The EXPOSS Study and How Often Extremity Pain Comes From the Spine

The EXPOSS study, published in 2019, excluded patients who believed their pain came from the spine. Clinicians trained in Mechanical Diagnosis and Therapy took a history, checked whether a change in sitting posture affected symptoms, and set a symptomatic, mechanical or functional extremity baseline, such as groin pain, limited internal rotation and a step-down test. They then assessed the spine with repeated movements and mobilizations and rechecked the baseline. A change meant spinal treatment continued; no change meant treatment went to the extremity, with no crossovers. Of 322 patients analyzed, 43% had extremity pain of spinal source: 25% of knee, 29% of ankle and foot, 71% of hip, 38% of wrist and hand, 44% of elbow and 47% of shoulder patients. Pain between joints raised the likelihood further. Video cases show knee and thumb pain changing with posture. Posture change affected symptoms in 50% of spinal source patients, but also in 10% of the extremity group, so Georg warns that this alone is not proof.