An exploratory study of provocation testing with padded wedges: can prone blocking demonstrate a directional preference?

Abstract 

Background

Currently, no traditional chiropractic examination method to determine a spinal listing offers demonstrated guidance in treatment decisions for low back pain (LBP) patients. Development of an examination that bypasses the difficulty of accurately and reliably identifying a listing, yet provides guidance on manipulative vectors, could be very valuable to clinicians and patients.

Objective

To explore 2 potential protocols for provocation testing and assessment of directional preference using padded wedges.

Methods

Two groups of 20 subjects were examined while lying prone on various positions of padded wedges. In the first group, pain pressure threshold (PPT) was measured at 4 anatomic points; in the second group, tenderness was measured at 1 anatomic point. We investigated whether either method could demonstrate a directional preference response.

Results

When tenderness was measured at 1 anatomic point, 70% of subjects demonstrated a directional response, and only 1 subject exhibited an increase in baseline tenderness at the end of the procedure. When PPT was measured at 4 anatomic points, 40% of subjects demonstrated a directional response, but 12 subjects exhibited decreased PPT at the end of the procedure.

Conclusion

Measuring changes in tenderness at 1 anatomic point in response to various padded wedge patterns appears promising as an examination procedure to determine directional preference.

Keywords:  Chiropractic, Physical Examination