title: A systematic, critical review of manual palpation for identifying myofascial trigger points: evidence and clinical significance.
abstract: OBJECTIVE
  To determine the reproducibility of manual palpation in identifying trigger points based on a systematic review of available literature.
  
  
  METHODS
  Medline (1965-2007), CINHAL (1982-2007), ISI Web of Science (1945-2007), and MANTIS (1966-2007) databases and reference lists of articles.
  
  
  METHODS
  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 kappa statistics as part of their statistical assessment.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
authors.affiliation: Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark. cmyburgh@health.sdu.dk
authors.forename: Corrie
authors.initials: C
authors.lastname: Myburgh
authors.forename: Anders Holsgaard
authors.initials: AH
authors.lastname: Larsen
authors.forename: Jan
authors.initials: J
authors.lastname: Hartvigsen
mesh_terms: D006801:Humans; D009209:Myofascial Pain Syndromes / Q000175:diagnosis*; D010173:Palpation; D015203:Reproducibility of Results; D012107:Research Design