In determining the site to apply a manipulation or a Chiropractic adjustment, the following chart summarizes the most common functional joint evaluation methods.
(Order of Least to Most Invasive)
| METHOD | RATIONALE | STRENGTHS | WEAKNESSES |
| Positional and Postural | ~Misalignment creates joint and connective tissue stress | ~Assesses muscle imbalance and tightness
~Positional dyskinesia demonstrated |
~Difficult to assess anomalies
~Alignment doesn’t correlate with kinetic disturbance ~Doesn’t identify unstable joints |
| ROM | ~Altered instantaneous axis of rotation | ~Easy to implement
~Quick screen ~Demonstrative to patient |
~Assesses quantity but not quality of motion
~Global, not-specific |
| Reactive Muscle Testing
(Active MMT, Passive Reflex Testing) |
~Mechanoreceptor dysfunction | ~Neurological indicator of joint stress
~Indicates neurological dysfunction ~Very demonstrative to patient |
~Secondary indicator
~Poor validity and reliability ~Can’t gauge prognosis ~Highly skill dependent with questionable accuracy and reliability |
| Motion Palpation (Joint Play Testing) | ~Connective, muscular, and articular tissue restrictions prevent normal arthokinematics | ~Primary indicator
~Can assess quality of motion ~Can differentiate between acute and chronic conditions ~Can identify unstable joints ~Can monitor progress ~Can offer prognosis information |
~Labor intensive
~Highly skill dependent requiring extensive practice ~Modest t o good intra-examiner reliability; fair to moderate inter-examiner reliability ~Best used in combination with other exam methods rather than as a stand-alone |
| Provocative Testing | ~Pain on testing indicates tissue irritation or inflammation | ~Most literature evidence support
~Demonstrative to patient ~Can be integrated with orthopedic exam (overpressure) and joint play end feel analysis |
~Narrow scope of assessment (pain only) |
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