An Exploration of Zink’s Common Compensatory Pattern: Comparing Myofascial Restrictions to Segmental Spinal Somatic Dysfunctions: A Retrospective Study
Authors: Sanchez Jesus , Brohard Justin , Thai Richard 
Published: August 2021

Abstract

Background
Zink’s Common Compensatory Pattern (CCP) is a pattern of somatic dysfunction that can be observed in the spinal transitional zones. The CCP can be described as left/right/left/right rotation in the regions of C0/C1/C2, C7/T1, T12/L1, and L5/S1, respectively. It has been proposed that Zink’s pattern can be identified by both myofascial and segmental assessments. This retrospective study investigates myofascial restrictions and spinal somatic dysfunctions to determine whether an agreement exists between myofascial rotation restrictions and osteopathic structural exam findings.

Methods
Osteopathic manipulative medicine (OMM) screening exams were completed for incoming first-year osteopathic medical students at the Western University of Health Sciences College of Osteopathic Medicine of the Pacific in August 2012. In this retrospective study, there were 208 participants, of which 15 had documented significant previous medical history. For the structural exam, rotational restrictions were assessed at OA, C7, T12, and L5. Myofascial restrictions were assessed at the craniocervical, cervicothoracic, thoracolumbar, and lumbosacral transitional zones.
This method of assessment creates 8 separate variables. These variables were recorded using a simple binomial system with 3 options: R for right rotation, L for left rotation, and O for lack of rotational restriction. The authors then evaluated these variables using kappa statistical analysis and the Fisher’s exact test to determine if there was any statistically or clinically significant correlation present between the structural findings and the myofascial restrictions.

Results
Of the 208 participants, 14 individuals (6.731%) matched all 4 of the structural exam restrictions with the myofascial restrictions, 24 (11.538%) matched 3 of the 4 transition zones, 62 (29.808%) matched 2 zones, 73 (35.096%) matched 1, and 35 (16.827%) exhibited 0 matches.
Of the 15 individuals with documented significant previous medical history, 2 individuals (13.333%) had all 4 matches, 1 (6.667%) had 3 matches, 6 (40%) had 2 matches, and 6 (40%) had 1 match.
Of the 198 individuals without significant limitations, 12 individuals (6.218%) had all 4 matches, 23 (11.917%) had 3 matches, 56 (29.016%) had 2 matches, 67 (34.715%) had 1 match, and 35 (18.135%) lacked any agreement between structural and myofascial findings.
On initial kappa analysis with all 208 participants, the authors found a total of 325 matches within the data, yielding a kappa value of 0.0527 with a 95% confidence interval of 0.0025 to 0.1028. For the 15 participants with medical limitations, the authors found the kappa value to be 0.2450 with a 95% confidence interval of 0.0615 to 0.4284 (P=0.0063). For the 198 individuals without limitations, the authors found the kappa value to be 0.0373 with a 95% confidence interval of -0.0147 to 0.0893 (P=0.1488).

Conclusion
Regarding the group of 208 participants, there is a weak, but statistically significant correlation between all data points. For the 15 individuals with significant medical limitations, there is a statistically significant correlation between structural and myofascial exam findings, excluding the lumbosacral transition zone. For the remaining 198 individuals, there is no statistically significant correlation between structural and myofascial findings.
Ambiguity of significant medical limitations and lack of interrater reliability should be addressed in future research. With the limitations of this retrospective pilot study, the authors hope to further investigate the correlation between myofascial restrictions and structural exam findings.