Detailed guides to painful problems, treatments & more

Location of back and neck pain could not be detected by feel

PainSci » bibliography » Maigne et al 2012
Tags: neck, massage, fun, back pain, head/neck, spine, manual therapy, treatment, pain problems

Six articles on PainSci cite Maigne 2012: 1. Does Massage Therapy Work?2. The Complete Guide to Low Back Pain3. The Complete Guide to Neck Pain & Cricks4. You’re Really Tight5. Palpatory Pareidolia & Diagnosis by Touch6. Cramps, Spasms, Tremors & Twitches

PainSci commentary on Maigne 2012: ?This page is one of thousands in the 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 wherever possible.

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 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.

~ Paul Ingraham

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.

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: