Trigger Points: Do They Exist?
There has been a lot of debate lately in the evidence-based community about so-called “Trigger Points” whether they exist or not, and if we should abandon trying to find and treat them.
The newest evidence shows that the reliability with which a single practitioner can locate a painful trigger point on a patient without feedback is low, and the reliability between multiple practitioners being able to find the same trigger points or to agree upon the area to be treated is even lower.
Does this mean, however, that trigger points do not exist? The answer, of course, is no. The phenomena of a hypersensitive area in a band of taut muscle fibers which is exquisitely sensitive to palpation and has referred pain (pain far from the site of origin) undeniably, 100% exists.
So what does this research mean for evidence-based practice of musculoskeletal healthcare then? It means that subjective information from the patient is incredibly important to find their specific pain generators and the sources of their referred pain patterns. It means that we as clinicians must exercise humility enough to trust the patient to accurately report their pain experience and to guide our therapeutic interventions in the case of referred pain syndromes and myalgia.
The fact that Trigger points don’t seem to be reliably palpated does not mean that they don’t exist, it only means that we’re not great at finding them on our own. This distinction has muddied the waters and led to endless circular debates in the profession. It’s time to bring this debate to a close.