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Second-year Osteopathic Student Evaluation of the Prevalence of a Positive Thomas Test and a Psoas Tender Point Before and After Treatment with Counterstrain Technique

Journal: The AAO Journal Date: 2014/03, 24(1):Pages: 21, type of study: clinical trial

Free full text   (https://www.academyofosteopathy.org/aaoj)

Keywords:

Thomas test [1]
musculus psoas [1]
tender point [11]
strain and counterstrain [24]
conference abstract [108]
clinical trial [612]

Abstract:

Objectives: Psoas muscle dysfunctions can cause low back pain. Osteopathic physicians use counterstrain to treat the tender point that can occur when there is a muscle contraction or spasm in the psoas. The Thomas test is a special test utilized to diagnosis a psoas spasm, and there have been several studies which established the Thomas test as an effective means to diagnose these dysfunctions. However, there have not been any studies that looked for a relationship between a positive Thomas test and psoas tender point presence. We had three objectives in this study: 1. to establish that subjects with a positive Thomas test would have higher odds of a positive psoas tender point; 1. to look for an improved Thomas test following treatment with the appropriate ounterstrain technique (if the tender point was present); and 1. to collect data to determine the effectiveness of counterstrain treatment for the psoas muscle as performed by students. Methods: Second-year medical students at New York Institute of Technology College of Osteopathic Medicine (NYITCOM) utilized an osteopathic manipulative medicine (OMM) lab worksheet which asked students to work in pairs and perform a Thomas test, look for a psoas tender point, and if it was present, grade it on a pain scale of 0 to 10, treat it with counterstrain and then reassess the tenderness and Thomas test. Students recorded all responses on their worksheets, which were collected at the end of the laboratory session. The student responses were analyzed as data. Results: Students with a positive Thomas test had a psoas tender point in a statistically significant higher proportion than those with a negative Thomas test (p=.04). If the subject with a positive Thomas test also had a psoas tender point that was treated, we found that 68.2% had an improved Thomas test, defined as decreased hip flexion of the affect side. Of all psoas tender points students found and treated, 3.4 was the initial mean number reported on the pain scale. After treatment the mean was reduced to 0.6, suggesting effective treatment of the psoas tender point (p<.001). Conclusions: Our results have shown that in a healthy population of second-year medical students, the finding of a positive Thomas test increases the probability a psoas tender point is present twofold. The results also demonstrated that second-year students were effective in utilizing counterstrain technique to treat a psoas tender point when found. While not statistically significant, we also showed that a large percentage of positive Thomas tests can be improved with counterstrain treatment to the psoas.


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