Tech 524

Motion Palpation

Dr. Ron Castellucci

Professor
Sherman College of Chiropractic
 Essentials of Motion Palpation

The objective of motion palpation is to identify joint motion restrictions of the vertebral segments and their
immediate articulations. Once a segment loses its normal articular juxtaposition, it will exhibit aberrant motion
and joint restriction along one or more planes of its range of motion, thus a subluxation will often exhibit some
degree of joint restriction/fixation. Motion palpation analyzes the quality and quantity of joint motion in the
spinal column and pelvis.

The motion of a single vertebra occurs as that vertebra articulates with segments immediately above and below.
This is known as a functional spinal unit (FSU). The FSU consists of two vertebrae and the disc in between.
When a segment is subluxated, one or more of the joints within the FSU are exhibiting aberrant motion due to
joint restriction. Joint motion is determined by a number of factors including:
 the type of joint
 shape of the joint surfaces
 laxity or tautness of the supporting ligaments
 the tone of the related musculature
 structural limitations due to injury or degenerative processes

Joint Restriction/Fixation: Restrictions within a joint’s active range are typically myofascial shortening,
splinting, hypertrophy, contractures or other myofascial or ligamentous derangement such as shortened joint
capsule and/or other peri-articular soft tissues.

Common causes of joint restriction/fixation are myofascial and ligamentous:

 Contracture of ligaments; contracture of paraspinal ligaments and joint capsules.
 Myofascial: muscle contracture, muscle shortening, atrophy, adhesions, scarring
 Peri-articular soft tissue inflammation due to trauma causing swelling and scar tissue

Other causes of joint restriction/fixation include:

 Inter-aticular Block: due to meniscoid entrapment which is a tag of capsular ligament that gets
caught in the apophyseal joint or the rim of the joint and becomes inflamed.
 Intra-discal block; nuclear fragments in the annular fibers of the posterior aspect of the disc.
 Disc degeneration causing aberrant and restricted motion of the motor unit due to spondylosis,
chronic inflammatory processes and derangement of the inter-vertebral disc.
 Bony Fusion: surgical or congenital

Joint Restriction (fixation) and Subluxation: Joint restriction/fixation is present when a vertebra is
unable to move through a specific plane of movement. It is important to understand that joint restriction/fixation
is only one characteristic of a subluxation. Subluxation, by definition, affects proper neurological function thus
if joints are restricted yet there is no neurological effect, the vertebra is not considered to be a subluxation.

Evaluation of Mopal Findings:

The findings derived motion palpation depends upon what form of mopal being used. Dynamic mopal will
reveal joint motion restriction aka fixation while passive mopal will reveal limitations of a vertebra’s range of
motion. Motion palpation findings of restriction joint motion or limitations of range of motion are only one of
the indicators of subluxation. To label a vertebra as being subluxated requires more information than just static
boney or motion palpation findings.

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 Dynamic & Passive Motion Palpation
Dynamic mopal is the most common motion palpation method used in the profession and is the method tested
on national boards. Passive mopal is unique to Sherman College and while not widely used within the
profession, is an effective method for evaluating A/O joint motion.

Dynamic Motion Palpation method

Dynamic motion palpation is an evaluation of the quality of motion which takes place at the joint in a specific
plane of motion. Subluxation typically involves aberrant motion and joint restriction. Joint restriction is
evaluated by moving a vertebra to the end of its range of motion and applying gentle over-pressure. A soft,
springy feeling represents the normal quality of resistance met at the end of a joint’s passive range of motion.
Joint restriction is often described as a hard end feel and is noted before the joint reaches the end of its passive
range of motion. When reporting dynamic mopal findings, reference the segment level and the direction of the
restricted motion, for example C5 has restricted right rotation.
Passive Motion Palpation method
Passive motion palpation is an investigation of the quantity of motion that takes place between the segments of
the spine. Subluxation typically involves a loss of juxtaposition thus when a vertebra misaligns, it uses up some
of its available range of motion in the misaligned direction. This limited range of motion is evaluated by
moving the vertebra through its passive range of motion. When reporting passive mopal findings, reference the
segmental level and the direction of the limited motion, for example C5 is limited during right rotation.

Dynamic Mopal & Joint Restriction Overview

(Bergmann & Peterson, 3rd ed, ch. 3, pg 49)

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 Dynamic Motion Palpation
Occiput
L-M glide
Patient position: seated
Doctor position: standing or seated
Palpating Hand: thumb and thenar on the lateral aspects of the skull with fingers oriented inferior
Indifferent Hand: thumb and thenar on the lateral aspects of the skull with fingers oriented inferior
Action: induce L-M & S-I motion in an arc along across the condyles; evaluate end play
Expected Normal Motion: soft, flexible, springy end feel
Findings: joint restriction / hard end feel
Indications: lateral -medial glide restriction
Listing: RS / LS occiput (gonstead); lateral flexion mal-position (mal-position)

P-A glide
Patient position: seated
Doctor position: standing or seated
Palpating Hand: thumb and thenar on the lateral aspects of the skull with fingers oriented inferior
Indifferent Hand: thumb and thenar on the lateral aspects of the skull with fingers oriented inferior
Action: induce P-A, S-I & L-M motion in an arc along the plane of the condyles; evaluate end play
Expected Normal Motion: soft, flexible, springy end feel
Findings: joint restriction / hard end feel
Indications: P-A glide restriction
Listing: PS-RS/PS-LS occiput (gonstead), flexion mal-position (mal-position)

A-P glide
Patient position: seated
Doctor position: standing or seated
Palpating Hand: hand under the occipital shelf pointing
Indifferent Hand: on top-front portion of the head
Action: induce A-P, S-I glide motion; evaluate end play
Expected Normal Motion: soft, flexible, springy end feel
Findings: joint restriction / hard end feel
Indications: A-P glide restriction
Listing: AS occiput (gonstead), extension mal-position (mal-position)
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 Atlas
L-M Glide
Patient position: seated
Doctor position: standing
Palpating Hand: contact the lateral aspect of the atlas TP with tip or pad of index or middle finger
Indifferent Hand: support the opposite mastoid; assist the lateral flexion motion
Action: with slight lateral flexion push L-M on the TP; evaluate end play
Expected Normal Motion: soft, flexible, springy end feel
Findings: joint restriction / hard end feel
Indications: restricted L-M glide
Listing: Right / Left (palmer)

P-A glide
Patient position: seated
Doctor position: standing
Palpating Hand: contact the posterior aspect of atlas TP with tip or pad of index or middle finger
Indifferent Hand: on top of the head
Action: with slight extension and lateral flexion gentle push P-A; evaluate end play
Expected Normal Motion: soft, flexible, springy end feel
Findings: joint restriction / hard end feel
Indications: restricted P-A glide
Listing: Posterior (palmer)

A-P glide
Patient position: seated
Doctor position: standing
Palpating Hand: contact the anterior aspect of atlas TP with tip or pad of index or middle finger
Indifferent Hand: on top of the head
Action: with slight flexion and lateral flexion gentle pull A-P; evaluate end play
Expected Normal Motion: soft, flexible, springy end feel
Findings: joint restriction / hard end feel
Indications: restricted A-P glide
Listing: Anterior (palmer)

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 Cervical C2 – C7
Rotation
Patient position: seated
Doctor position: standing
Palpating Hand: contact the posterior aspect of articular pillar with pad of index or middle finger
Indifferent Hand: on top of the head
Action: gently push the joint P-A; evaluate end play
Expected Normal Motion: soft, flexible, springy end feel
Findings: joint restriction / hard end feel
Indications: rotation restriction
Listing: R or L (gonstead); rotation mal-position (mal-position)

Lateral Flexion
Patient position: seated
Doctor position: standing
Palpating Hand: contact lateral aspect of articular pillar in the facet joint space with middle finger
Indifferent Hand: on top of the head
Action: laterally flex the segment around your palpating finger isolating the facet joint
Expected Normal Motion: lateral bending and closing of the facet joint on the side of lateral flexion
Findings: joint restriction / hard end feel
Indications: lateral flexion restriction may be due to disc wedging or rotation (consider normal biomechanics)
Listing: R or L (gonstead) or if disc wedging S or I (gonstead); lateral flexion malposition (mal-position)

P-A Glide
Patient position: seated
Doctor position: standing
Palpating Hand: contact the posterior aspect of articular pillar with middle finger
Indifferent Hand: on top of the head
Action: with slight extension and lateral flexion gentle push P-A; evaluate end play
Expected Normal Motion: soft, flexible, springy end feel
Findings: joint restriction / hard end feel
Indications: restricted P-A glide
Listing: R or L (gonstead); rotation mal-position (mal-position)

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A-P Glide
Patient position: seated
Doctor position: standing
Palpating Hand: contact the anterior aspect of the TP with middle finger
Indifferent Hand: on top of the head
Action: with slight flexion and lateral flexion gentle pull A-P; evaluate end play
Expected Normal Motion: soft, flexible, springy end feel
Findings: joint restriction / hard end feel
Indications: restricted A-P glide
Listing: R or L (gonstead); rotation mal-position (mal-position)

Flexion/Extension
Patient position: seated
Doctor position: seated or standing
Palpating Hand: contact the inter-spinous space with index or middle fingers
Indifferent Hand: on top of the head
Action: flex and extend the spine; note normal spinous movement
Expected Normal Motion: opening (upon flexion) and closing (upon extension) of the inter-spinous spaces
Findings: joint restriction is present if inter-spinous spaces do not open and close
Indications: general restriction
Listing: non specific

Thoraco-Lumbar Spine
Rotation
Patient position: seated
Doctor position: standing
Palpating Hand: thumb or index on the lateral aspect of the spinous process or on the opposite TP
Indifferent Hand: with patient’s arms crossed, reach across the front and grasp the opposite shoulder or elbow
Action: rotate the patient toward you while gently pushing on the SP or TP; evaluate end play
Expected Normal Motion: soft, flexible, springy end feel
Findings: joint restriction / hard end feel
Indications: rotation restriction
Listing: R or L (gonstead); rotation mal-position (mal-position)

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Lateral Flexion
Patient position: seated
Doctor position: standing
Palpating Hand: thumb or index on the lateral aspect of the spinous process
Indifferent Hand: with patient’s arms crossed, reach across the front and grasp the opposite shoulder or elbow
Action: laterally flex the patient while gently pushing on the SP; evaluate end play
Expected Normal Motion: soft, flexible, springy end feel
Findings: joint restriction / hard end feel (if restriction is noted, disc wedging may be present)
Indications: R or L, if disc wedging S or I (gonstead); rotation if disc wedging lateral flexion (mal-position)

Flexion/Extension
Patient position: seated
Doctor position: seated or standing
Palpating Hand: contact the inter-spinous space with index or middle fingers
Indifferent Hand: with patient’s arms crossed, reach across the front and grasp the opposite shoulder or elbow
Action: flex and extend the spine; note normal spinous movement
Expected Normal Motion: opening (upon flexion) and closing (upon extension) of the inter-spinous spaces
Findings: joint restriction is present if inter-spinous spaces do not open and close
Indications: general restriction
Listing: non specific

The General Scan

The general scan identifies areas of restricted motion within the spine and pelvis and thus is a dynamic mopal
assessment. The general scan involves a gentle P-A gliding motion over the spine evaluating for glide
restriction. If there is a subluxation present, then there will The general scan does not identify specific joint
restrictions but simply that there is restriction within the FSU (functional spinal unit). When areas of motion
restriction are identified, they must evaluated through all ranges of motion to assess specific joint restriction.

General Scan procedure and results: During P-A glide assessment, the doctor should feel a subtle gliding
and recoil at each segment or FSU assessed. The movement should be uniform and pain free. Unilateral or
bilateral resistance or a tendency for the segment to rotate out of the sagittal plane may indicate segmental
dysfunction or joint restriction within the segment being evaluated. Further evaluation is then necessary.

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 Passive Motion Palpation
Atlas
Protraction / Retraction
Patient position: seated
Doctor position: standing
Palpating Hand: with both hands contact the atlas TP’s and mastoid process with pad of middle finger; note the
space between the mastoid and atlas TP as well as the position of TP relative to mastoid
Action: while guiding the motion, induce protraction then induce retraction
Expected Normal Motion: TP’s move posterior during protraction / TP’s move anterior during retraction
Findings: TP does not move posterior during protraction or anterior during retraction
Indications: atlas is limited during protraction (inferior atlas) / limited during retraction (superior atlas)
Listing: I or S (palmer)

Lateral Flexion
Patient position: seated
Doctor position: standing
Palpating Hand: with both hands contact the atlas TP’s and mastoid process with pad of middle finger; note the
space between the mastoid and atlas TP.
Action: laterally flex isolating the A/O joint and note the spacing between the TP and mastoid process
Expected Normal Motion: the space between the TP and mastoid process will close on the side of lateral flexion
Findings: the space between the atlas TP and mastoid process does not close on the side of lateral flexion
Indications: atlas is limited during lateral flexion (lateral atlas)
Listing: R or L (palmer)

Rotation
Patient position: seated
Doctor position: standing
Palpating Hand: with both hands contact the atlas TP’s and mastoid process with pad of middle finger; note the
space between the mastoid and atlas TP.
Action: rotate the patients head to the end of passive ROM
Expected Normal Motion: TP will move posterior on opposite side rotation and anterior on side of rotation
Findings: TP will not move posterior on opposite side of rotation; TP will not move anterior on side of rotation
Indications: atlas is limited on the (note the side) during (note the direction) rotation
Listing: atlas P or A (palmer)

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 Cervical C2 – C7

Rotation
Patient position: seated
Doctor position: standing
Palpating Hand: contact the tip of SP of the segment being evaluated as well as the SP above and below
Indifferent Hand: palm on the forehead or top-front portion of the head
Action: rotate fully and feel for a stair-stepping of the SP’s, note SP deviation opposite of rotation
Expected Normal Motion: SP’s will move from midline to opposite side of rotation following a stair-stepping
motion of the SP above and below
Findings: SP’s will not move from the midline to the opposite side of rotation
Indications: the vertebra is limited during rotation
Listing: R or L (gonstead); rotation mal-position (mal-position)

Thoraco-Lumbar Spine
Rotation
Patient position: seated
Doctor position: standing
Palpating Hand: contact the tip of SP of the segment being evaluated as well as the SP above and below
Indifferent Hand: palm on the forehead or top-front portion of the head
Action: rotate fully and feel for a stair-stepping of the SP’s, note SP deviation opposite of rotation
Expected Normal Motion: SP’s will move from midline to opposite side of rotation following a stair-stepping
motion of the SP above and below
Findings: SP’s will not move from the midline to the opposite side of rotation
Indications: the vertebra is limited during rotation
Listing: R or L (gonstead); rotation mal-position (mal-position)

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 Dynamic Mopal Evaluation of the Sacrum & Pelvis

Standing Sacro-iliac mobility test aka Gillet’s Test

Patient position: standing with hand on a wall or chair for support
Doctor position: standing or sitting behind the patient
Palpating Hand: thumb contact on the PSIS with fingers grasping the iliac crest.
Indifferent Hand: thumb contact on the 2nd sacral tubercle with fingers grasping the iliac crest
Action: Instruct the patient to lift the ipsi-lateral leg causing flexion of the ipsi-lateral ilium then instruct the
patient to lift the contra-lateral leg causing extension of the ipsi-lateral ilium
Expected Normal Motion: upon flexion of the ipsi-lateral leg, the ipsi-lateral PSIS will move posterior-inferior
relative to the sacral tubercle; upon flexion of the contra-lateral leg, the ipsi-lateral PSIS will move anterior-
superior relative to the 2nd sacral tubercle
Findings: PSIS will not move inferior upon flexion motion or superior upon extension motion
Indications: flexion restriction (AS ilium); extension restriction (PI ilium)
Listing: AS aka extension mal-position / PI ilium aka flexion malposition

Seated Sacro-iliac mobility test

Patient position: Initially with the patient prone, note the space between the R/L PSIS relative to the second
sacral tubercle; then have the patient seated at the edge of the table with feet together and knees at 90 degrees
Doctor position: sitting behind the patient
Palpating Hand: thumb contact on the PSIS with fingers grasping the iliac crest
Indifferent Hand: thumb contact on the second sacral tubercle with fingers grasping the opposite iliac crest
Action: ask patient to separate their knees
Expected Normal Motion: the PSIS will glide medially and the sacral base will glide anterior
Findings: glide restriction
Indications: L-M glide restriction (EX); M-L glide restriction (IN); P-A glide restriction of sacrum (posterior)
Listing: IN if the IN side does not glide medially; EX if the EX side does not glide medial; P-R/P-L if the
sacrum does not glide anterior

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Standing Sacral inferiority test
Patient position: standing
Doctor position: sitting behind the patient
Palpating Hands: bilaterally contact the base of sacrum with pads of index and middle fingers
Action: ask patient to laterally flex at the trunk
Expected Normal Motion: inferior movement of the sacral base on the side of lateral flexion
Findings: no inferior movement is palpated
Indications: sacrum is in an inferior position
Listing: inferior sacrum (PIL/PIR/AIL/AIR)

General Sacro-Iliac Joint Restriction

Patient position: prone
Doctor position: standing square to the table
Palpating Hand: hand heel contact on the 1st sacral tubercle with fingers directed inferior
Indifferent Hand: use this hand to evaluate the degree of leg extension; (optional) palpate SI joint for motion
Action: with the hip/pelvis on the table and without bending the knee, ask patient to lift leg off the table as high
as possible; repeat this procedure on the other leg
Expected Normal Motion: both legs will rise equally
Finding: one leg does not rise up as much as the other
Indications: general SI joint fixation/dysfunction
Listing: none specific

References:
Bergmann & Peterson - Chiropractic Technique principles and procedures
(Bergmann & Peterson, 3rd ed. ch. 5)
Schafer & Faye - Motion Palpation and Chiropractic Technique
(Schafer & Faye, 1st ed)
Gillet & Liekens, Belgian Chiropractic Research Notes
(Gillet & Leikens)

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