Joint Mobilization and Manipulation: Palpation, Assessment, and Reliability

In this course, we cover a topic that has only recently become controversial. Palpation and palpation assessment (passive accessory motion exam) were considered standard components of a physical examination, and they were performed by a variety of healthcare providers. Recently, the reliability and efficacy of these techniques have been critiqued and contrarian therapists on social media claim they are no longer worthy of inclusion in practice. Although healthy skepticism is always encouraged, the research does not support dismissing these techniques. Deep palpation may require more skill and have lower reliability when performed by less experienced therapists, and the efficacy of a technique may be affected by a certain body part being harder to palpate because of its position deep to an internal organ. Further, additional palpation skills may be required to work around a structure carrying critical blood flow, light palpation may be needed when addressing effusion and an increase in joint fluids, and differentiation between tissues may require advanced anatomy knowledge. Despite these factors affecting the reliability and efficacy of palpation, it would be a logical fallacy to dismiss a technique for any presumed flaw. Reliability and efficacy are not binary measures, they are probabilistic measures. Less reliable or effective, does not imply "not reliable or effective".

This course is built from a comprehensive, systematic review of all relevant research, carefully explains the issues involved in interpreting the research, and attempts to develop the nuanced conclusions necessary to make evidence-based recommendations. A couple of examples from the research summary:

• Joint Motion Assessment by Palpation: When research investigates a well-differentiated definition of a positive finding, a practically relevant range of agreement, considers therapist confidence in findings (and perhaps therapist skill), good or better inter-therapist and intra-therapist reliability is achievable for joint motion assessment by palpation.
• Combined Assessments: Range of motion (ROM) assessments and special tests are generally more reliable than joint motion assessment by palpation; however, the addition of joint motion assessment by palpation to a combination of assessments (as is commonly observed in practice) likely increases the reliability of these assessments and the reliability of the evaluation overall.

We hope this course aids in providing clarity for a relatively complex topic and provides simple suggestions for practical application. Further, this course is pre-approved for credits toward the Integrated Manual Therapist (IMT) Certification, and pre-approved for continuing education credits for sports medicine professionals and health care providers (physical therapists, athletic trainers, massage therapists, chiropractors, occupational therapists, etc.).

Brookbush Institute's Position Statement (Sample from Course):

• Good to excellent inter-therapist and intra-therapist reliability may be achieved for the palpation of anatomical landmarks, joint stiffness assessment by palpation, and therapist force during mobilization/manipulation when parameters are well-defined, therapist confidence in findings is considered, and reliability is analyzed using a continuous interval measure and/or practically relevant range of agreement. The reliability, predictive value, and utility of these techniques are likely to improve when integrated into a standard patient evaluation that includes multiple assessments, and/or added to an integrated (multi-modal) intervention plan. Further, adding these techniques to practice reliably and significantly improves mean patient outcomes.
  • In short, when these techniques are judged based on how they are commonly used in practice, they demonstrate sufficient reliability to significantly improve patient outcomes.

Related Courses

• Joint Mobilization and Manipulation: Introduction
• Effects of Joint Mobilizations and Manipulations
• Joint Mobilizations and Manipulations: Risk of Adverse Events
• Joint Mobilizations and Manipulations: Evidenced-based Teaching and Learning