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Lower back pain and neck pain: Is it possible to identify the painful side by palpation only? - 20/03/12

Doi : 10.1016/j.rehab.2012.01.001 
J.-Y. Maigne a, , P. Cornelis a, G. Chatellier b
a Service de médecine physique, Hôtel-Dieu de Paris, 1, place du Parvis-Notre-Dame, 75181 Paris cedex 04, France 
b Direction de l’informatique hospitalière, HEGP, 20, rue Leblanc, 75015 Paris, France 

Corresponding author.

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Abstract

Objectives

Back pain is often attributed to increased tension in the back muscles, regardless of whether the tension is primary or related to a disc/facet pathology. We hypothesized that when either lower back pain or neck pain is unilateral, the muscle tension would be more pronounced on the painful side and could be detected by palpation alone (i.e. without the need to apply pain-triggering manoeuvres).

Methods

Patients with unilateral neck or lower back pain were enrolled in the study. Participants with scoliosis, obesity, a history of spinal surgery or pain radiating below the knee or the elbow were excluded. The patients were examined by comparative muscle palpation only. The examiner was unaware of which body side was painful and the patient was told to remain still and silent. The spinal muscles were examined bilaterally, with superficial and deep palpation. The examiner had to determine on which side the tension was greater. The patients’ age, body mass index, time since onset of symptoms and Rolland Morris (lower back pain) and INDIC (neck pain) functional disability questionnaire scores were recorded.

Results

Ninety-one patients with unilateral lower back pain (35males, 56females; mean±SD age: 45.2±15 yrs) and 94patients with unilateral neck pain (26males, 68females, 49.1±15 yrs) were enrolled in the study. The lower back pain and neck pain were right-sided in 50 (54.9%) and 53 (56.4%) of cases, respectively. The examiners correctly identified the painful side in 64.8% of the cases of lower back pain (a significantly better percentage than chance alone (i.e. 50%), P=0.02) and 58.5% (P=0.10) of the cases of neck pain. In lower back pain patients, the results were better for right-side pain than for left-side pain (70.0% and 58.5% of correct answers, respectively, ns). In neck pain patients, the results were better for left-side pain than right-side pain (61% and 56.6%, respectively, ns). There were no significant differences between the two examiners’ respective performance levels. The patients’ clinical parameters did not appear to influence successful detection of the painful side.

Conclusion

Our findings suggest that palpation can detect increased muscle tension in a limited proportion of cases.

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Résumé

Objectifs

La douleur de dos est souvent attribuée à une tension augmentée des muscles du dos, quelle qu’en soit la cause (primitive ou secondaire à une pathologie discale ou facettaire). Nous avons fait l’hypothèse qu’en cas de douleur unilatérale (lombaire ou cervicale), la tension musculaire devrait être plus marquée du côté douloureux et qu’elle pourrait être détectée par la palpation seule, à l’exclusion des manœuvres de reproduction de la douleur.

Méthode

Les patients avec une douleur lombaire ou cervicale unilatérale furent enrôlés. Furent exclus les patients avec scoliose, obésité, antécédents de chirurgie vertébrale ou douleur irradiant au-delà du genou ou du coude. Les patients ne furent examinés que par palpation musculaire comparative. L’examinateur ignorait le côté douloureux, et le patient devait rester passif et muet. Les muscles spinaux étaient palpés des deux côtés (palpation superficielle et profonde). L’examinateur devait déterminer de quel côté la tension était la plus marquée. L’âge, l’IMC, la durée des symptômes et les résultats des questionnaires EIFEL et INDIC furent notés.

Résultats

Quatre-vingt-onze patients avec lombalgie unilatérale (35hommes, 56femmes, âge 45,2±15) et 94 avec cervicalgie unilatérale (26hommes, 68femmes, âge49,1±15) furent disponibles pour l’analyse finale. La douleur était à droite dans respectivement 50 (54,9 %) et 53 (56,4 %) cas. Le côté correct fut trouvé dans respectivement 64,8 % des cas, un résultat meilleur que le hasard (50 %, p=0,02) et 58,5 %, un résultat non différent du hasard (p=0,10). Chez les patients lombalgiques, les résultats furent meilleurs pour le côté droit que pour le gauche (70,0 % contre 58,5 % de bonnes réponses, ns). Chez les patients cervicalgiques, ils furent meilleurs pour le côté gauche (61 % contre 56,6 %, ns). Il n’y eu pas de différence significative entre les deux examinateurs. Il n’y avait aucune influence des différents paramètres cliniques sur les taux de succès.

Conclusion

Notre étude montre que la palpation peut reconnaître une tension musculaire augmentée dans un nombre limité de cas.

Il testo completo di questo articolo è disponibile in PDF.

Keywords : Muscle tension, Muscle hardness, Spinal muscles, Physical examination, Neck pain, Lower back pain

Mots clés : Tension musculaire, Fermeté musculaire, Muscles spinaux, Examen clinique, Cervicalgie, Lombalgie


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Vol 55 - N° 2

P. 103-111 - Marzo 2012 Ritorno al numero
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