Related Experiment Video
Updated: Jul 27, 2026
Manual Muscle Testing: A Method of Measuring Extremity Muscle Strength Applied to Critically Ill Patients
Published on: April 12, 2011
Interexaminer reliability of the palpation of trigger points in the trunk and lower limb muscles
C Y Hsieh1, C Z Hong, A H Adams
1Center for Research and Spine Care, Research Division, Los Angeles College of Chiropractic, CA, USA.
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:
Whittier 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.
Results:
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.
Related Concept Videos
01:11Pulse Assessment Sites
01:24Physical Assessment of the Respiratory Tract II: Palpation
Thoracic Palpation
Thoracic palpation detects tenderness, masses, lesions, respiratory excursions, and vocal fremitus. The nurse assesses...
01:23Assessment of the Abdomen III: Palpation
01:27Assessment of the Cardiovascular System III: Palpation
Jugular Venous Pressure (JVP) Measurement
Position the patient at a thirty- to forty-five-degree angle or in a semi-fowler's position. Look for the highest point of pulsation in the internal jugular vein and measure the vertical distance to the angle of Loius or sternal angle. A normal JVP is 3-4 cm above the...