Review and Meta-analysis. Morelli 2017 Am J Sports Med.
- Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain: Systematic Review and Meta-analysis. Paige 2017 JAMA.