Coupled motion in the clinical examination of the patient
certainties and doubts, more than a hundred years later
Abstract
Coupling is an inherent property of vertebral mechanics incorporated as an integral part of the evaluation and treatment in the manual therapy and osteopathy field. Coupling motion has acquired clinical relevance, as its alteration was associated with various spinal pathologies, particularly spine dysfunctions. The current literature raises questions on several assumptions inherent to this model of movement synthesized in Fryette's laws and, consequently, on the diagnostic system of segmental lesions based on these principles. The purpose of this article is to review the literature concerning coupling motion, incorporating the latest works that use technology with high measurement accuracy. Secondly, to comprehensively describe the main coupling theories and analyze in a comparative way the most relevant findings. After an extensive non-systematic review of different academic databases, except for the cervical spine, consensus regarding the coupling behavior that should exist at the different vertebral levels was not found. The presence of laws governing coupling in large sectors of the spine was not empirically verified. These results suggest that resorting to a vertebral coupling for a diagnosis would be an inadequate practice. Finally, the present review discusses the implications of consistent coupling findings across studies in localized areas of the spine. Moreover, it outlines possible future directions for the application of coupling motion in clinical practice.References
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