The Palpation Paradox

The Problem: Chasing a Moving Target

For decades, manual therapy assessment has focused on finding "the spot"—the positional fault, the joint restriction, the tight tissue. The evidence, however, is clear: this approach is fundamentally flawed.

• Poor Inter-Rater Reliability: Studies consistently show that two skilled clinicians palpating the same structure will often come to different conclusions. If we can't agree on the finding, how can it be the basis for treatment?
• Lack of Validity: Even if a "dysfunction" is identified, there is little evidence to suggest it's the actual source of the patient's pain or limitation. We're often treating anatomical variations, not pathologies.

The Real Mechanism: It's Neurophysiological

If we aren't "fixing" structures, why do patients feel better? Manual therapy works by providing a powerful, novel input to the nervous system, which creates a window of opportunity for pain relief and improved movement. It's not mechanical; it's neurological. Key effects include:

• Pain Modulation: Activating the brain's own descending inhibitory pathways (the "top-down" pain relief system) and reducing central sensitization.
• Autonomic Changes: Inducing sympathoexcitatory effects that can influence blood flow and threat perception.
• Motor System Reset: Altering afferent input to change motor output, reducing protective muscle guarding and improving movement patterns.

A Better Way: The Test-Retest Model

Instead of searching for a flawed structural finding, let's assess what really matters: the patient's function. This model is simple, reliable, and patient-centered.