Introduction A reliable biomechanical diagnosis is necessary to justify the use of spinal manipulative treatment to correct it. Palpation is considered to be one of the most informative aspects of physical examination of patients with musculoskeletal pain and is the most commonly used method for the examination of the spine for joint dysfunction. Previous studies into reliability of palpation of joint dysfunction are confounded by the clinician having first to correctly identify the appropriate spinal segment, introducing a further measurement error. The purpose of this study was to examine the intra-observer reliability of identifying a manipulable lesion in the lumbar and thoracic spine.

Methods 12 asymptomatic subjects were examined by an experienced osteopath and the selected joint marked on two occasions using a ultra-violet marker rather than by naming the spinal level. The marks were recorded on acetates by a separate researcher and intra-rater reliability was assessed by measuring the agreement between the two markings. Using the palpation examination protocol resulted in an excellent level of intra-rater agreement in the lumbar spine ICC (1,1) .96 but poor reliability ICC (1,1) .70 in the thoracic spine.

Conclusion Intra-rater reliability for identifying a spinal segment exhibiting signs of segmental dysfunction was excellent in the lumbar spine, but poor in the thoracic spine. The examiner was experienced in the examining method for the lumbar spine, but less so in the thoracic spine, highlighting that experience improves palpatory agreement.

Background: Prospective population studies demonstrate that poor paraspinal muscle endurance increases the risk of developing first-time LBP and many CLBP studies also document excessive paraspinal muscle fatigability. The question arises as to whether this could have predisposed to chronic symptoms, through impaired spinal instability, especially in light of the wide inter-individual variation observed in the constitutionally determined paraspinal muscle fibre-type composition, which governs contractile performance.

Objective: To determine whether CLBP-associated excessive paraspinal fatigue results from a paucity in the type I fibre content.

Design: Control comparison using male subjects.

Subjects: Thirty-five CLBP patients with Von-Korff Chronic Pain Scores of ≤ III (high level of residual function, despite pain, to negate effects of disuse atrophy), and 32 controls of similar age.

Outcome measures: Fatigue-induced median frequency (MF) declines in the surface EMG signal, monitored bilaterally at L4 level during Biering-Sorensen- and 60%MVC- isometric fatigue tests. Percutaneous para-spinal muscle biopsies permitted histomorphometric comparisons.

Results: Between-group differences were assessed using independent t-tests (p < 0.05). There were no differences for MF decline during the Biering-Sorensen -0.37(0.16) vs. -0.36(0.12), and the 60% MVC test −0.42(0.31) vs −0.51(0.29), and in the percentage number of type I fibres, 63.6% vs 64.3%, or percentage area occupied by type I fibres, 69.4% vs 67.2%, in the paraspinal muscles for patients and controls respectively (p> 0.05).

Conclusion: Impaired CLBP-associated endurance is not the result of a constitutionally ‘adverse’ fibre-type composition.