The EXPOSS (Extremity Pain of Spinal Source) Study was published in 2019 in the Journal of Manual & Manipulative Therapy. It turned the heads of a lot of musculoskeletal practitioners at the time. And rightfully so… the claims made were substantial and could significantly change the way we treat common issues related to the shoulders, hips, knees, etc.
The study's conclusions ultimately boil down to the methods used to assess and treat the participants/patients. A system of Mechanical Diagnosis and Therapy (MDT) was utilized NOT to find the anatomical cause of pain, but to find out how the patient’s symptoms BEHAVE due to various movements/exercises. For example, the behavior of someone's shoulder pain might be that it gets worse with repeated flexion and gets better with repeated extension. The clinician cannot be certain of the exact anatomic reason WHY the shoulder hurts when flexed, but he CAN be certain that extension makes the pain better.
Using the principles of MDT to assess/treat participants (322 total), the study results included the following:
71% of HIP pain was of a spinal source (22/31)
72.2% of THIGH/LEG pain was of a spinal source (13/18)
25.6% of KNEE pain was of a spinal source (20/78)
29.2% of ANKLE/FOOT pain was of a spinal source (14/48)
47.6% of SHOULDER pain was of spinal source (40/84)
83.3% of ARM/FOREARM pain was of spinal source (10/12)
44% of ELBOW pain was of a spinal source (11/25)
38.5% of WRIST/HAND pain was of a spinal source (10/26)
It would be misleading not to mention that all of the authors on this EXPOSS paper were extensively trained in MDT and therefore may have had a slight bias in reporting their results…. BUT their results speak for themselves in our opinion.
In summary, know that there are options out there if you’re struggling with extremity pain and haven’t found a solution. Often times it’s simply a matter of looking at the problem from a different perspective, and that perspective is something we offer here at SCWC.
