![travell and simons heel travell and simons heel](https://cdn.shopify.com/s/files/1/0270/8663/products/Beautifeel_Rosalina_Black_2_grande.jpg)
Furthermore, in a systematic review on the reliability of physical examination for the diagnosis of myofascial trigger points, Lucas et al 3 found an unacceptable inter-rater reliability range (kappa range -0.05 to 0.57) for the local twitch response.
Travell and simons heel manual#
To our knowledge, such a study does not exist, and according to Myburgh et al, 4 the gluteus medius (kappa range 0.29 to 0.49) and the quadratus lumborum (kappa range 0.36 to 0.50) are the only muscles in the human body with distinct and predictable pain referral patterns that have acceptable reproducibility on manual examination. We would like to encourage Cotchett et al 1 to provide evidence from an original, peer-reviewed experimental study, not a textbook written by Travell and Simons, 5, 6 that supports the diagnostic accuracy and reliability for the use of “characteristic pattern of referred pain” and/or the presence of “a local twitch response” in making the diagnosis of a MTrP within the quadratus plantae, flexor digitorum brevis, or other intrinsic muscles of the foot. 2-4 Yet, irrespective of the existing evidence, Cotchett et al 1 still decided to use “a characteristic pattern of referred pain” and “a local twitch response” as 2 of the 4 criteria for the identification and diagnosis of myofascial trigger points in the foot and lower leg.
![travell and simons heel travell and simons heel](https://cdn.shopify.com/s/files/1/0270/8663/products/Dansko_Danae_Oyster_1.jpg)
In a recent systematic review, Tough et al 2 concluded, “There is a lack of robust empirical evidence validating the clinical diagnostic criteria proposed by both Travell & Simons (1999) and Fischer (1997).” In another systematic review on the reliability of physical examination for the diagnosis of myofascial trigger points, Lucas et al 3 concluded, “There is no accepted reference standard for the diagnosis of trigger points, and data on the reliability of physical examination for trigger points is conflicting.” In addition, a predictable pattern of pain referral and the local twitch response are each no longer considered sufficient or necessary for diagnosing trigger points. There are several original trials, literature reviews and meta-analyses that support our contention on this issue.
![travell and simons heel travell and simons heel](https://iaom-us.com/wp-content/uploads/2016/10/IMG_1088_web-1-e1596756070188.jpg)
Therefore, the results of the Cotchett et al 1 study, including the reported frequency counts of myofascial trigger points in specific foot intrinsic and lower leg muscles, should be questioned, or at least viewed cautiously. It was with interest and some concern that we read the study by Cotchett et al 1 published in the August 2014 issue of Physical Therapy titled “Effectiveness of trigger point dry needling for plantar heel pain: a randomized controlled trial.” While the authors reported statistically significant differences in first-step pain and foot pain in favor of trigger point dry needling over sham dry needling, it appears that the actual palpatory methods used by Cotchett et al 1 to identify the location of the target trigger points, and therefore the entry point, angulation, and depth of needle insertion, have not yet been found to possess accurate diagnostic validity or acceptable intra- or inter-examiner reliability for muscles in the foot or lower leg. (2014) On “Effectiveness of trigger point dry needling for plantar heel pain: a randomized controlled trial.” Physical Therapy, 94 (11): 1677-1680. Published as a Letter to the Editor in Physical Therapy.ĭunning J, Butts R, Perreault, T.