Currently, I am in radiology rotation at Parker. It is a program designed for everyone to get their x-ray credits in Tri 9, within either a 4-week every other day basis, or a 2 week every day basis. Rad rotation is overseen by a DACBR so that they can sign off on x-rays and give their “chiropractic” opinions on each patient file.
Two weeks ago, one of the DACBRs was going over case types. He was discussing x-rays with us. We came across one x-ray that initiated a discussion on how to find a misalignment. He opined that palpation was the best way of finding fixation and restriction, that it was good enough to tell you where to adjust.
With that in mind, I thought I would post a study B.J. Palmer conducted on palpation years ago. You can find this in Volume XXXV- History in the Making.
“One of many tests, to prove inaccuracy of reliability of palpation in a universal referral sense, or in an office procedure from day to day, is this:
In one certain Lyceum we had 200 experienced field chiropractors who had been practicing under the palpation system some for many years, some less.Here was our test:
We had 100 stools arranged systematically in rows. On each we had one chiropractor acting as patient with entire back exposed, full length. Correspondingly we had 100 chiropractors acting as palpating
doctor, one to each patient.Director of this test, went from patient to patient, and with skin pencil, marked two different lines on patient’s back, opposite two different vertebrae, no two alike.
To each doctor was given a printed slip on which was listed 100 places for 100 patient’s listings he palpated.
(a) Patient No. ?
(b) my palpation lists the two as, then he was to name the two vertebrae he palpated opposite those two lines.After palpating patient No. 1, chiropractor No. 1 moved on to patient No. 2, and so on until he had 100 listings listed of what he palpated.
After each of 100 had palpated each of 100 patients, then entire group was reversed; patients who were down were up, and chiropractors who were up, were down. At end of this test, comparisons were made of palpation listings.
THERE WASN’T ANY ONE OF 200 TESTS MADE WHERE ANY ONE CHIROPRACTOR UP AGREED WITH THE LISTINGS OF ANY OTHER OF THE 200 CHIROPRACTORS UP, yet ALL HAD SAME LINES FOR PALPATIONS. Some had as low as 6th DORSAL listed as 4th CERVICAL. Two, 3 4 or 5 off was common.
The test was TO PROVE that, if the chiropractor relied ON PALPATION ALONE, he could be in serious error.
After this test, we took a 15 minute recess, then went back to original ups and downs, also reversing them. Printed slips were passed out as before. Same marks were left where they had been
originally.SECOND SET OF LISTINGS OF EACH PERSON WERE THEN COMPARED WITH FIRST SET OF LISTINGS OF SAME CHIROPRACTOR WITH SAME PATIENT. There was less than 2% agreed (out of 100) second time with his first time listings, on
same patient, 15 MINUTES LATER.If there was this great discrepancy within 15 minutes, what would there be if he relied on memory to locate HP, SP, LUP, KP, etc., merically, NEXT DAY especially if he had to rely on memory to FIND THE SAME EXACT SUBLUXATION FOR ADJUSTMENT MERICALLY SECOND DAY AS FIRST and the only way he could do this was by palpation, with his fickle memory at work, as well as his inaccuracies of palpation to rely upon?
There is nothing that substitutes for GRAPHING OF records for accuracy.”
The heck with x-rays and instrumentation… It’s all about the palpation!
Spare me.
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{ 4 comments… read them below or add one }
What a perfect title for this post. I don’t understand the notion that long lever manipulation and “palpation-only” is somehow more modern and scientific than UC chiropractic. If anyone can find it, I highly recommend BJ’s book “An Exposition of Old Moves” which is basically a pictorial argument for the use of the toggle recoil in a full-spine context. He goes over every which way patients have been adjusted, from bone-setters to Osteopaths, and it’s quite something to see a supine diversified set-up with a notation from BJ saying something like: this move first originated among the osteopaths, with a reference to a book published in the late 1800s.
Of course, my favorite question is: how do you palpate and the angle and location of the occipital condyles?
I like the title too! I loved this when Dr. Kale shared it! Palpation and leg checks are iffy to me as a patient. I think x-rays and scanning is the way to go. But what do I know, right?!
Palpation is a tool. Just like x-ray is a tool. All tools are useful for certain jobs. No tool works for every job.
I agree that palpation all by itself lacks a lot of inter-examiner reliability. But in conjunction with a good case history, a thorough examination and perhaps even x-ray studies, we are able to gain a clear clinical impression of what’s going on with our patients.
Great post and the timing could have not been better for me to read this post. Recently on another board I went head to head with a another Doc who thought xrays were only used to educate patients. it’s a VERY effective tool for finding the position and visualizing the corrections of Subluxations.