Intra-rater reliability of an experienced physiotherapist in locating myofascial trigger points in upper trapezius muscle

Barbero, Marco; Bertoli, Paolo; Cescon, Corrado; Macmillan, Fiona; Coutts, Fiona; Gatti, Roberto

doi:10.1179/2042618612y.0000000010

Cited by 60 publications

(35 citation statements)

References 31 publications

(33 reference statements)

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“…Additionally, study participants with pain had symptoms suggesting endometriosis which limited the number with pain without an endometriosis history. We did not assess sensitization in locations remote from the pelvis nor did we identify a second physiatrist skilled in performing these neuro-musculoskeletal exams which hampered our ability to determine inter-rater reliability and may limit generalizability (37,38). The reproducibility of these techniques and findings warrant confirmation, given our small sample size.…”

Section: Discussionmentioning

confidence: 99%

Association of Chronic Pelvic Pain and Endometriosis With Signs of Sensitization and Myofascial Pain

Stratton

Khachikyan

Sinaii

et al. 2015

Obstetrics &Amp; Gynecology

157

126

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Objective To evaluate sensitization, myofascial trigger points, and quality of life in women with chronic pelvic pain with and without endometriosis. Methods A cross-sectional prospective study of women aged 18 to 50 with pain suggestive of endometriosis and healthy, pain-free volunteers without history of endometriosis. Patients underwent a physiatric neuro-musculoskeletal assessment of clinical signs of sensitization and myofascial trigger points in the abdominopelvic region. Pain symptoms, psychosocial, and quality-of-life measures were also assessed. All pain participants underwent laparoscopic excision of suspicious lesions to confirm endometriosis diagnosis by histologic evaluation. Results Patients included 18 with current, biopsy-proven endometriosis, 11 with pain only, and 20 healthy volunteers. The prevalence of sensitization as measured by regional allodynia and hyperalgesia was similar in both pain groups (83% and 82%) but much lower among healthy volunteers (15%, p<0.001). Nearly all women with pain had myofascial trigger points (94% and 91%). Adjusting for study group, those with high anxiety (OR=1.05, 95% CI:1.004–1.099; p=0.031) and depression (OR=1.06, 95% CI:1.005–1.113; p=0.032) scores were more likely to have sensitization. Pain patients with any history of endometriosis had the highest proportion of sensitization compared to the others (87% v 67% v 15%; p<0.001). Adjusting for any history of endometriosis, those with myofascial trigger points were most likely sensitized (OR=9.41, 95% CI:1.77–50.08, p=0.009). Conclusions Sensitization and myofascial trigger points were common in women with pain regardless of whether they had endometriosis at surgery. Those with any history of endometriosis were most likely to have sensitization. Traditional methods of classifying endometriosis-associated pain based on disease, duration, and anatomy are inadequate and should be replaced by a mechanism-based evaluation, as our study illustrates.

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Section: Discussionmentioning

confidence: 99%

Association of Chronic Pelvic Pain and Endometriosis With Signs of Sensitization and Myofascial Pain

Stratton

Khachikyan

Sinaii

et al. 2015

Obstetrics &Amp; Gynecology

157

126

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“…40 It has been suggested that differences in muscular activity between the left and right limbs and morphological differences in the left and right hemibody may contribute to this laterality. 41 Treating MPS and MTrPs using a combined therapeutic approach is not novel. Hou and his team 7 claimed that IFT was superior to TENS when added to combination therapy for immediate improvements in cervical myofascial pain and trigger-point sensitivity.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Effectiveness of Transcutaneous Electrical Nerve Stimulation and Interferential Therapy on the Upper Trapezius in Myofascial Pain Syndrome

Dissanayaka

Pallegama

Suraweera

et al. 2016

American Journal of Physical Medicine &Amp; Rehabilitation

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“…Barbero et al 150 reported ‘moderate to high’ intra-rater reliability of an experienced physiotherapist for determining the location of MTrPs within the upper trapezius muscle. However, in a recent systematic review on the reliability of physical examination for the diagnosis of myofascial TrPs, Lucas et al 144 concluded, ‘There is no accepted reference standard for the diagnosis of trigger points, and data on the reliability of physical examination for trigger points is conflicting’.…”

Section: Poor Inter-examiner Reliability For Trp Locationmentioning

confidence: 99%

Dry needling: a literature review with implications for clinical practice guidelines

Dunning¹,

Butts

Mourad³

et al. 2014

Physical Therapy Reviews

241

210

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Background:Wet needling uses hollow-bore needles to deliver corticosteroids, anesthetics, sclerosants, botulinum toxins, or other agents. In contrast, dry needling requires the insertion of thin monofilament needles, as used in the practice of acupuncture, without the use of injectate into muscles, ligaments, tendons, subcutaneous fascia, and scar tissue. Dry needles may also be inserted in the vicinity of peripheral nerves and/or neurovascular bundles in order to manage a variety of neuromusculoskeletal pain syndromes. Nevertheless, some position statements by several US State Boards of Physical Therapy have narrowly defined dry needling as an ‘intramuscular’ procedure involving the isolated treatment of ‘myofascial trigger points’ (MTrPs).Objectives:To operationalize an appropriate definition for dry needling based on the existing literature and to further investigate the optimal frequency, duration, and intensity of dry needling for both spinal and extremity neuromusculoskeletal conditions.Major findings:According to recent findings in the literature, the needle tip touches, taps, or pricks tiny nerve endings or neural tissue (i.e. ‘sensitive loci’ or ‘nociceptors’) when it is inserted into a MTrP. To date, there is a paucity of high-quality evidence to underpin the use of direct dry needling into MTrPs for the purpose of short and long-term pain and disability reduction in patients with musculoskeletal pain syndromes. Furthermore, there is a lack of robust evidence validating the clinical diagnostic criteria for trigger point identification or diagnosis. High-quality studies have also demonstrated that manual examination for the identification and localization of a trigger point is neither valid nor reliable between-examiners.Conclusions:Several studies have demonstrated immediate or short-term improvements in pain and/or disability by targeting trigger points (TrPs) using in-and-out techniques such as ‘pistoning’ or ‘sparrow pecking’; however, to date, no high-quality, long-term trials supporting in-and-out needling techniques at exclusively muscular TrPs exist, and the practice should therefore be questioned. The insertion of dry needles into asymptomatic body areas proximal and/or distal to the primary source of pain is supported by the myofascial pain syndrome literature. Physical therapists should not ignore the findings of the Western or biomedical ‘acupuncture’ literature that have used the very same ‘dry needles’ to treat patients with a variety of neuromusculoskeletal conditions in numerous, large scale randomized controlled trials. Although the optimal frequency, duration, and intensity of dry needling has yet to be determined for many neuromusculoskeletal conditions, the vast majority of dry needling randomized controlled trials have manually stimulated the needles and left them in situ for between 10 and 30 minute durations. Position statements and clinical practice guidelines for dry needling should be based on the best available literature, not a single paradigm or school of thought; therefore, ...

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Intra-rater reliability of an experienced physiotherapist in locating myofascial trigger points in upper trapezius muscle

Cited by 60 publications

References 31 publications

Association of Chronic Pelvic Pain and Endometriosis With Signs of Sensitization and Myofascial Pain

Association of Chronic Pelvic Pain and Endometriosis With Signs of Sensitization and Myofascial Pain

Comparison of the Effectiveness of Transcutaneous Electrical Nerve Stimulation and Interferential Therapy on the Upper Trapezius in Myofascial Pain Syndrome

Dry needling: a literature review with implications for clinical practice guidelines

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