The best position is to have the patient prone on the examination table with the thoracic spine preferably in slight flexion. This is achieved by lowering the top of the table.

Test passive extension of each joint with firm pressure from the pad of the thumbs or the bony hand (either the pisiform prominence or the lateral border of the fifth metacarpal). Spring up and down with a few firm oscillations, keeping the elbows straight, but being well above the patient. Ask the patient if the pressure reproduces the pain. Apart from asking the patient 'Is that the pain?' note:

• the distribution of pain and its change with movement

• the range of movement

• the type of resistance in the joint

• any muscle spasm

Palpation must follow a set plan in order to reproduce the patient's pain. The sequence is as follows:

1. Central—over spinous processes

2. Unilateral—over apophyseal joints (2-3 cm from midline)

3. Transverse—on side of spinous processes

4. Unilateral—costotransverse junctions (4-5 cm from midline)

5. Unilateral—over ribs (spring over posterior rib curve with ulnar border of hand, along axis of rib)

Back Pain Relief

Back Pain Relief

This informational eBook will present you with the most recent research and findings available so that you can learn more about Back Pain relief, covering as many bases as possible from A to Z.

Get My Free Ebook

Post a comment