Critical Assessment: “Motion Palpation: Guide or Guise? – A Clinical Commentary”

Original Article: Williams et al. J Contemp Chiropr 2025;8:10–20.
Review Written by: James Demetrious, DC, DABCO
Overview

This clinical commentary by Williams et al. offers a well-structured assessment of motion palpation as a diagnostic tool in chiropractic and osteopathic manual therapy. It offers a comprehensive review of the evidence questioning the accuracy, reliability, and theoretical underpinnings of motion palpation and traditional listing systems. The authors challenge historical paradigms while encouraging a more modern, evidence-informed approach to spinal assessment.

While the article is informative and progressive, it also offers opportunities to further refine how chiropractors determine the specifics of delivering spinal adjustments, including when, where, and why they are performed.

This review explores the article’s strengths and limitations and provides enhancements that align with contemporary best practices.

Strengths

Thorough Literature Review

The commentary draws on biomechanical, neurological, and clinical research, including work on mechanoreception and variability in spinal coupling behavior across postures and segments (1–3). The critique of Fryette’s laws and static listing models is timely, given the contradictions found in modern dynamic imaging (4,5).

Evidence-Based Skepticism

Studies consistently reveal poor interexaminer reliability in motion palpation, even among experienced practitioners (6–9). The article rightly questions the specificity of manual contacts and the concept of repositioning vertebrae, citing fluoroscopic studies that show non-specific cavitations and segmental return to baseline positions post-adjustment (10–12).

Updated Clinical Framework

The proposed multi-step clinical model is a strength. Incorporating history, static and dynamic assessments, and pain provocation testing aligns with clinical prediction models and biopsychosocial best practices (13,14).

Limitations and Areas for Improvement

Underdeveloped Insight on Why to Adjust

The article critiques outdated “bone out of place” theories but misses the opportunity to cite modern neurophysiological effects of spinal manipulation, including central pain modulation, proprioceptive reorganization, and cortical processing enhancements (16-19). These effects explain why spinal adjustments retain therapeutic value even in the absence of structural realignment.

Ambiguity in When to Adjust

The paper lacks guidance on timing spinal adjustments. Predictors of responsiveness—such as symptom duration, lack of radiculopathy, and fear-avoidance beliefs—are well established in spinal manipulation research (20,21). Incorporating these would clarify clinical decision-making.

Inadequate Discussion on How to Adjust Safely

While it critiques the illusion of segmental specificity, the article omits pragmatic guidelines on force vectors, dosage, patient tolerance, and red flag exclusion. Studies suggest the clinical impact may depend more on the global mechanical input and the context of delivery than on the precision of contact (10,17, 20).

Limited Integration of Technology and Outcome Tracking

The article references dynamic imaging but does not explore the use of real-time diagnostic adjuncts (e.g., motion capture, CBCT, sEMG, PROMs). These tools could reinforce assessment accuracy and patient-reported outcome measurement—key elements in modern, value-based care (23, 24).

Philosophical Overtones Could Alienate Traditionalists

While challenging dogma is essential, reframing legacy models as historically relevant but biomechanically insufficient may foster a more inclusive evolution. Bridging traditional practices with evidence-based updates could improve adoption among diverse practitioners (24).

Proposed Chiropractic HVLA Spinal Adjustment Reasoning
Element Recommendation
How? HVLA spinal adjustments with the intent of gapping zygapophyseal joints within capuslar and ligamentous integrity. Technique predicated on regional complex intra-articular, extra-articular, and neurogenic causes of segmental joint hypomobility, coupled segmental motion and neurophysiological responses. Complete extensive preceptor training and use available biofeedback tools to develop technique and impulse training.
What? Target regions of dysfunction informed by global and segmental motion restriction, pain provocation, muscle tone, palpatory tenderness, and posture.
When? Determine absolute and relative contraindications. Intervene in accordance of acute, sub-acute and chronic MSK complaints. Modify technique as clinically indicated. Consider and adapt to spinal canal and neural foraminal compromise, spinal hyper-mobility, instability and psychosocial flags. Dosing predicated on clinical need.
Where? Consider and apply regional interdependence and fascial chain models of affected segmental regions of spinal hypo-mobility and mechanical neurologic compromise.
Why? Adjust to stimulate segmental motion to functionally stretch new/old adhesions and degenerative compromise along stress planes. To gap zygopophyseal joint surfaces to alleviate entrapped intrarticular tissue. Attempt to improve segmental motion to facilitate CSF, cellular, venous and lymphatic exchange. To facilitate proprioception and peripheral-CNS modulation/homeostasis. To improve health and alleviate suffering. 
Conclusion

In their article Williams et al. offer a thoughtful and necessary challenge to outdated chiropractic assessment models. It calls for the profession to integrate motion palpation as one component of a broader, evidence-informed clinical assessment strategy. Future work should articulate when and why to adjust the spine, embrace technological adjuncts, and clarify outcome-based treatment models to improve their impact.

A follow-up guide outlining validated decision trees, technique parameters, and neuromechanical rationale could provide greater clinical utility and bridge generational gaps in practice philosophy.

References
  1. Johansson RS, Vallbo AB. Tactile sensibility in the human hand: relative and absolute densities of four types of mechanoreceptive units in glabrous skin. J Physiol. 1979;286:283–300.
  2. Legaspi O, Edmond SL. Does the evidence support the existence of lumbar spine coupled motion? A critical review of the literature. J Orthop Sports Phys Ther. 2007;37(4):169–78.
  3. Fryette’s Laws – definition of Fryette’s Laws in the Medical Dictionary. The Free Medical Dictionary [Internet]. Available from: https://medical-dictionary.thefreedictionary.com
  4. Shin JH, Wang S, Yao Q, Wood KB, Li G. Investigation of coupled bending of the lumbar spine during dynamic axial rotation. Eur Spine J. 2013;22(12):2671–7.
  5. Tang B, Yao H, Wang S, et al. In vivo 3D kinematics study of the healthy cervical spine using CBCT and 3D-3D registration. Spine. 2021;46(24):E1260–6.
  6. Nolet PS, Yu H, Côté P, et al. Reliability and validity of manual palpation for the assessment of patients with low back pain: a systematic and critical review. Chiropr Man Therap. 2021;29:33.
  7. Cooperstein R, Haneline M, Young M. Interexaminer reliability of thoracic motion palpation using confidence ratings and continuous analysis. J Chiropr Med. 2010;9(3):99–106.
  8. Downey B, Taylor N, Niere K. Can manipulative physiotherapists agree on which lumbar level to treat based on palpation? Physiotherapy. 2003;89(2):74–81.
  9. Humphreys BK, Delahaye M, Peterson CK. Validity of cervical motion palpation using congenital block vertebrae as a gold standard. BMC Musculoskelet Disord. 2004;5:19.
  10. Ross JK, Bereznick DE, McGill SM. Determining cavitation location during lumbar and thoracic spinal manipulation. Spine. 2004;29(13):1452–7.
  11. Dunning J, Mourad F, Barbero M, et al. Bilateral and multiple cavitation sounds during upper cervical thrust manipulation. BMC Musculoskelet Disord. 2013;14:24.
  12. Nim CG, Downie A, O’Neill S, et al. The importance of selecting the correct site to apply spinal manipulation: myth or reality? Sci Rep. 2021;11:21239.
  13. Flynn T, Fritz J, Whitman J, et al. A clinical prediction rule for classifying patients with low back pain who demonstrate short-term improvement with spinal manipulation. Spine. 2002;27(24):2835–43.
  14. O’Sullivan P. Diagnosis and classification of chronic low back pain disorders: maladaptive movement and motor control impairments. Man Ther. 2005;10(4):242–55.
  15. Cramer GD et al. Zygapophyseal joint gapping with spinal manipulative therapy. J Manipulative Physiol Ther. 2002;25(8):511–521.
  16. Gyer G, Michael J, Inklebarger J, Tedla JS. Spinal manipulation therapy: is it all about the brain? A current review. J Integr Med. 2019;17(5):328–37.
  17. Kawchuk GN, Fryer J, Jaremko JL, et al. Real-time visualization of joint cavitation. PLoS One. 2015;10(4):e0119470.
  18. Haavik H, Murphy B. The role of spinal manipulation in addressing disordered sensorimotor integration and altered motor control. J Electromyogr Kinesiol. 2012;22(5):768–76.
  19. Childs JD, Fritz JM, Flynn TW, et al. A clinical prediction rule to identify patients with low back pain likely to benefit from spinal manipulation. Ann Intern Med. 2004;141(12):920–8.
  20. Beneciuk JM, Bishop MD, George SZ. Clinical prediction rules in physical therapy: the need for critical appraisal of the literature. J Orthop Sports Phys Ther. 2009;39(5):336–40.
  21. Evans DW, Breen AC. A biomechanical model for mechanically efficient cavitation production during spinal manipulation. Med Hypotheses. 2006;66(6):1080–8.
  22. Mior SA, Laporte A, McGregor M, et al. An overview of chiropractic usage and outcomes in Canadian workers’ compensation cases. J Manipulative Physiol Ther. 2010;33(7):493–503.
  23. Peterson CK, Bolton J, Humphreys BK. Outcome measures in chiropractic: a review of the literature. Chiropr Osteopat. 2005;13:4.
  24. Leach RA. The chiropractic theories: principles and clinical applications. 4th ed. Philadelphia: Lippincott Williams & Wilkins; 2004.

PostGradDC offers advanced post-graduate chiropractic continuing education. Our founder, Dr. James Demetrious, is a distinguished board-certified chiropractic orthopedist, educator, author, and editor. Register for 10-hour, Cervical Artery Dissection Certification© at PostGradDC.com.

Disclosure

The information provided in this article and all PostGradDC coursework should not be considered standards of care. We offer this information for educational purposes only. This information is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or qualified healthcare provider with any questions you may have regarding medical conditions or treatment.

© 2025 – James Demetrious, DC, DABCO. Open Access. Unrestricted use, distribution, and reproduction are allowed in any medium, provided you give appropriate credit by citing the original author and source: Demetrious J. PostGradDC. Critical Assessment: “Motion Palpation: Guide or Guise? – A Clinical Commentary”. PostGradDC.com; 2025.