Four articles on PainSci cite Myburgh 2008: 1. The Complete Guide to Trigger Points & Myofascial Pain 2. Is Diagnosis for Pain Problems Reliable? 3. Trigger Point Doubts 4. Palpatory Pareidolia & Diagnosis by Touch
PainSci commentary on Myburgh 2008: ?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.
This 2008 review of the reliability of trigger point diagnosis resoundingly concluded that the question simply hasn’t been properly studied. The authors urge clinicians and scientists to “move toward simpler, global assessments of patient status.” Translation: “Nothing to see here, move along!”
This is essentially the same conclusion as a 2009 review by Lucas et al.
~ Paul Ingraham
original abstract †Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.
OBJECTIVE: To determine the reproducibility of manual palpation in identifying trigger points based on a systematic review of available literature.
DATA SOURCES: Medline (1965-2007), CINHAL (1982-2007), ISI Web of Science (1945-2007), and MANTIS (1966-2007) databases and reference lists of articles.
STUDY SELECTION: Reproducibility studies relating to identification and diagnosis of trigger points through palpation. Acceptable studies were required to specifically consider either inter- or intrarater reliability of trigger point identification through manual palpation and include kappa statistics as part of their statistical assessment.
DATA EXTRACTION: Three independent reviewers considered the studies for inclusion and rated their methodologic quality based on the Standards for Reporting of Diagnostic Accuracy guidelines for the reporting of diagnostic studies.
DATA SYNTHESIS: Eleven studies were initially included; however, 5 were subsequently excluded based on the inclusion and exclusion criteria. Only 2 studies were judged to be of high quality, and the level of evidence criteria suggested that, at best, moderate evidence could be found from which to make pronouncements on the literature. Only local tenderness of the trapezius (kappa range, .15-.62) and pain referral of the gluteus medius (kappa range, .298-.487) and quadratus lumborum (kappa range, .36-.501) were found to be reproducible.
CONCLUSIONS: The methodologic quality of the majority of studies for the purpose of establishing trigger point reproducibility is generally poor. More high-quality studies are needed to comment on this procedure. Clinicians and scientists are urged to move toward simpler, global assessments of patient status.
- “Reliability of physical examination for diagnosis of myofascial trigger points: a systematic review of the literature,” Nicholas Lucas, Petra Macaskill, Les Irwig, Robert Moran, and Nikolai Bogduk, Clinical Journal of Pain, 2009.
- “Interrater Agreement of Manual Palpation for Identification of Myofascial Trigger Points: A Systematic Review and Meta-Analysis,” Alasdair T L Rathbone, Liza Grosman-Rimon, and Dinesh A Kumbhare, The Clinical Journal of Pain, 2017.
- “Clinical precision of myofascial trigger point location in the trapezius muscle,” V M Sciotti, V L Mittak, L DiMarco, L M Ford, J Plezbert, E Santipadri, J Wigglesworth, and K Ball, Pain, 2001.
- “Interrater reliability in myofascial trigger point examination,” R D Gerwin, S Shannon, C Z Hong, D Hubbard, and R Gevirtz, Pain, 1997.
- “Travell, Simons and Cargo Cult Science,” Fred Wolfe, FMperplex.com.
- “The fibromyalgia and myofascial pain syndromes: a preliminary study of tender points and trigger points in persons with fibromyalgia, myofascial pain syndrome and no disease,” F Wolfe, D G Simons, J Fricton, R M Bennett, D L Goldenberg, R Gerwin, D Hathaway, G A McCain, I J Russell, and H O Sanders, Journal of Rheumatology, 1992.
- “Interrater reliability: the kappa statistic,” Mary L McHugh, Biochem Med (Zagreb), 2012.
- “The measurement of observer agreement for categorical data,” J R Landis and G G Koch, Biometrics, 1977.
This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights:
- Photobiomodulation therapy is not better than placebo in patients with chronic nonspecific low back pain: a randomised placebo-controlled trial. Guimarães 2021 Pain.
- No effect of creatine monohydrate supplementation on inflammatory and cartilage degradation biomarkers in individuals with knee osteoarthritis. Cornish 2018 Nutr Res.
- The CANBACK trial: a randomised, controlled clinical trial of oral cannabidiol for people presenting to the emergency department with acute low back pain. Bebee 2021 Med J Aust.
- Relationships Between Sleep Quality and Pain-Related Factors for People with Chronic Low Back Pain: Tests of Reciprocal and Time of Day Effects. Gerhart 2017 Ann Behav Med.
- Modulation in the elastic properties of gastrocnemius muscle heads in individuals with plantar fasciitis and its relationship with pain. Zhou 2020 Sci Rep.