Physical examination to detect the presence of musculoskeletal dysfunction forms an important element of manual therapy assessment. Palpation of the spine for tenderness is a part of this manual examination. Tenderness in musculoskeletal disorders may be the result of local tissue damage or may indicate an alteration in afferent processing of mechanical stimuli by second order neurons within the dorsal horn. Pain threshold measurements appears to be the most useful among these methods as it is a traumatic and repeatable over long periods. mid-thoracic spine normally tender or does increased sensitivity in this area indicate local dysfunction is the point of concern. Comparison of the pressure pain threshold values can be used as an aid in diagnosis and as an outcome measure for therapeutic interventions.