Intertester reliability of judgments of the presence of trigger points in patients with low back pain. Interrater reliability in myofascial trigger point examination Stimulation of myofascial trigger points with ultrasound induces segmental antinociceptive effects: A randomized controlled study Assessment of the Short-Term Effectiveness of Kinesiotaping and Trigger Points Release Used in Functional Disorders of the Masticatory Muscles Rationale, design, and baseline findings from a randomized trial of collaborative care for chronic musculoskeletal pain in primary care. Interexaminer reliability of the palpation of trigger points in the trunk and lower limb muscles. The occurrence and inter-rater reliability of myofascial trigger points in the quadratus lumborum and gluteus medius: a prospective study in non-specific low back pain patients and controls in general practice. Correlation of clinical examination characteristics with three sources of chronic low back pain. Diagnosing painful sacroiliac joints: A validity study of a McKenzie evaluation and sacroiliac provocation tests. The effect of dry needling on pain, pressure pain threshold and disability in patients with a myofascial trigger point in the upper trapezius muscle. Diagnostic utility of facet (zygapophysial) joint injections in chronic spinal pain: a systematic review of evidence. Myofascial Trigger Point-focused Head and Neck Massage for Recurrent Tension-type Headache: A Randomized, Placebo-controlled Clinical Trial Centralization as a predictor of provocation discography results in chronic low back pain, and the influence of disability and distress on diagnostic power. Effectiveness of trigger point dry needling for multiple body regions: a systematic review A Gold Standard Evaluation of the “Discogenic Pain” Diagnosis as Determined by Provocative Discography Effects of the electrical stimulation of myofascial trigger points with tension headache. Injection in the cervical facet joint for shoulder pain with myofascial trigger points in the upper trapezius muscle.
The purpose of this study was to determine the intertester reliability of assessment s of the presence of trigger points in the region of the lumbar spine of patients with low back pain ( LBP ) . A total of six trigger points described by Travell and Simons were studied . The trigger point examination procedures described by Travell and Simons were used by 12 physical therapists . R and omly paired therapists examined 50 patients for 197 trigger points . The Kappa coefficient , percent agreement , the observed proportion of positive agreement ( Ppos ) , and the observed proportion of negative agreement ( Pneg ) were used to describe reliability . Kappa values ranged from .29 to .38 . Percent agreement ranged from 76 % to 79 % . Ppos ranged from .43 to .52 . The low Kappa and Ppos values suggest different therapists are unable to reliably determine when a trigger point is present in a patient with LBP . This study suggests the usefulness of examining for the presence of trigger points in patients with LBP should be question ed Abstract 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 b and 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 Abstract Musculoskeletal pain affects a significant proportion of the general population . The myofascial trigger point is recognized as a key factor in the pathophysiology of musculoskeletal pain . Ultrasound is commonly employed in the treatment and management of soft tissue pain and , in this study , we set out to investigate the segmental antinociceptive effect of ultrasound .  Subjects ( n = 50 ) with identifiable myofascial trigger points in the supraspinatus , infraspinatus and gluteus medius muscles were selected from an outpatient rehabilitation clinic and r and omly assigned to test or control groups . Test subjects received a therapeutic dose of ultrasound to the right supraspinatus trigger point while control groups received a sham ( null ) exposure .  Baseline pain pressure threshold ( PPT ) readings were recorded at the ipsilateral infraspinatus and gluteus medius trigger‐point sites prior to ultrasound exposure . The infraspinatus point was chosen due to its segmental neurologic link with the supraspinatus point ; the gluteus medius acted as a segmental control point . Following the ultrasound intervention , PPT readings were recorded at 1 , 3 , 5 , 10 and 15 min intervals at both infraspinatus and gluteus medius trigger points ; the difference between infraspinatus and gluteus medius PPT values , PPTseg , represents the segmental influence on the PPT . The ultrasound test group demonstrated statistically significant increases in PPTseg ( decreased infraspinatus sensitivity ) at 1 , 3 and 5 min , when compared with PPTseg in the sham ultrasound group . These results establish that low‐dose ultrasound evokes short‐term segmental antinociceptive effects on trigger points which may have applications in the management of musculoskeletal pain Chronic face pain syndrome is a diagnostic and therapeutic problem for many specialists , and this proves the interdisciplinary and complex nature of this ailment . Physiotherapy is of particular importance in the treatment of pain syndrome in the course of temporom and ibular joint functional disorders . In patients with long-term dysfunction of masticatory muscles , the palpation examination can localize trigger points , that is , thickening in the form of nodules in the size of rice grains or peas . Latent trigger points located in the muscles can interfere with muscular movement patterns , cause cramps , and reduce muscle strength . Because hidden trigger points can spontaneously activate , they should be found and released to prevent further escalation of the discomfort . Kinesiotaping ( KT ) is considered as an intervention that can be used to release latent myofascial trigger points . It is a method that involves applying specific tapes to the patient 's skin in order to take advantage of the natural self-healing processes of the body . The aim of the study was to evaluate the effect of the kinesiotaping method and trigger points inactivation on the nonpharmacological elimination of pain in patients with temporom and ibular disorders . The study was conducted in 60 patients ( 18 to 35 years old ) . The subjects were r and omly divided into two subgroups of 30 people each . Group KT ( 15 women and 15 men ) were subjected to active kinesiotaping application . Group TrP , composed of 16 women and 14 men , was subjected to physiotherapy with the release of trigger points by the ischemic compression method . The results show that the KT method and TrP inactivation brought significant therapeutic analgesic effects in the course of pain-related functional disorders of the muscles of mastication . The more beneficial outcomes of the therapy were observed after using the KT method , which increased the analgesic effect in dysfunctional patients OBJECTIVE This article describes the rationale , design , and baseline findings from an ongoing study of collaborative care for chronic musculoskeletal pain and comorbid depression . DESIGN Cluster r and omized clinical trial . PARTICIPANTS AND SETTING Forty-two clinicians and 401 patients from five Veterans Affairs primary care clinics . INTERVENTION The intervention was based on the chronic care model , and included patient and provider activation and education , patient assessment , outcomes monitoring , and feedback to providers over 12 months . The intervention team consisted of a full-time psychologist care manager and a part-time physician internist . Approaches included goal setting emphasizing function , patient activation and educating about fear avoidance , and care management . OUTCOME MEASURES Main outcomes are Rol and -Morris Disability Question naire ( RMDQ ) score , depression severity ( Patient Health Question naire-9 ) , and pain severity ( Chronic Pain Grade Severity subscale ) at 6 and 12 months . BASELINE RESULTS Fifteen percent of primary care patients mailed a study advertisement letter requested screening for the study . The mean age of enrolled patients was 62 . Back and neck or joint pain diagnoses were present in 67 % and 65 % of patients , respectively . Mean pain duration was 15 years , and mean RMDQ score ( range 0 - 24 ) was 14.7 ( st and ard deviation = 4.4 ) . Sixty-five percent of patients were receiving disability . Eighteen percent of patients met criteria for major depression , 17 % for posttraumatic stress disorder , and 9 % for alcohol misuse . Thirty-nine percent of patients felt strongly that experiencing pain was a sign of damage , and 60 % reported strong avoidance of painful activities . CONCLUSIONS These baseline data support the rationale to develop a multifaceted approach to treat chronic pain in primary care that includes detection and treatment of psychiatric comorbidity OBJECTIVES To determine the interexaminer reliability of palpation of three characteristics of trigger points ( taut b and , local twitch response , and referred pain ) in patients with subacute low back pain , to determine whether training in palpation would improve reliability , and whether there was a difference between the physiatric and chiropractic physicians . DESIGN Reliability study . SETTING Whittier Health Campus , Los Angeles College of Chiropractic . PARTICIPANTS Twenty-six nonsymptomatic individuals and 26 individuals with subacute low back pain . INTERVENTION Twenty muscles per individual were first palpated by an expert and then r and omly by four physician examiners . MAIN OUTCOME MEASURES Palpation findings . RESULTS Kappa scores for palpation of taut b and s , local twitch responses , and referred pain were .215 , .123 , and .342 , respectively , between the expert and the trained examiners , and .050 , .118 , and .326 , respectively , between the expert and the untrained examiners . Kappa scores for agreement for palpation of taut b and s , twitch responses , and referred pain were .108 , -.001 , and .435 , respectively , among the nonexpert , trained examiners , and -.019 , .022 , and .320 , respectively , among the nonexpert , untrained examiners . CONCLUSIONS Among nonexpert physicians , physiatric or chiropractic , trigger point palpation is not reliable for detecting taut b and and local twitch response , and only marginally reliable for referred pain after training The presence of a trigger point is essential to the myofascial pain syndrome . This study centres on identifying clearer criteria for the presence of trigger points in the quadratus lumborum and gluteus medius muscle by investigating the occurrence and inter-rater reliability of trigger point symptoms . Using the symptoms and signs as described by Simons ' 1990 definition and two other former sets of criteria , 61 non-specific low back pain patients and 63 controls were examined in general practice by 5 observers , working in pairs . From the two major criteria of Simons ' 1990 definition only ' localized tenderness ' has good discriminative ability and inter-rater reliability ( kappa > 0.5 ) . This study does not find proof for the clinical usefulness of ' referred pain ' , which has neither of these two abilities . The criteria ' jump sign ' and ' recognition ' , on the condition that localized tenderness is present , also have good discriminative ability and inter-rater reliability . Trigger points defined by the criteria found eligible in this study allow significant distinction between non-specific low back pain patients and controls . This is not the case with trigger points defined by Simons ' 1990 criteria . Concerning reliability there is also a significant difference between the two different criteria sets . This study suggests that the clinical usefulness of trigger points is increased when localized tenderness and the presence of either jump sign or patient 's recognition of his pain complaint are used as criteria for the presence of trigger points in the M. quadratus lumborum and the M. gluteus medius BACKGROUND CONTEXT Research has demonstrated some progress in using a clinical examination to predict discogenic or sacroiliac ( SI ) joint sources of pain . No clear predictors of symptomatic lumbar zygapophysial joints have yet been demonstrated . PURPOSE To identify significant components of a clinical examination that are associated with symptomatic lumbar discs , zygapophysial joints and SI joints . STUDY DESIGN A prospect i ve , criterion-related concurrent validity study performed at a private radiology practice specializing in spinal diagnostics . PATIENT SAMPLE The sample consisted of 81 patients with chronic lumbopelvic pain referred for diagnostic injections .  OUTCOME MEASURES Contingency tables were constructed for nine features of the clinical evaluation compared with the results of diagnostic injections . Statistical analysis included chi-squared test for independence , phi and odds ratios with confidence intervals . METHOD Patients received blinded clinical examinations by physical therapists , and diagnostic injections were used as the criterion st and ard . RESULTS Significant relationships were found between discogenic pain and central ization of pain during repeated movement testing , and pain when rising from sitting . Lumbar zygapophysial joint pain was associated with absence of pain when rising from sitting . Sacroiliac joint pain was related to three or more positive pain provocation tests , pain when rising from sitting , unilateral pain and absence of lumbar pain . CONCLUSIONS Significant correlations exist between clinical examination findings and symptomatic lumbar discs , zygapophysial and SI joints . The strongest relationships were seen between SI joint pain and three or more positive pain provocation tests , central ization of pain for symptomatic discs and absence of pain when rising from sitting for symptomatic lumbar zygapophysial joints Research suggests that clinical examination of the lumbar spine and pelvis is unable to predict the results of diagnostic injections used as reference st and ards . The purpose of this study was to assess the diagnostic accuracy of a clinical examination in identifying symptomatic and asymptomatic sacroiliac joints using double diagnostic injections as the reference st and ard . In a blinded concurrent criterion-related validity design study , 48 patients with chronic lumbopelvic pain referred for diagnostic spinal injection procedures  were examined using a specific clinical examination and received diagnostic intraarticular sacroiliac joint injections . The central isation and peripheralisation phenomena were used to identify possible discogenic pain and the results from provocation sacroiliac joint tests were used as part of the clinical reasoning process . Eleven patients had sacroiliac joint pain confirmed by double diagnostic injection . Ten of the 11 sacroiliac joint patients met clinical examination criteria for having sacroiliac joint pain . In the primary subset analysis of 34 patients , sensitivity , specificity and positive likelihood ratio ( 95 % confidence intervals ) of the clinical evaluation were 91 % ( 62 to 98 ) , 83 % ( 68 to 96 ) and 6.97(2.70 to 20.27 ) respectively . The diagnostic accuracy of the clinical examination and clinical reasoning process was superior to the sacroiliac joint pain provocation tests alone . A specific clinical examination and reasoning process can differentiate between symptomatic and asymptomatic sacroiliac Dry needling ( DN ) has been used recently by physical therapists as a therapy of choice for patients with myofascial trigger points ( TrP ) . The purpose of this r and omized controlled trial was to investigate the effect of DN in the treatment of TrPs in the upper trapezius ( UT ) muscle . A sample of convenience of 33 patients with TrP in the UT muscle participated in this study . Patients were r and omly assigned to a st and ard ( N = 17 ) or experimental group ( N = 16 ) . The treatment protocol for the st and ard group consisted of trigger point compression technique ( TCT ) on MTP , while the patients in the experimental group received DN .  Pain intensity and pressure pain thresholds were assessed for both groups before and after the treatment sessions . In addition , the Disability of Arm , H and , and Shoulder ( DASH ) was administered . Statistical analysis ( paired t-test ) revealed a significant improvement in pain , PPT and DASH scores after treatment in the experimental ( DN ) and st and ard ( TCT ) group compared with before treatment ( P < 0.05 ) . The ANCOVA revealed significant differences between the DN and TCT groups on the post-measurement VAS score ( P = 0.01 ) . There was , however , no significant difference between the two groups on the post-measurement score of the PPT ( P = 0.08 ) and DASH ( P = 0.34 ) . DN produces an improvement in pain intensity , PPT and DASH and may be prescribed for subjects with TrP in UT muscles especially when pain relief is the goal of the treatment BACKGROUND Chronic refractory spinal pain poses a peculiar diagnostic challenge because of multiple putative pain sources , overlapping clinical features , and nonspecific radiologic findings . Diagnostic injection techniques are employed to isolate the source ( s ) of pain . Facet or zygapophysial joint pain is an example of spinal pain diagnosed by local anesthetic injections of the facet joint or its nerve supply . Diagnostic facet joint injections are expected to meet the cardinal features of a diagnostic test ( i.e. , accuracy , safety and reproducibility ) . Accuracy must be compared with a " gold " or criterion st and ard that can confirm presence or absence of a disease . There is , however , no available gold st and ard , such as biopsy , to measure presence or absence of pain . Hence , there is a degree of uncertainty concerning the accuracy of diagnostic facet joint injections . OBJECTIVES To evaluate accuracy , safety and reproducibility of facet or zygapophysial joint injections in diagnosing chronic spinal pain of facet joint origin . STUDY DESIGN A systematic review of the literature for clinical studies on efficacy and utility of facet joint/nerve injections in diagnosing spinal pain from facet joints . METHODS Relevant literature on diagnostic facet injections was identified through data base search es . Excluded were abstract s , review s , book chapters , case reports and studies based on single blocks or blocks without radiologic control . Prospect i ve studies with placebo control , or controlled comparative local anesthetic blocks , were given priority over retrospective studies . Each study was grade d using AHRQ and QUADAS criteria . The level of evidence was classified as conclusive , strong , moderate , limited , or inconclusive . RESULTS Available literature pointed to strong evidence for controlled comparative local anesthetic facet joint medial branch blocks in the diagnosis of neck and low back pain . There was moderate evidence in the diagnosis of pain arising from thoracic facet joints . CONCLUSION The evidence obtained from literature review suggests that controlled comparative local anesthetic blocks of facet joint nerves ( medial branch or dorsal ramus ) are reproducible , reasonably accurate , and safe . The sensitivity , specificity , false-positive rates , and predictive values of these diagnostic tests for neck and low back pain have been vali date d and reproduced in multiple studies Objective : Myofascial trigger points ( MTrPs ) are focal disruptions in the skeletal muscle that can refer pain to the head and reproduce the pain patterns of tension-type HA ( TTH ) . The present study applied massage focused on MTrPs of patients with TTH in a placebo-controlled , clinical trial to assess efficacy on reducing headache ( HA ) pain . Methods : Fifty-six patients with TTH were r and omized to receive 12 massage or placebo ( detuned ultrasound ) sessions over 6 weeks , or to wait-list . Trigger point release massage focused on MTrPs in cervical musculature . HA pain ( frequency , intensity , and duration ) was recorded in a daily HA diary . Additional outcome measures included self-report of perceived clinical change in HA pain and pressure-pain threshold at MTrPs in the upper trapezius and suboccipital muscles . Results : From diary recordings , group differences across time were detected in HA frequency ( P=0.026 ) , but not for intensity or duration . Post hoc analysis indicated that HA frequency decreased from baseline for both massage ( P<0.0003 ) and placebo ( P=0.013 ) , but no difference was detected between massage and placebo . Patient report of perceived clinical change was greater reduction in HA pain for massage than placebo or wait-list groups ( P=0.002 ) . Pressure-pain threshold improved in all muscles tested for massage only ( all P’s<0.002 ) . Discussion : Two findings from this study are apparent : ( 1 ) MTrPs are important components in the treatment of TTH , and ( 2 ) TTH , like other chronic conditions , is responsive to placebo . Clinical trials on HA that do not include a placebo group are at risk for overestimating the specific contribution from the active intervention BACKGROUND CONTEXT The " central ization phenomenon " ( CP ) is the progressive retreat of referred pain towards the spinal midline in response to repeated movement testing ( a McKenzie evaluation ) . A previous study suggested that it may have utility in the clinical diagnosis of discogenic pain and may assist patient selection for discography and specific treatments for disc pain . PURPOSE Estimation of the diagnostic predictive power of central ization and the influence of disability and patient distress on diagnostic performance , using provocation discography as a criterion st and ard for diagnosis , in chronic low back pain patients . STUDY DESIGN / SETTING This study was a prospect i ve , blinded , concurrent , reference st and ard-related validity design carried out in a private radiology clinic specializing in diagnosis of chronic spinal pain . PATIENT SAMPLE Consecutive patients with persistent low back pain were referred to the study clinic by orthopedists and other medical specialists for interventional radiological diagnostic procedures . Patients were typically disabled and displayed high levels of psychosocial distress . The sample included patients with previous lumbar surgery , and most had unsuccessful conservative therapies previously . OUTCOME MEASURES DIAGNOSIS results of provocation discography . INDEX TEST The CP . Psychometric evaluation : Rol and -Morris , Zung , Modified Somatic Perception question naires , Distress Risk Assessment Method , and 100-mm visual analog scales for pain intensity . METHODS Patients received a single physical therapy examination , followed by lumbar provocation discography .  Sensitivity , specificity , and likelihood ratios of the CP were estimated in the group as a whole and in subgroups defined by psychometric measures . RESULTS A total of 107 patients received the clinical examination and discography at two or more levels and post-discography computed tomography .  Thirty-eight could not tolerate a full physical examination and were excluded from the main analysis . Disability and pain intensity ratings were high , and distress was common . Sensitivity , specificity , and positive likelihood ratios for central ization observed during repeated movement testing for pain distribution and intensity changes were 40 % , 94 % , and 6.9 respectively . In the presence of severe disability , sensitivity , specificity , and positive likelihood ratios were 46 % , 80 % , 3.2 and for distress , 45 % , 89 % , 4.1 . In the subgroups with moderate , minimal , or no disability , sensitivity and specificity were 37 % , 100 % and for no or minimal distress 35 % , 100 % . CONCLUSIONS Central ization is highly specific to positive discography but specificity is reduced in the presence of severe disability or psychosocial distress Background : Trigger point dry needling ( TDN ) is commonly used to treat musculoskeletal pain related to myofascial trigger points ( MTrPs ) . To date , no systematic review of high- quality r and omised controlled trials ( RCTs ) investigating TDN to multiple body regions exists . Purpose : The aim of this review is to determine the effectiveness of TDN based on high- quality RCTs for all body regions . Methods : To ensure thorough reporting , Preferred Reporting Items for Systematic Review s and Meta-Analyses ( PRISMA ) guidelines were followed as the method ological basis for this systematic review . PubMed , Physiotherapy Evidence Data base ( PEDro ) , Cinahl , Cochrane and reference lists were search ed for the years 2000–2014 and the terms ‘ TDN ’ , ‘ dry needling NOT trigger point ’ , ‘ functional dry needling ’ and ‘ intramuscular manual therapy ’ . Inclusion criteria : RCTs with PEDro scores 6–10 investigating TDN . Exclusion criteria : duplicates , non-human participants , non-English language , exclusive focus on acupuncture or medicinal injections . Three investigators search ed data bases , applied criteria , read and assigned PEDro scores to every RCT . Nineteen studies met the criteria . As compared to either baseline or control groups , significant differences were found for pain ( 14 studies ) , range of motion ( ROM ) ( five studies ) and at least one item on function and quality of life measures ( six studies ) . Limitations : This review was limited by inclusion criteria , timeframe , language and data bases search ed . Conclusion : The majority of high- quality studies included in this review show measured benefit from TDN for MTrPs in multiple body areas , suggesting broad applicability of TDN treatment for multiple muscle groups . Further high- quality research is warranted to st and ardise TDN methods to determine clinical applicability Study Design . This is a prospect i ve study of the validity of a positive test result in provocative lumbar discography for the diagnosis of “ discogenic pain . ” Objective . To investigate the hypothesis that provocative discography by strict criteria accurately identifies a low back pain illness due to a primary disc lesion . Summary and Background Data . According to the Sackett and Haynes criteria for establishing diagnostic test validity , no test without a gold st and ard external st and ard can be meaningfully applied . Provocative discography as a test for determining “ discogenic pain ” has , to date , not been compared against a gold st and ard . Absent a gold st and ard reference , there can be no validity assessment or systematic improvement of test accuracy . This is the first study to apply an external gold st and ard evaluation of the diagnostic validity of discography in any manner . Methods . Over a 5-year period using a strict enrollment protocol , 32 patients with low back pain and a positive single-level low-pressure provocative discogram , underwent spinal fusion . Subjects with known patient selection comorbidities were excluded . Generic surgical limitations /morbidity were controlled by comparison to the clinical outcomes of a strictly-matched cohort of 34 patients having a well-accepted single-level lumbar pathology ( unstable spondylolisthesis ) . Treatment success was compared between groups . Results . In the control-spondylolisthesis group , 23 of 32 patients ( 72 % ) met the highly effective success criteria compared with 8 of 30 in the presumed discogenic pain cohort ( 27 % ) . The proportion of patients who met the “ minimal acceptable outcome ” was 29 of 32 ( 91 % ) in the spondylolisthesis group and 13 of 30 ( 43 % ) in the presumed discogenic pain group . Adjusting for surgical morbidity and dropout failure , by either criteria of success , the best-case positive predictive value of discography was calculated to be 50 % to 60 % . Conclusions . Positive discography was not highly predictive in identifying bona fide isolated intradiscal lesions primarily causing chronic serious LBP illness in this first study comparing discography results to a gold st and ard The effects of electrical stimulation by simple pocket size stimulator were evaluated on myofascial trigger points by pain threshold ( PTH ) algometry . The study consisted 14 patients with 76 treated trigger points in r and omly selected double blind cross-over study protocol . The effects of 30 seconds stimulation increased the PTH values 0.58 kg/cm2 in study group , but only 0.13kg/cm2 in controls ( p < 0.01 ) . These results suggested that the stimulation had positive effects on myofascial trigger points , but these effects were seen only on the treated points The goal of this double-blinded , r and omized , controlled study was to confirm the effectiveness of the cervical facet joint injection in treating shoulder pain with the myofascial trigger point in the upper trapezius muscle secondary to cervical facet lesion . Eighty-nine patients with chronic unilateral shoulder pain due to myofascial trigger points in the upper trapezius muscle received an injection to the C4 - 5 facet joint in the experimental group and to the corresponding unilateral multifidi muscle in the control group .  Subjective pain intensity and pressure pain threshold of the myofascial trigger point were assessed , and the prevalence of endplate noise in the myofascial trigger point region was measured in 28 patients before , immediately after , and 1 month after the injection . Half of the patients in the experimental group , but none of the control patients , reported being completely pain free 1 month after the injection . Both the decrease in the pain intensity and the increase in pressure pain threshold were significantly more in the experimental group than in the control group either immediately or 1 month after the injection . There was no significant difference in the change of endplate noise prevalence between the 2 groups . This study demonstrates that intra-articular or peri-articular injection into the cervical facet joint region can effectively inactivate the upper trapezius myofascial trigger point secondary to the facet lesion
On the basis of the limited number of studies available , and significant problems with their design , reporting , statistical integrity , and clinical applicability , physical examination can not currently be recommended as a reliable test for the diagnosis of trigger points .
BACKGROUND Trigger points are promoted as an important cause of musculoskeletal pain .
There is no accepted reference st and ard for the diagnosis of trigger points , and data on the reliability of physical examination for trigger points are conflicting .
OBJECTIVES To systematic ally review the literature on the reliability of physical examination for the diagnosis of trigger points .