THE STATIC PALPATION ERRORS BETWEEN THE SKIN AND THE BONY STRUCTURES IN THE LUMBAR SPINE

OBJECTIVES

The challenges of precision for manual palpation exist. Suggested possible reasons causing errors of palpation are discussed during past literatures (Billis et al 2003, Harlick et al 2007, Smedmark et al 2000) However, it does not know whether definite factors are existed to affect the precision of static palpation. The aim of this study is to investigate the vertebral parameters causing static palpating errors between skin and bony structures. It is also the first study to develop a geometric model to quantify the static palpation error.

MATERIAL& METHODS

Thirty-seven subjects (17 male and 20 female, 27- 64 years) presenting non-specific mechanical low back pain are recruited. An experienced physical therapist palpates the lumbar spinous processes and adhere stainless markers with elastic tapes on the palpating spinous processes in the sidelying position. Lateral radiographs are then taken.

MEASUREMENT

Points were first marked in each film by tracking the radiographic images by a research assistant. The vertebral parameters are analyzed by digitizing selected points on the lateral radiographic images then transformed into the data of the coordinate system by using SigmaScan software (Version 5; Jandel Scientific, San Rafael, CA). Static palpation errors are defined the distance between the stainless markers and the virtue markers located on the skin. It is by the distance timing the inclined angle between the marker and the vertebrae (Dn=D*(α-β)), which is called static palpation error (Fig.1).

Cheng SC

_{Hsu RM}

_{, Huang YC}

_{, Lin RM}

_{, Su FC}

1

_{Institute of Biomedical Engineering,}

_{Department of Orthopedics, National Cheng Kung University, Tainan, Taiwan}

_{Department of Physical Therapy and}

_{Science Center, Fooyin University, Kaohsiung, Taiwan.}

4

_{Department of Physical Therapy, Shu-Zen College of Medicine and Management, Kaohsiung, Taiwan.}

_{Department of Physical Medicine and Rehabilitation, Fooyin University Hospital, Pingtung, Taiwan}

E-mail:

suchun.cheng@msa.hinet.net

RESULTS

Static palpation errors are highly related to the inclined angles of each lumbar vertebra statistically (Table 1). It is not related to the thickness of the soft tissue. Only the height of L3 spinous process shows the weak correlation with the static palpation error.

REFERENCES

1. Billis EV, Foster NE, Wright CC (2003) Reproducibility and repeatability: errors of three groups of

physiotherapists in locating spinal levels by palpation. Man Ther 8: 223-232.

2. Harlick JC, Milosavljevic S, Milburn PD (2007) Palpation identification of spinous processes in the lumbar spine. Man Ther 12: 56-62.

3. Jackson RP, Kanemura T, Kawakami N, Hales C (2000) Lumbopelvic lordosis and pelvic balance on repeated

standing lateral radiographs of adult volunteers and

untreated patients with constant low back pain. Spine 25: 575-586.

4. Lin RM, Yu CY, Chang ZJ, Lee CC, Su FC (1994)

Flexion-extension rhythm in the lumbosacral spine. Spine (Phila Pa 1976) 19: 2204-2209.

5. Smedmark V, Wallin M, Arvidsson I (2000)

Inter-examiner reliability in assessing passive intervertebral motion of the cervical spine. Man Ther 5: 97-101.

The static palpation errors between skin and the bony structures

in the lumbar spine

DISCUSSION &CONCLUSION

This study demonstrates that the inclined angles of lumbar vertebrae play an important role in the precision of manual palpation. Although much debate has been discussed about the lumbar lordosis between subjects with asymptomatic and low back disorders (Jackson et al 2000), it is true that transitional and rotational movement of lumbar spine depend on the change of vertebral inclination (Lin et al 1994). By understanding the relationship between inclined angles and the palpation error may provide the better palpation knowledge In future clinical implication.

Fig1. Calculation of the displacement between the surface palpation and the ideal position of palpation

Table 1. Pearson‘s correlation between static palpation errors and the measuring parameters of lumbar spine