Trigger point (muscle knot) diagnosis is a tricky business

I reported on this study back in August: a 2009 survey of the accuracy of muscle knot diagnosis for the Clinical Journal of Pain. I’m highlighting it again because I think this is one of the most important nuggets of science I’ve come across this year — it’s going to make my top ten list for 2009, guaranteed.

The paper explains that past research has not “reported the reliability of trigger point diagnosis according to the currently proposed criteria.” The authors also explain that “there is no accepted reference standard for the diagnosis of trigger points, and data on the reliability of physical examination for trigger points are conflicting.” Given these conditions, it’s hardly surprising that the conclusion of the study was disappointing:

Physical examination cannot currently be recommended as a reliable test for the diagnosis of trigger points.

This is not to say that trigger points cannot be diagnosed, but it does strongly suggest that trigger point diagnosis is probably generally a bit dodgy in practice.

It’s important for both patients and professionals to understand that trigger points are clinically significant on the one hand, but also difficult to diagnose and treat. They are there, and they matter, but it’s hard to treat what you can’t find. This may explain why patients get such unpredictable results when they seek massage therapy for muscle pain.