Three articles on PainSci cite Gerwin 1997: 1. Massage Therapy for Low Back Pain (Again) 2. The Complete Guide to Trigger Points & Myofascial Pain 3. Trigger Point Doubts
PainSci commentary on Gerwin 1997: ?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 describes a failed initial attempt to confirm that the diagnosis of trigger points is reliable, and then goes on to report on greater success with practitioners who were more thoroughly trained. Unsurprisingly, the authors conclude that some diagnostic signs are more difficult to reliably detect than others, and some trigger points are harder to diagnose in some muscles than others.
~ 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.
The myofascial trigger point (MTrP) is the hallmark physical finding of the myofascial pain syndrome (MPS). The MTrP itself is characterized by distinctive physical features that include a tender point in a taut band of muscle, a local twitch response (LTR) to mechanical stimulation, a pain referral pattern characteristic of trigger points of specific areas in each muscle, and the reproduction of the patient's usual pain. No prior study has demonstrated that these physical features are reproducible among different examiners, thereby establishing the reliability of the physical examination in the diagnosis of the MPS. This paper reports an initial attempt to establish the interrater reliability of the trigger point examination that failed, and a second study by the same examiners that included a training period and that successfully established interrater reliability in the diagnosis of the MTrP. The study also showed that the interrater reliability of different features varies, the LTR being the most difficult, and that the interrater reliability of the identification of MTrP features among different muscles also varies.
- “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.
- “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.
- “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.