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Interrater reliability in myofascial trigger point examination

updated

Tags: massage, trigger points doubts, diagnosis, muscle pain, manual therapy, treatment, muscle, pain problems

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 summary of 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 at the bottom of the page, as often as 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.

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