(Walsh & Hall, 2009)
Aim: The aim of this study was to determine the reliability, validity and diagnostic accuracy of manual palpation of the sciatic, tibial and common peroneal nerves in the examination of low-back related leg pain.
Methods: 45 subjects. Palpation compared to SLR + Slump. Inclusion: presence of unilateral low-back related leg pain, 18 to 70yo, English speaking. Exclusion: signs of serious pathology, history of spinal surgery or neurological disease, unable to tolerate testing process.
Palpation at the sciatic nerve at the midway point of a line from ischial tuberosity to the greater trochanter of the femur; the tibial nerve where it bisects the popliteal fossa at the mid-point of the popliteal crease; and the common peroneal nerve where it passes behind the head of fibula to wind around the neck of fibula. Bilateral simultaneous palpation. Positive if pain or discomfort on one leg or more on one leg if bilaterally. Following palpation: PPT measured at same spots. 3 measures 10 s rest, asymptomatic leg then symptomatic, mean of 3 measures taken. Proximal to distal. 2nd blinded examiner did Slump and SLR. For each test, reproduction of presenting symptoms, which was made worse by dorsiflexion, was recorded as a positive finding. Positive if +ve Slump AND +ve SLR. First 20 subjects did the exact same procedure with a 3rd examiner to measure inter tester reliability.
Results: Reliability: Substantial agreement was found for all palpation tests. K=0,7-0,8. PPT reliability demonstrated excellent inter-tester reliability.
Validity: There were no significant differences in PPTs between sides at any of the nerves in subjects who were negative on manual palpation. In subjects who were positive on manual palpation, mean PPTs were significantly lower on the symptomatic side compared to the asymptomatic side for each of the nerves
Limitations: Small sample from Australia, SLR and Slump non gold standard.
In Practice: This study provides support for the use of nerve palpation in clinical examination, with evidence of excellent reliability and diagnostic accuracy as well as validity of manual palpation for three lower limb nerve sites.
Walsh, J., & Hall, T. (2009). Reliability, validity and diagnostic accuracy of palpation of the sciatic, tibial and common peroneal nerves in the examination of low back related leg pain. Manual Therapy, 14(6), 623–629. https://doi.org/10.1016/j.math.2008.12.007