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J Man Manip Ther. 2019 Sep 2:1-9. doi: 10.1080/10669817.2019.1661706. [Epub ahead of print]

A study exploring the prevalence of Extremity Pain of Spinal Source (EXPOSS).

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Physiotherapist, London Health Sciences Centre , London , Canada.
Physiotherapist, Advance Sports and Spine Physical Therapy , Portland , OR , USA.
Physiotherapist, Inform Physiotherapy Limited , Silverstream , New Zealand.
Physiotherapist, Pulz Physiotherapy , Freiburg , Germany.
Centre for Interdisciplinary Research in Rehabilitation, Constance Lethbridge Rehabilitation Centre, and School of Physical and Occupational Therapy, McGill University , Montreal , Canada.


Objectives: To investigate the proportion of patients that present with isolated extremity pain who have a spinal source of symptoms and evaluate the response to spinal intervention. Methods: Participants (n = 369) presenting with isolated extremity pain and who believed that their pain was not originating from their spine, were assessed using a Mechanical Diagnosis and Therapy differentiation process. Numerical Pain Rating Scale, Upper Extremity/Lower Extremity Functional Index and the Orebro Questionnaire were collected at the initial visit and at discharge. Global Rating of Change outcomes were collected at discharge. Clinicians provided MDT 'treatment as usual'. A chi-square test examined the overall significance of the comparison within each region. Effect sizes between spinal and extremity source groups were calculated for the outcome scores at discharge Results: Overall, 43.5% of participants had a spinal source of symptoms. Effect sizes indicated that the spinal source group had improved outcomes at discharge for all outcomes compared to the extremity source group. Discussion: Over 40% of patients with isolated extremity pain, who believed that their pain was not originating from the spine, responded to spinal intervention and thus were classified as having a spinal source of symptoms. These patients did significantly better than those whose extremity pain did not have a spinal source and were managed with local extremity interventions. The results suggest the spine is a common source of extremity pain and adequate screening is warranted to ensure the patients ́ source of symptoms is addressed.


Differentiation; McKenzie Method; directional preference; extremity pain; mechanical diagnosis and therapy; musculoskeletal; repeated movements; spinal source

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