A systematic, critical review of manual palpation for identifying myofascial trigger points: Evidence and clinical significance

Objective: To determine the reproducibility of manual palpation in identifying trigger points based on a systematic review of available literature. Data Sources: Medline (1965-2007), CINHAL (1982-2007), ISI Web of Science (1945-2007), and MANTIS (1966-2007) databases and reference lists of articles. Study Selection: Reproducibility studies relating to identification and diagnosis of trigger points through palpation. Acceptable studies were required to specifically consider either inter- or intrarater reliability of trigger point identification through manual palpation and include K statistics as part of their statistical assessment. Data Extraction: Three independent reviewers considered the studies for inclusion and rated their methodologic quality based on the Standards for Reporting of Diagnostic Accuracy guidelines for the reporting of diagnostic studies. Data Synthesis: Eleven studies were initially included; however, 5 were subsequently excluded based on the inclusion and exclusion criteria. Only 2 studies were judged to be of high quality, and the level of evidence criteria suggested that, at best, moderate evidence could be found from which to make pronouncements on the literature. Only local tenderness of the trapezius (kappa range, .15-62) and pain referral of the gluteus medius (kappa range, .298-.487) and quadratus lumborum (kappa range, .36-501) were found to be reproducible. Conclusions: The methodologic quality of the majority of studies for the purpose of establishing trigger point reproducibility is generally poor. More high-quality studies are needed to comment on this procedure. Clinicians and scientists are urged to move toward simpler, global assessments of patient status.