Article

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 (35 males, 56 females; mean+/-SD age: 45.2+/-15 yrs) and 94
patients with unilateral neck pain (26 males, 68 females, 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.
CI - Copyright A(c) 2012 Elsevier Masson SAS. All rights reserved.

Langue : ANGLAIS ; FRANCAIS