Reliability and validity of manual palpation for the assessment of patients with low back pain: a systematic and critical review

Chiropr Man Therap. 2021 Aug 26;29(1):33. doi: 10.1186/s12998-021-00384-3.


Background: Static or motion manual palpation of the low back is commonly used to assess pain location and reproduction in low back pain (LBP) patients. The purpose of this study is to review the reliability and validity of manual palpation used for the assessment of LBP in adults.

Method: We systematically searched five databases from 2000 to 2019. We critically appraised internal validity of studies using QAREL and QUADAS-2 instruments. We stratified results using best-evidence synthesis. Validity studies were classified according to Sackett and Haynes.

Results: We identified 2023 eligible articles, of which 14 were low risk of bias. Evidence suggests that reliability of soft tissue structures palpation is inconsistent, and reliability of bony structures and joint mobility palpation is poor. We found preliminary evidence that gluteal muscle palpation for tenderness may be valid in differentiating LBP patients with and without radiculopathy.

Conclusion: Reliability of manual palpation tests in the assessment of LBP patients varies greatly. This is problematic because these tests are commonly used by manual therapists and clinicians. Little is known about the validity of these tests; therefore, their clinical utility is uncertain. High quality validity studies are needed to inform the clinical use of manual palpation tests.

Keywords: Assessment; Low back pain; Manual palpation; Reliability; Systematic review; Validity.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Adult
  • Humans
  • Low Back Pain* / diagnosis
  • Palpation
  • Radiculopathy*
  • Range of Motion, Articular
  • Reproducibility of Results