PATIENT EVALUATION

A.     Subjective:

•    Patient complaint

•    Location

•    Onset and duration of symptoms

•    Description of symptoms (i.e. numbness. pain [constant, dull, sharp) hypersensitivity, stiffness): use pain scale

•    Pattern of referred pain

•    Pattern of when symptoms occur (AM, PM, after activity, etc.)

•    Self-help or other formal treatment

•    Other medical problems, history

•    Concurrent medications and allergies

B.     Objective:

1.  Inspection of trigger point area:

•    Redness, swelling, warmth

•    Scars

•    Location

•    Size of trigger point

•    Referred pain with palpation

•    Single or multiple foci

•    Posture alignment

•    Extremities

•    Pelvis and sacrum alignment

2. Palpation:

•    Locate point tenderness

•    Differentiate spasm

•    Differentiate soft tissue tenderness between muscle, ligament and tendon

3. Mobility:

•  Active and passive ROM

4. Muscle Testing:

•  Of the underlying muscle

5. Provocation test:

•  Press on trigger point and assess radiating pain
pattern

6. Clearing exam for other areas:

•  Test neck, shoulders, arms, hips and legs for
secondary involvement

7. Review x-ray films, MRI or CT scans and
physician's report.

C.     Assessment:

1. Problem list

2.   Goals

3.   Treatment:

•   Iontophoresis (medications, dosages, electrode size)

•   Other modalities (e.g., spray and stretch, ice or heat, friction massage, rest, work hardening, home program, activity or sport re-education to prevent re-injury when indicated)

•   Oral or injectable medications (administered by physician, e.g., NSAIDs, corticosteroids)

D.     Plan:

1. Frequency and duration of treatment.

2.    Date(s) for assessment of progress.

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