Musculoskeletal Palpation Testing Is Largely Useless

Clinicians should base diagnosis and treatment on tests that are reliable and valid. I have attended courses that taught me how to determine sacral and facet positioning with my fingers. Only later did I realize that stuff was ridiculous. When you palpate (touch) a structure at rest, for starters, you’re touching many structures. In addition, it doesn’t consider referred pain. For instance, if I touch your Achilles tendon and it feels thickened or it feels painful to the patient, I can't make strong inferences from that other than it feels thickened or it feels painful to the patient. It doesn't help with diagnosing what is causing those phenomena. If you want to use that as a baseline test and see if it changes with the intervention, that is fine; but that is not the original intent of these palpation tests that are commonly taught, which are geared more to defining (diagnosing) a problem. Palpation during movement tests are similarly flawed - most notably because they purport that clincians can reliably detect small amounts of movement. Reliablitiy is not only in question when the same clinician performs the test on different occassions, but is clearly questionable when it comes to comparing several clinicians. We’re better than saying we know the diagnosis by eliciting pain when we touch something (which is below skin and everything else). And we’re better than saying we know the diagnosis based on (allegedly) feeling a 5-degree rotation in a joint. ​-- Laura