Interexaminer reliability of the palpation of trigger points in the trunk and lower limb muscles

Objectives: To determine the interexaminer reliability of palpation of three characteristics of trigger points (taut band, 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: Whittler 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 randomly by four physician examiners. Main Outcome Measures: Palpation findings. esults: Kappa scores for palpation of taut bands, 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 bands, 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 band and local twitch response, and only marginally reliable for referred pain after training.