Five articles on PainSci cite Lucas 2009: 1. The Complete Guide to Trigger Points & Myofascial Pain 2. The Complete Guide to Low Back Pain 3. Is Diagnosis for Pain Problems Reliable? 4. Trigger Point Doubts 5. Palpatory Pareidolia & Diagnosis by Touch
PainSci commentary on Lucas 2009: ?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 paper is a survey of the state of the art of trigger point diagnosis as of 2009, which is a confusing mess, unfortunately. It explains that past research has not “reported the reliability of trigger point diagnosis according to the currently proposed criteria.” The authors also explain that “there is no accepted reference standard for the diagnosis of trigger points, and data on the reliability of physical examination for trigger points are conflicting.” Given these conditions, it’s hardly surprising that the conclusion of the study was disappointing: “Physical examination cannot currently be recommended as a reliable test for the diagnosis of trigger points.”
This is essentially the same conclusion as a review the year before by Myburgh 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.
BACKGROUND: Trigger points are promoted as an important cause of musculoskeletal pain. There is no accepted reference standard for the diagnosis of trigger points, and data on the reliability of physical examination for trigger points are conflicting.
OBJECTIVES: To systematically review the literature on the reliability of physical examination for the diagnosis of trigger points.
METHODS: MEDLINE, EMBASE, and other sources were searched for articles reporting the reliability of physical examination for trigger points. Included studies were evaluated for their quality and applicability, and reliability estimates were extracted and reported.
RESULTS: Nine studies were eligible for inclusion. None satisfied all quality and applicability criteria. No study specifically reported reliability for the identification of the location of active trigger points in the muscles of symptomatic participants. Reliability estimates varied widely for each diagnostic sign, for each muscle, and across each study. Reliability estimates were generally higher for subjective signs such as tenderness (kappa range, 0.22-1.0) and pain reproduction (kappa range, 0.57-1.00), and lower for objective signs such as the taut band (kappa range, -0.08-0.75) and local twitch response (kappa range, -0.05-0.57).
CONCLUSIONS: No study to date has reported the reliability of trigger point diagnosis according to the currently proposed criteria. On the basis of the limited number of studies available, and significant problems with their design, reporting, statistical integrity, and clinical applicability, physical examination cannot currently be recommended as a reliable test for the diagnosis of trigger points. The reliability of trigger point diagnosis needs to be further investigated with studies of high quality that use current diagnostic criteria in clinically relevant patients.
- “A systematic, critical review of manual palpation for identifying myofascial trigger points: evidence and clinical significance,” Corrie Myburgh, Anders Holsgaard Larsen, and Jan Hartvigsen, Archives of Physical Medicine & Rehabilitation, 2008.
- “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:
- No long-term effects after a three-week open-label placebo treatment for chronic low back pain: a three-year follow-up of a randomized controlled trial. Kleine-Borgmann 2022 Pain.
- Exercise and education versus saline injections for knee osteoarthritis: a randomised controlled equivalence trial. Bandak 2022 Ann Rheum Dis.
- Association of Lumbar MRI Findings with Current and Future Back Pain in a Population-based Cohort Study. Kasch 2022 Spine (Phila Pa 1976).
- A double-blinded randomised controlled study of the value of sequential intravenous and oral magnesium therapy in patients with chronic low back pain with a neuropathic component. Yousef 2013 Anaesthesia.
- Is Neck Posture Subgroup in Late Adolescence a Risk Factor for Persistent Neck Pain in Young Adults? A Prospective Study. Richards 2021 Phys Ther.