Construct validity of Cyriax's selective tension examination: Association of end-feels with pain at the knee and shoulder

Study Design: Descriptive. Objectives: To examine the relationship between pain and normal and abnorma l-pathologic end-feels during passive physiologic motion assessment at the knee and shoulder. We theorized that abnormal-pathologic end-feels would be more painful than normal end-feels. Background: End-feel testing and pain intensity information are part of phy sical therapy musculoskeletal patient examinations. End-feels are categoriz ed as normal or abnormal-pathologic. No previous studies have examined the relationship between pain during end-feel testing and the type of end-feel. Methods and Measures: Two physical therapists examined subjects with unilat eral knee or shoulder pain. Each subject was examined twice. Passive physio logic motions, 2 at the knee and 5 at the shoulder, were tested by applying an overpressure at the end of range of motion using standardized positions . Subjects reported the amount of pain (0-10) immediately after the evaluat or recorded the end-feel. Analyses included one-way ANOVAs and post-hoc Tuk ey's Honestly Significant Difference tests. Results: Some abnormal-pathologic end-feels were significantly more painful than the normal end-feels at both the knee and the shoulder for all physio logic motions. Among the abnormal-pathologic end-feel categories there were no statistical differences in pain intensity, although small samples in so me categories may be responsible for this finding. Conclusion: Abnormal-pathologic end-feels are associated with more pain tha n normal end-feels during passive physiologic motion testing at the knee or shoulder. Dysfunction should be suspected when abnormal-pathologic end-fee ls are present.