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Reliability and validity of assessment, palpation, referral pain, and locating trigger points (knots). Assessment and efficacy of manual release/massage and trigger point release techniques on common overactive muscles like the trapezius, rhomboids, pectoralis minor, rotator cuff, pectoralis major, post delt, back muscles (paraspinal), quadratus lumborum (QL), quadriceps, and calves (gastrocnemius and soleus). 

Trigger Point Assessment (and Palpation)

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I have almost completed my CPT certification and am half-way through the Human Movement certification to inform my massage practice. The different modalities of reading, watching audiovisual materials, and attending live or recorded webinars have been important to my learning style and for review.

Brookbush Institute has the most detailed, specific and effective tools for online learning for movement and/or bodywork professionals. I love the combination of the videos as well as the text available online.

I recently completed the CPT course. It was demanding yet practical. I would highly recommend it for anyone wanting an education about human movement.

I have my personal trainer certificate through here and am almost finished my human movement specialist certification. Overall, the education that Brookbush has packaged together for clinicians and trainers is invaluable. I am a physio assistant so coming from more of a rehab background I appreciate that this education has been beneficial both as a trainer and in a rehab setting. I love that I have been able to do all learning at my own pace and able to work around my schedule. Thank you for setting up this platform! Highly recommend :)

I have been a massage therapist for 10 yrs and I feel like all the “pieces” I’ve learned throughout the yrs have been put into place and can see the full picture. I am also a member to tons of great content since I love to learn! I plan to get my CPT through them as well.

I have been following Brent Brookbush for nearly a decade- back when I was a personal Trainer and now as a Physical Therapist. BBI is an incredible resource for any movement nerds and corrective exercise specialists! The information is thorough with multiple real world applications. I am looking forward to an in-person Manual Therapist course the second they do one a little bit closer to Virginia ;)

I have taken both the Human Movement Specialist and Certified Personal Trainer certificate programs and have found the value in understanding the how and ways the body moves and functions and from evidence, non-biased, outcome, conceptual, theoretical, and practical approach to helping my clients/patients look better, feel better, and move better.

Over the last years I've returned time and again to Brookbush Institute for stellar coursework as I've worked toward a Human Movement Specialist certification. (I'm currently ACE CPT, and in training with Anatomy Trains for Structural Integration Manual Therapy.) Every Brookbush Institute module is fantastic and each one includes detailed informational videos, written descriptions of how to-do, and, more importantly, why to-do!

I am a 70 yr old chiropractor and no other healthcare provider was able to come up with an exercise protocol particular to my structural and balances and muscle deficits and keep me in the game. And as for continuing education on human skeletal movement, the website is phenomenal full of great exercises for particular mechanical dysfunction.

The H.M.S. is the most valuable certificate I have earned and was a fraction of the the cost of my others. Define the best bang for your buck!

Brookbush is the most efficient Personal Training Certification I have ever come across. All the lessons are well thought out and very straight to the point.

I am getting my Master's degree in Kinesiology, and I would like to say that I have benefited greatly from the rich, comprehensive, well-documented scientific content of Brookbush Institute that links theory to practical applications. Proudly I've got my CPT certificate, and I am on my way to get my HMS certificate.

Having courses count towards different certifications makes it so users can transition seamlessly from one certification to another. In my case, going from earning the BI CPT to earning the BI HMS was an easy decision and I am proud to have earned both certifications. I have also had the pleasure of going to a Live HMS workshop that was well taught by Instructor Boettcher and that was excellent to see how the methods and techniques are implemented.



I have been a member of BBI for years and every course I have taken has been incredibly informative. I learn more from these courses than I do at local CEU courses for my PTA license. I also earned my CPT and HMS certifications through the platform. It was so convenient and the content was top notch! Forever member.

We learn principles in academia, we learn cool new modalities via whatever specialty certification, but BBI really concentrates on the nuances of passive treatment and they do a fantastic job. The format in which BBI instructs soft tissue specialists (DPTs, Chiros, ATs) like myself feels like almost like an apprenticeship. You get a thoroughly detailed explanation of the “why’s”, and a visual comprehension of how to apply. Personally, I believe application is where the good and the great are distinguished.

Brookbush has been incredibly helpful since I was in massage school and now as I’m in my career! I run my own practice and it gives me the resources I need to not only improve what I already know, but also help me navigate better, more efficient ways of treatment.

Totally loving the convenience and affordability of this program with my crazy lifestyle! I feel like I am getting a quality education without a massive cost! My favorite part is the videos I can watch in the courses. I learn so much better that way. Once I really spent more time on the site, I figured out how to maneuver around a lot better! I enjoy the sense of humor, as well as the easy explanation, and short tests. And if I am really tired, I can have the computer read me the lessons. 😁

Challenging concepts are explained in very understandable terms without dumbing down the material, and I find this program to be superior in quality to other personal training programs.

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Integrated Manual Therapist

In this course, we cover a topic that has only recently become controversial. Trigger point therapy has a relatively long history in medicine, including publications referencing trigger point injection for muscle pain in the early 1900s. Additional papers referencing the treatment of pain by addressing a trigger point, muscle knot, muscle spasm, or pressure point, start to increase in number in the 1960s. Travell and Simons published the 1st edition of their classic 2 volume set,

, in the early 1990s, including definitions of the terms trigger point, latent trigger point, active trigger point (painful trigger point), trigger point pain, and a detailed description of how trigger points may develop in muscle fibers and how they may affect normal movement. In the 1990s and early 2000s, EMG research correlated trigger points with an increase in muscle activity and muscle spasm. In the early 2000s, microdialysis was introduced, providing a more detailed account of the chemical environment of trigger points. Finally, more recent advances in imaging technology have provided the first images of active trigger points within a contracting muscle.

Additionally, in the last 3 decades, randomized controlled trials (RCTs) have compared the efficacy of conventional treatment methods to a trigger point therapy session, trigger point massage, pressure point massage, trigger point acupressure, and trigger point injections. As well as, research investigating therapies that may affect trigger points such as massage therapy and specific therapeutic exercise. The superior efficacy of adding trigger point therapy sessions to conventional treatment methods has been demonstrated for the treatment of neck pain, tension headache, whiplash syndrome, chronic pain of the low back, knee pain, general leg pain, pain management for fibromyalgia, sports injuries, connective tissue disorders, and nerve pain.

It is rather unnerving to witness a young, under-educated group of new therapists, condemn nearly 100 years of scientific inquiry, research, and refinement. Trigger point therapy (including self-administered, manual, and needling techniques) is one of the most effective techniques available for addressing muscle tension and muscle spasm that often accompanies an increase in muscle activity, with the presence of latent trigger points and active trigger points. Further, the research is clear, that locating a trigger point in an affected muscle via palpation is reliable, with a relatively small amount of training.

We hope this course aids in providing clarity around a topic that has been confounded by a recent proliferation of misinformation. Further, this course is pre-approved for credits toward the Integrated Manual Therapist (IMT) Certification, and pre-approved for continuing education credits for sports medicine professionals and health care providers (physical therapists, athletic trainers, massage therapists, chiropractors, occupational therapists, etc.).

The majority of research investigating the reliability of trigger point assessment demonstrates moderate to excellent reliability (1- 3, 5 -8, 10- 26, 33 - 37), with only a few studies demonstrating less than moderate, or variable reliability (4, 9, 27, 32). A review of all published original research has highlighted several modifications that may improve reliability in practice. The one systematic review that could be located by Myburgh et al. (1) makes similar suggestions as below; however, ads that more high-level randomized control trials (RCTs) should be a focus of future research on this topic. Muscle-specific recommendations based on all relevant research lean heavily toward moderate to excellent reliability and are also discussed below.

Brookbush Institute Evidence-based Trigger Point Assessment

Identify muscles to be treated via movement assessment.

Palpate muscles to be treated and strum fascicles perpendicular to fiber direction to identify taut bands.

Search the taut band for a tender spot, nodule, or area of increased tissue density.

Note: Based on the current studies, trigger point assessment may use "taut bands" for direction, and referral pain patterns as confirmation, but should rely on point tenderness for identification.

For a review of muscle fiber dysfunction and trigger point etiology:

Muscle Fiber Dysfunction and Trigger Points

Course Description: Trigger Point Assessment and Palpation

Introduction

Review of muscle fiber dysfunction and trigger point etiology:

Muscle Fiber Dysfunction and Trigger Point

Trigger Point - "A hyper-irritable spot in skeletal muscle that is associated with a hypersensitive palpable nodule in a taut band. The spot is painful on compression and can give rise to characteristic referred pain, referred tenderness, motor dysfunction, and autonomic phenomena (38)."

Travell and Simons Assessment Criteria (38):

Patient's recognition of pain induced by pressure on tender nodule

Painful limit to full stretch range of motion

Jump sign (patient cringes or pulls away)

Brookbush Institute (research refined) Guidelines for Trigger Point Assessment

Search taut band for a tender spot, nodule, or area of increased tissue density.

Note: Based on the current studies, trigger point assessment may use "taut bands" for direction, referral pain patterns as confirmation, but should rely on point tenderness for identification.

Flexor Hallucis Longus (FHL) and Flexor Digitorum Longus (FDL) Manual Release

Definitions and Recommendations

Research Summary

The majority of research investigating the reliability of trigger point assessment demonstrates moderate to excellent reliability (1- 3, 5 -8, 10- 26, 33 - 37), with only a few studies demonstrating less than moderate, or variable reliability (4, 9, 27, 32). Review of all studies has highlighted several modifications that may improve reliability in practice. The one systematic review that could be located by Myburgh et al. (1) makes similar suggestions as below; however, ads that more high-level randomized control trials (RCTs) should be a focus of future research on this topic. Muscle-specific recommendations based on all relevant research lean heavily toward moderate to excellent reliability and are also discussed below.

Several studies support the validity of manual palpation for the assessment of trigger points. Mayoral del Moral et al. demonstrated good reliability and validity of manual 

 trigger points assessment by comparing both symptomatic and asymptomatic sides and between symptomatic and asymptomatic individuals (shoulder pain) using blinded assessors (17). The methodology used in the study by Ohrbach et al. was similar, demonstrating temporomandibular trigger points had a significantly lower pain pressure threshold (PPT) when compared to the same site in the contralateral muscle; further, PPT was significantly lower at sites producing referred pain compared to sites producing localized pain on palpation, and adequate reliability of trigger point assessment was demonstrated in all patient groups (34). Fryer et al. demonstrated that medial paraspinal sites identified as having abnormal tissue texture via palpation were correlated with sites with a lower PPT identified using algometry, when compared to sites immediately above, below, and on the opposite side to the abnormal region (22). A study by Zale et al. adds to the validity of manual palpation of trigger points, demonstrating a correlation between diagnosis, manual palpation, and points assessed using sonography (including the 

), further implying that ultrasound may be a useful tool for assessment (33) These studies support the validity of manual palpation by demonstrating trigger points are more sensitive to pressure than surrounding tissues, the same site on the opposite side, common trigger point sites in asymptomatic muscles, and the same trigger point site in asymptomatic individuals. Further, trigger point sites have been confirmed using various modalities, correlating manual palpation with algometry, sonography, and pain patterns related to various diagnoses.

The amount of trigger point-specific training the examiners have acquired before playing the role of the examiner in published studies is not discussed enough in the body of reliability research. The studies demonstrating poor or variable reliability, all lack trigger point specific training as part of the methodology and make no mention of the specific training or expertise of the examiners (4, 9, 27, 32). The study by Gerwin et al. is likely the most pertinent to this issue, demonstrating that inter-rater reliability of trigger point assessment was initially low, but good reliability for multiple muscles was achieved after a 3-hour training course (2). Further, it appears that level of education, i.e. general training, is not a sufficient minimum standard for reaching reliability, as a study Hsieh et al. demonstrated poor reliability between physicians, physiatrists, and chiropractors (4). It is the stance of the Brookbush Institute that the reliability of all palpation skills is an education problem, and cannot be reduced to a binary judgment of "is" or "is not" reliable. Further, reliability should be based on training specific to the technique being studied and not a general level of education.

Reliability of trigger point assessment may also be affected by sensitivity/intensity of symptoms and trigger point/muscle location. Research by Lew et al. demonstrated lower reliability in asymptomatic individuals (7), which may be due at least in part to the higher pain pressure threshold of latent trigger points as demonstrated by Hong et al. (8). This problem may be analogous to "specificity"; implying that higher rates of true-positives are noted when positive predictive values (patients are experiencing symptoms) are also higher. That is, when pain pressure threshold is reduced, the specificity of trigger point assessment increases as a result of the ease of finding an exquisitely tender spot. The depth or ease at which a muscle/trigger point may be palpated may also have an effect on reliability. For example, the study by Hsieh et al. (discussed above) demonstrated low reliability of trigger point assessment, when taut bands were used as a criterion for 

 is deep to several layers of muscle, it should not be surprising that identifying individual fascicles is more difficult, or that identifying painful sites is less reliable due to the reduction in acute pressure that can be used to identify tender points. A study by Bron et al. directly compared the reliability of various muscles and found that infraspinatus trigger point assessment was more reliable than assessing 

 and biceps brachii trigger points (16). Although depth is not the issue in the Bron et al. study, it does demonstrate that some variability in reliability may be expected depending on the muscle being palpated. These studies imply that consideration should be given to the intensity of symptoms, and the ease at which the muscle/trigger point may be palpated.

The reliability of trigger point assessment may also be affected by repeated assessments/compression in a short period of time, and whether manual palpation or algometry is used. Consideration should be given to the fact that compression is used for assessment and treatment, and sustained compression results in the desensitization of trigger points. The study by Jones et al. demonstrated good inter-rater reliability of 

 trigger point assessment but noted a decrease in sensitivity and reliability as repeated measures were taken throughout the day (12). A similar effect seems to have occurred in the study by Levoska et al., demonstrating low reliability of both dolorimetry and manual compression; however, the methodology included multiple measurements, with both techniques, within a short time frame (9). Another interesting trend in the research is better reliability of manual palpation when compared to algometry or dolorimetry. Tunks et al. demonstrated that manual palpation of trigger points in fibromyalgia patients was more reliable than algometry (38). Rasmussen et al. stated that a pressure-algometer may be useful for research, but in daily practice, palpatory examination was likely more reliable (36). Further, in an interesting study by Koo et al., manual algometry was found to be as reliable as machine (computerized) algometry for identifying trigger points (25). These studies favor manual palpation for the reliability of trigger point assessment and demonstrate that initial assessment may be more reliable than repeated assessments.

The review by Myburgh et al. (1), as well as other studies, suggest that certain criteria/signs should be prioritized to increase the reliability of trigger point assessment. Myburgh et al. found that based on the RCTs currently available, tenderness and referral pain were the most reproducible signs (1). However, a study by Hong et al. found that referral pain was not a reliable sign (8). The discrepancy in conclusions may be due to the "low sensitivity" and " high specificity" of referral pain. That is, relying on referral pain patterns alone would result in many trigger points being missed; however, if referral pain is noted it is very likely that the point is a trigger point. Hsieh et al. (discussed above) demonstrated low reliability of trigger point assessment when taut bands were used as a criterion (4); however, no training was included in this study and manual assessment without locating taut bands results in less direction-specific exploration. Last, there is a trend in the research of shying away from "snapping palpation" and a "localized twitch response" (36). This is likely due to the difficulty of teaching the "snapping palpation", which may inevitably lead to lower reliability during the formal study. Generally, reliability improves as instruction is refined and simplified, and reliability decreases with complexity. Based on the current studies, trigger point assessment may use "taut bands" for direction, referral pain patterns as confirmation, but should rely on point tenderness for identification. Other related signs may improve practitioner confidence in findings, but should not be relied upon.

Last, in an interesting study by Hollingworth et al., treating shoulder pain using trigger point release (including the 

) was more effective when a functional assessment was used to determine the trigger points addressed, as opposed to using palpation alone (21). Note, in this study, functional assessment included pain during resistance and/or restrictions in range of motion. The Brookbush Institute, always recommends starting evaluation with a dynamic postural assessment (e.g. 

), followed by more specific movement assessments (e.g. 

), and only addressing those trigger points located in muscles assessed as likely over-active.

Summary of Research Findings

Research Corner

Trapezius, Rhomboids and Pectoralis Minor

Trapezius, Rhomboids, & Pectoralis Minor

Infraspinatus & Subscapularis

Pectoralis Major & Posterior Deltoid

Paraspinals & Quadratus Lumborum

Rectus Femoris, Sartorius, Quadriceps

Gastrocnemius, Solues, Fibularis Muscles, EHL and EDL

Muscle Specific Research Findings

Additional Research

Additional studies have investigated the reliability of manual palpation for various issues. A study by Ohrbach et al. demonstrated that temporomandibular trigger points had a significantly lower pain pressure threshold (PPT) when compared to the same site in the contralateral muscle; further, PPT was significantly lower at sites producing referred pain compared to sites producing localized pain on palpation, and adequate reliability of trigger point assessment was demonstrated in all patient groups (34). Rasmussen et al. demonstrated that the use of pressure-algometry may be useful for research, but in the daily clinical routine, palpatory examination for tender points may be more reliable (35). Wolfe et al. demonstrated that palpation of tender points in fibromyalgia patients was reliable; however, referral pain pattern and twitch response were not reliable signs (36). Tunks et al. demonstrated that manual palpation of trigger points in fibromyalgia patients was actually more reliable than algometry (37). The studies above demonstrate that trigger point assessment is reliable in a variety of patient populations, and that manual palpation is likely more reliable than algometry.

Myburgh, C., Larsen, A. H., & Hartvigsen, J. (2008). A systematic, critical review of manual palpation for identifying myofascial trigger points: evidence and clinical significance. 

Archives of physical medicine and rehabilitation

Gerwin, R. D., Shannon, S., Hong, C. Z., Hubbard, D., & Gevirtz, R. (1997). Interrater reliability in myofascial trigger point examination. 

Sciotti, V. M., Mittak, V. L., DiMarco, L., Ford, L. M., Plezbert, J., Santipadri, E., … & Ball, K. (2001). Clinical precision of myofascial trigger point location in the trapezius muscle. 

Hsieh, C. Y. J., Hong, C. Z., Adams, A. H., Platt, K. J., Danielson, C. D., Hoehler, F. K., & Tobis, J. S. (2000). Interexaminer reliability of the palpation of trigger points in the trunk and lower limb muscles. 

Myburgh, C., Lauridsen, H. H., Larsen, A. H., & Hartvigsen, J. (2011). Standardized manual palpation of myofascial trigger points in relation to neck/shoulder pain; the influence of clinical experience on inter-examiner reproducibility. 

Persson, A., Brogardh, C., & Sjolund, B. H. (2004). Tender or not tender: test-retest repeatability of pressure pain thresholds in the trapezius and deltoid muscles of healthy women. 

Lew, P. C., Lewis, J., & Story, I. (1997). Inter-therapist reliability in locating latent myofascial trigger points using palpation. 

Hong, C. Z., Chen, Y. N., Twehous, D., & Hong, D. H. (1996). Pressure threshold for referred pain by compression on the trigger point and adjacent areas. 

Levoska, S., Keinänen-Kiukaanniemi, S. I. R. K. K. A., & Bloigu, R. (1993). Repeatability of measurement of tenderness in the neck-shoulder region by a dolorimeter and manual palpation. 

Barbero, M., Cescon, C., Tettamanti, A., Leggero, V., Macmillan, F., Coutts, F., & Gatti, R. (2013). Myofascial 

 and innervation zone locations in upper trapezius muscles. 

Jones, D. H., Kilgour, R. D., & Comtois, A. S. (2007). Test-retest reliability of pressure pain threshold measurements of the upper limb and torso in young healthy women. 

Hong, C. Z., Kuan, T. S., Chen, J. T., & Chen, S. M. (1997). Referred pain elicited by palpation and by needling of myofascial trigger points: a comparison. 

Hong, C. Z. (1998). Algometry in evaluation of trigger points and referred pain. 

do Nascimento, J. D. S., Alburquerque-Sendín, F., Vigolvino, L. P., de Oliveira, W. F., & de Oliveira Sousa, C. (2018). Inter-and intraexaminer reliability in identifying and classifying myofascial trigger points in shoulder muscles. 

Fischer, A. A. (1987). Pressure algometry over normal muscles. Standard values, validity and reproducibility of pressure threshold. 

Bron, Carel, Jo Franssen, Michel Wensing, and Rob AB Oostendorp. "Interrater reliability of palpation of myofascial trigger points in three shoulder muscles." 

Mayoral del Moral, O., Torres Lacomba, M., Russell, I. J., Sánchez Méndez, Ó., & Sánchez Sánchez, B. (2017). Validity and reliability of clinical examination in the diagnosis of myofascial pain syndrome and myofascial trigger points in upper quarter muscles. 

Al-Shenqiti, A. M., & Oldham, J. A. (2005). Test-retest reliability of myofascial trigger point detection in patients with rotator cuff tendonitis. 

De Groef, A., Van Kampen, M., Dieltjens, E., De Geyter, S., Vos, L., De Vrieze, T., … & Devoogdt, N. (2017). Identification of myofascial trigger points in breast cancer survivors with upper limb pain: interrater reliability. 

Jalil, N. A., Prateepavanich, P., & Chaudakshetrin, P. (2010). Atypical chest pain from myofascial pain syndrome of subscapularis muscle. 

Hollingworth, G. R., Ellis, R. M., & Hattersley, T. S. (1983). Comparison of injection techniques for shoulder pain: results of a double blind, randomised study. 

Fryer, G., Gibbons, P., & Morris, T. (2004). The relation between thoracic paraspinal tissues and pressure sensitivity measured by a digital algometer. 

Binderup, A. T., Arendt-Nielsen, L., & Madeleine, P. (2010). Pressure pain sensitivity maps of the neck-shoulder and the low back regions in men and women. 

Potter, L., McCarthy, C., & Oldham, J. (2006). Algometer reliability in measuring pain pressure threshold over normal spinal muscles to allow quantification of anti-nociceptive treatment effects. 

International journal of osteopathic medicine

Koo, T. K., Guo, J. Y., & Brown, C. M. (2013). Test-retest reliability, repeatability, and sensitivity of an automated deformation-controlled indentation on pressure pain threshold measurement. 

Journal of manipulative and physiological therapeutics

Nice, D. A., Riddle, D. L., Lamb, R. L., Mayhew, T. P., & Rucker, K. (1992). Intertester reliability of judgments of the presence of trigger points in patients with low back pain. 

Hua, N. K., & Van der Does, E. (1994). The occurrence and inter-rater reliability of myofascial trigger points in the quadratus lumborum and gluteus medius: a prospective study in non-specific low back pain patients and controls in general practice. 

Rozenfeld, E., Finestone, A. S., Moran, U., Damri, E., & Kalichman, L. (2017). Test-retest reliability of myofascial trigger point detection in hip and thigh areas. 

Journal of bodywork and movement therapies

Walsh, R., Kinsella, S., & McEvoy, J. (2017). The intra-rater reliability of locating and measuring the severity of latent trigger points in the quadriceps. 

Botter, A., Oprandi, G., Lanfranco, F., Allasia, S., Maffiuletti, N. A., & Minetto, M. A. (2011). Atlas of the muscle motor points for the lower limb: implications for electrical stimulation procedures and electrode positioning. 

Zuil-Escobar, J. C., Martínez-Cepa, C. B., Martín-Urrialde, J. A., & Gómez-Conesa, A. (2016). The prevalence of latent trigger points in lower limb muscles in asymptomatic subjects. 

Sanz, D. R., Lobo, C. C., López, D. L., Morales, C. R., Marín, C. S., & Corbalán, I. S. (2016). Interrater reliability in the clinical evaluation of myofascial trigger points in three ankle muscles. 

Zale, K. E., Klatt, M., Volz, K. R., Kanner, C., & Evans, K. D. (2015). A mixed-method approach to evaluating the association between myofascial trigger points and ankle/foot pain using handheld sonography equipment: a pilot study. 

Ohrbach, R., & Gale, E. N. (1989). Pressure pain thresholds, clinical assessment, and differential diagnosis: reliability and validity in patients with myogenic pain. 

Rasmussen, J. O., Smidth, M., & Hansen, T. M. (1990). Examination of tender points in soft tissue. Palpation versus pressure-algometer. 

Wolfe, F., Simons, D. G., Fricton, J., Bennett, R. M., Goldenberg, D. L., Gerwin, R., … & Sanders, H. O. (1992). The fibromyalgia and myofascial pain syndromes: a preliminary study of tender points and trigger points in persons with fibromyalgia, myofascial pain syndrome and no disease. 

Tunks, E. L. D. O. N., McCain, G. A., Hart, L. E., Teasell, R. W., Goldsmith, C. H., Rollman, G. B., … & DeShane, P. J. (1995). The reliability of examination for tenderness in patients with myofascial pain, chronic fibromyalgia and controls. 

Bibliography

Questions, comments, and criticisms are welcomed and encouraged

Trigger Point Assessment (and Palpation)

Related Courses:

Course Description: Trigger Point Assessment and Palpation

Definitions and Recommendations

Research Corner
1 Sub Section

Muscle Specific Research Findings
6 Sub Sections

Additional Research

Bibliography

Related Courses:

Comments

Guest

Trigger Point Assessment (and Palpation)

Related Courses:

Course Description: Trigger Point Assessment and Palpation

Definitions and Recommendations

Research Corner1 Sub Section

Muscle Specific Research Findings6 Sub Sections

Additional Research

Bibliography

Related Courses:

Comments

Guest

Research Corner
1 Sub Section

Muscle Specific Research Findings
6 Sub Sections