Digitally tender points: their significance in physiotherapy

Clinicians, including physiotherapists, involved in treatment of musculoskeletal conditions, routinely identify digitally tender points in superficial tissue. The characteristics of these points and their significance for assessment, prognosis and treatment of musculoskeletal conditions are controversial. There is evidence that altered central mediation of pain may explain some digitally tender points. Muscle spindle and end-plate abnormalities have also been implicated in the development of digitally tender points. Models proposed to explain muscle pain and dysfunction may provide insights into the physiological processes underlying digitally tender points. There is a need for further investigation to characterise digitally tender points and determine their significance for assessment and treatment of musculoskeletal conditions. The Strain–Counterstrain paradigm, in which tender points are located by palpation of defined anatomical sites and are used to guide passive body positioning treatment, appears to offer a convenient means for investigation of digitally tender points

Sensory characteristics of tender points in the lower back

Palpation of tender points in superficial tissue is commonly undertaken in the management of musculoskeletal pain. The sensory characteristics of digitally tender points (DTPs) have not been defined. This study had two major aims: 1) to characterise 'Strain-Counterstrain' DTPs, using quantitative sensory testing (QST) in participants with low back pain (LBP); 2) to compare corresponding points at lumbar sites in participants with LBP to those without LBP. Fifteen participants with LBP (9 females), mean (SD) Oswestry scores 20.8 (10.1)) and 15 participants without LBP (6 females) were included. QST was undertaken by a single examiner blind to the location of DTPs and included measurement of electrical detection and electrical pain threshold, thermal (hot/cold) detection and thermal pain threshold, vibration detection threshold and pressure-pain threshold. In participants with LBP, DTPs demonstrated significantly lower electrical detection and electrical pain thresholds compared to contralateral non-tender points (p < 0.0001). These findings may be indicative of altered central processing of Aβ afferents with terminal receptors at DTPs. Participants with LBP demonstrated elevated cold pain thresholds at lower back sites and at the peripheral shoulder site compared to participants without LBP (p < 0.001). This may also indicate augmented central pain processing in participants with LBP. © 2010 Elsevier Ltd

A randomised controlled study examining the short-term effects of Strain-Counterstrain treatment on quantitative sensory measures at digitally tender points in the low back

Strain-Counterstrain (SCS) intervention has been claimed to elicit immediate and sustained reductions in tenderness at digitally tender points (DTPs), however, there is little experimental evidence to support this. Twenty-eight volunteer participants with low back pain - LBP (17 females and 11 males with mean [SD] age of 39.2 [11.1] and Oswestry disability index of 15.7 [8.6]) participated in this controlled, within-participants study of the immediate and short-term effects of SCS intervention, on pressure pain threshold (PPT) electrical detection threshold (EDT) and electrical pain threshold (EPT) at DTPs in the low back region. Immediate increases in PPT at DTPs were found following all interventions; control intervention: 30.7 kPa [CI 95% - 3.3-64.8] (p= 0.041), sham-SCS intervention: 48.2 kPa [CI 95% 14.8-81.7] (p= 0.008) and SCS intervention: 93.4 kPa [CI 95% 60.0-126.9] (p< 0.0001). Results suggest that SCS intervention does elicit an immediate quantifiable reduction in tenderness at DTPs but that some of this reduction is attributable to the manual-contact component of the treatment. Increases in PPT at DTPs following SCS intervention did not appear to be maintained between 24 and 96 h after treatment. A further finding was that the control intervention elicited significant increases in both EDT (p= 0.044) and EPT (p= 0.026). The explanation for these findings is unclear. © 2010

RiSCC Manual Version 2.0

Regional Sensitivity to Climate Change in Antarctic Terrestrial and Limnetic Ecosystems (RiSCC) is an international research program on Antarctic terrestrial and limnetic organisms and ecosystems. It is sponsored by the Scientific Committee on Antarctic Research (SCAR), a committee of the International Council of Science (ICSU). The RiSCC programme was formally adopted as a research programme under the auspices of the SCAR Working Group on Biology during SCAR XXVI, in Tokyo, Japan, July 2000. A recommendation to approve of this programme was made to the Delegates Meeting of SCAR XXVI. The Delegates agreed to this recommendation. In this manual the agreed methods are being described, which are to be used in RiSCC projects. Methods presented here have been tried in polar regions under extreme conditions, or with organisms obtained from high latitudes, and have been considered appropriate, providing reliable data