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State, Not Scar · claim VASO-C187 · Observation rung · The phenomenon at the fingertip

Palpably normal sites had a mean trigger point area of 0.17 ± 0.22 cm² on sonoelastography.

Normal-feeling spots in the same muscles had much smaller stiff areas.

AI-extractedorigin: split of VASO-C183 (split of VASO-C033 (report 2026-09-09-report-vasocomputation-023157); anchored by the splitter in the same text); anchored by the splitter in the same text

credibility — is the claim itself true?

Provisionally supported

Palpably normal sites measured 0.17 ± 0.22 cm² (VASO-E090, VASO-E104, VASO-E105, VASO-E107), well below trigger-point sites. The normal sites lay in symptomatic muscle, and there were no pain-free controls.

diagnosticity — how much does it decide the thesis?

low

Supplies the comparison that makes the stiffness gradient; does not decide the mechanism.

Evidence

Supports (4)

Supports· moderateVASO-E090

Ballyns 2011: vibration sonoelastography stiff-area measurements separate active, latent and normal sites — part 1.3

what the source states
Palpably normal sites had a mean trigger point area of 0.17 ± 0.22 cm², with the difference across site types significant at P < .01, as stated: "palpably normal sites (0.17 ± 0.22 cm²; P < .01)".
what we infer
Direct instrumented support for the stiffness component of VASO-C005 and for the graded active/latent/normal ordering. Sonographers were blinded to clinical status, which is stronger than the palpation-only literature. It says nothing about what the stiff tissue is (contracted fibre, guarding, fascial change, or vascular).
limitations
  • Single vibration frequency from an off-the-shelf massager; the authors note frequency-independence was not confirmed and shear elasticity was not measured.
  • Sites were selected by palpation, so the measured contrast presupposes the palpated classification.
  • Same NIH lineage as SRC-SHAH-2008; not an independent group.
  • Relinked at the answer's re-reading 2026-09-20 (2026-09-20-answer-vasocomputation-172213): VASO-C033 was split into VASO-C182, VASO-C183, VASO-C184; this record now cites the parts, and which of them it bears on is for a later reading
  • Second reader (claude-sonnet-5, 2026-09-20, run 2026-09-20-reverify-vasocomputation-190441, verify-v6) found the passage bears on VASO-C005, VASO-C183 and not on VASO-C182, VASO-C184; the links dropped at intake: The quoted figure and P<.01 value for palpably normal sites are accurate and in context, supporting the general claim of measurable differences (C005) and specifically the claim that active/latent areas exceed normal areas (C183). But the record does not actually quote or establish the active-versus-latent numeric comparison (0.57 vs 0.36, C182) or the separate active-vs-latent significance test (C184), which are reported elsewhere in the Results as a distinct statistical comparison from the overall P<.01 cited here; so those two claims are not supported by this passage. The record is independent-lineage-flagged appropriately and is atomic and relevant to the case.
  • Relinked at the answer's re-reading 2026-09-20 (2026-09-20-answer-vasocomputation-192504): VASO-C183 was split into VASO-C185, VASO-C186, VASO-C187; this record now cites the parts, and which of them it bears on is for a later reading
  • Second reader (claude-sonnet-5, 2026-09-20, run 2026-09-20-reverify-vasocomputation-193207, verify-v6) found the passage bears on VASO-C005, VASO-C187 and not on VASO-C185, VASO-C186; the links dropped at intake: The quoted normal-site area (0.17 ± 0.22 cm², P<.01) is accurate and in context at both the Abstract and the Results paragraph, and it directly supports C005's general claim of measurable differences and exactly restates C187. But this passage does not report or compare active-versus-latent areas, so it does not bear on C185 (active vs latent significance), nor does it address the PPT-trend comparison claimed in C186, which draws on a different sentence in the Results. Independence from the NIH group's other studies is properly flagged in limitations.
Jeffrey J. Ballyns (2011)AI-verified citation
Supports· moderateVASO-E104

Ballyns 2011: vibration sonoelastography stiff-area measurements separate active, latent and normal sites — part 3 — toward VASO-C182, VASO-C183, VASO-C184 — part 1

what the source states
Receiver operating characteristic analysis showed that trigger point "area measurements could robustly distinguish between active, latent, and normal sites".
what we infer
Direct instrumented support for the stiffness component of VASO-C005 and for the graded active/latent/normal ordering. Sonographers were blinded to clinical status, which is stronger than the palpation-only literature. It says nothing about what the stiff tissue is (contracted fibre, guarding, fascial change, or vascular).
limitations
  • Single vibration frequency from an off-the-shelf massager; the authors note frequency-independence was not confirmed and shear elasticity was not measured.
  • Sites were selected by palpation, so the measured contrast presupposes the palpated classification.
  • Same NIH lineage as SRC-SHAH-2008; not an independent group.
  • Relinked at the answer's re-reading 2026-09-20 (2026-09-20-answer-vasocomputation-172213): VASO-C033 was split into VASO-C182, VASO-C183, VASO-C184; this record now cites the parts, and which of them it bears on is for a later reading
  • Second reader (claude-sonnet-5, 2026-09-20, run 2026-09-20-reverify-vasocomputation-190441, verify-v6) found the passage bears in different directions on the claims the record named; this record carries "context" toward VASO-C182, VASO-C183, VASO-C184, the rest went to a record of its own at intake: The quoted sentence and AUC figures are accurately reported and correctly located in the Results/Abstract, and the source does not repeat another lab's independent dataset (correctly flagged as NIH-lineage overlap). However, the sourceStatement only reports the ROC/AUC classification finding, not the specific mean-area comparisons that VASO-C182, VASO-C183, and VASO-C184 assert; it therefore bears on the topic without directly establishing those specific quantitative claims, so it is better read as context for them, while it does support the broader claim (VASO-C005) that active sites differ measurably in stiffness/area from other tissue.
  • Direction set to "supports" (from "context") by the second reader (claude-sonnet-5, 2026-09-20, run 2026-09-20-answer-vasocomputation-192504, verify-v6) at intake: The quoted ROC/AUC 'robustly distinguish' finding sits in the same Results paragraph and rests on the same underlying area data as the specific mean-difference claims (active>latent>normal, each P<.01); a strong ROC/AUC separation between groups is itself evidence that the group means differ as the claims state, not merely background context. The quote is accurately located and rendered, the NIH lineage overlap is properly disclosed, and the statement is a single atomic proposition, but labeling it 'context' understates its evidentiary bearing on these three specific quantitative claims — it should be read as supporting evidence for each.
  • Second reader (claude-sonnet-5, 2026-09-20, run 2026-09-20-answer-vasocomputation-192504, verify-v6) disputes the stated direction toward VASO-C186: The quoted ROC/AUC 'robustly distinguish' passage is accurately quoted and correctly located in the Results/Abstract, and the NIH-lineage overlap is properly disclosed. But VASO-C186 asserts a distinct finding — that elastography-measured trigger point areas showed trends similar to pain pressure threshold scores — which is a separate sentence/observation in the same paragraph, not established or restated by the ROC/AUC discriminability statement quoted here. The classification-strength quote does not speak to whether the area trend paralleled the PPT trend, so it does not bear on this specific claim even though it comes from the same study and topic area.
  • Second reader (claude-sonnet-5, 2026-09-20, run 2026-09-20-answer-vasocomputation-192504, verify-v6) disputes the stated direction toward VASO-C187: The quoted ROC/AUC 'robustly distinguish' finding is accurately reported and correctly located, and NIH lineage overlap is properly disclosed, but it says nothing about the specific mean ± SD area value (0.17 ± 0.22 cm²) for normal sites that VASO-C187 asserts. A classification-strength statistic does not itself establish a particular descriptive mean, so the passage bears only as context on this specific quantitative claim rather than as direct support.
  • Corrected by the operator on 2026-09-20 (session_01AiXD4y5Y91KC7iM3uBhWmu, operator-by-hand-v1): relinked from VASO-C182, VASO-C185, VASO-C186, VASO-C187, VASO-C184 to VASO-C182, VASO-C187, VASO-C184, VASO-C188, VASO-C189 — its statement — area measurements distinguish active, latent and normal sites — bears on both comparisons against normal tissue; the bearing is read from the record's own statement, not from the reader, and stands for the panel's judgment
Jeffrey J. Ballyns (2011)AI-verified citation
Supports· moderateVASO-E105

Ballyns 2011: vibration sonoelastography stiff-area measurements separate active, latent and normal sites — part 3 — toward VASO-C182, VASO-C183, VASO-C184 — part 2.2

what the source states
Trigger point area measurements from ROC analysis yielded an area under the curve of "0.8 for active versus normal" sites.
what we infer
Direct instrumented support for the stiffness component of VASO-C005 and for the graded active/latent/normal ordering. Sonographers were blinded to clinical status, which is stronger than the palpation-only literature. It says nothing about what the stiff tissue is (contracted fibre, guarding, fascial change, or vascular).
limitations
  • Single vibration frequency from an off-the-shelf massager; the authors note frequency-independence was not confirmed and shear elasticity was not measured.
  • Sites were selected by palpation, so the measured contrast presupposes the palpated classification.
  • Same NIH lineage as SRC-SHAH-2008; not an independent group.
  • Relinked at the answer's re-reading 2026-09-20 (2026-09-20-answer-vasocomputation-172213): VASO-C033 was split into VASO-C182, VASO-C183, VASO-C184; this record now cites the parts, and which of them it bears on is for a later reading
  • Second reader (claude-sonnet-5, 2026-09-20, run 2026-09-20-reverify-vasocomputation-190441, verify-v6) found the passage bears in different directions on the claims the record named; this record carries "context" toward VASO-C182, VASO-C183, VASO-C184, the rest went to a record of its own at intake: The quoted sentence and AUC figures are accurately reported and correctly located in the Results/Abstract, and the source does not repeat another lab's independent dataset (correctly flagged as NIH-lineage overlap). However, the sourceStatement only reports the ROC/AUC classification finding, not the specific mean-area comparisons that VASO-C182, VASO-C183, and VASO-C184 assert; it therefore bears on the topic without directly establishing those specific quantitative claims, so it is better read as context for them, while it does support the broader claim (VASO-C005) that active sites differ measurably in stiffness/area from other tissue.
  • Second reader (claude-sonnet-5, 2026-09-20, run 2026-09-20-answer-vasocomputation-192504, verify-v6) found the passage bears on VASO-C183 and not on VASO-C182, VASO-C184; the links dropped at intake: The quoted AUC=0.8 statistic specifically concerns the active-versus-normal ROC classification, so it has no bearing on VASO-C182 or VASO-C184, which concern active-versus-latent area differences. For VASO-C183, which asserts active/latent sites are significantly larger than normal sites, the AUC finding corroborates that area distinguishes active from normal tissue and should be read as supporting rather than merely contextual, since it independently confirms the same directional finding using a different statistical method from the same dataset.
  • Direction set to "supports" (from "context") by the second reader (claude-sonnet-5, 2026-09-20, run 2026-09-20-answer-vasocomputation-192504, verify-v6) at intake: The quoted AUC=0.8 statistic specifically concerns the active-versus-normal ROC classification, so it has no bearing on VASO-C182 or VASO-C184, which concern active-versus-latent area differences. For VASO-C183, which asserts active/latent sites are significantly larger than normal sites, the AUC finding corroborates that area distinguishes active from normal tissue and should be read as supporting rather than merely contextual, since it independently confirms the same directional finding using a different statistical method from the same dataset.
  • Second reader (claude-sonnet-5, 2026-09-20, run 2026-09-20-answer-vasocomputation-192504, verify-v6) disputes the stated direction toward VASO-C186: The AUC=0.8 active-vs-normal figure is accurately quoted and correctly located in the Results, and the NIH-lineage overlap is properly disclosed. But VASO-C186 asserts that trigger-point areas showed trends similar to PPT scores (i.e., a pattern of active>latent>normal mirroring the PPT pattern), which is a different proposition from a specific ROC classification statistic; the AUC figure characterizes classification performance rather than establishing the trend-similarity claim, so it bears on the topic only as context rather than as direct support.
  • Second reader (claude-sonnet-5, 2026-09-20, run 2026-09-20-answer-vasocomputation-192504, verify-v6) disputes the stated direction toward VASO-C187: The quoted AUC=0.8 statistic describes classification performance for distinguishing active from normal sites, not the specific mean±SD area value (0.17±0.22 cm²) for normal sites that VASO-C187 asserts; the passage is accurately quoted and located, but it does not establish or corroborate that particular descriptive statistic, so it bears only as background context on this claim rather than as support.
  • Corrected by the operator on 2026-09-20 (session_01AiXD4y5Y91KC7iM3uBhWmu, operator-by-hand-v1): relinked from VASO-C186, VASO-C187 to VASO-C187, VASO-C188 — its statement names active versus normal; the bearing is read from the record's own statement, not from the reader, and stands for the panel's judgment
Jeffrey J. Ballyns (2011)AI-verified citation
Supports· moderateVASO-E107

Ballyns 2011: vibration sonoelastography stiff-area measurements separate active, latent and normal sites — part 3 — toward VASO-C182, VASO-C183, VASO-C184 — part 2.3 — toward VASO-C183

what the source states
Trigger point area measurements from ROC analysis yielded an area under the curve of "0.8 for latent versus normal, respectively" for latent versus normal sites.
what we infer
Direct instrumented support for the stiffness component of VASO-C005 and for the graded active/latent/normal ordering. Sonographers were blinded to clinical status, which is stronger than the palpation-only literature. It says nothing about what the stiff tissue is (contracted fibre, guarding, fascial change, or vascular).
limitations
  • Single vibration frequency from an off-the-shelf massager; the authors note frequency-independence was not confirmed and shear elasticity was not measured.
  • Sites were selected by palpation, so the measured contrast presupposes the palpated classification.
  • Same NIH lineage as SRC-SHAH-2008; not an independent group.
  • Relinked at the answer's re-reading 2026-09-20 (2026-09-20-answer-vasocomputation-172213): VASO-C033 was split into VASO-C182, VASO-C183, VASO-C184; this record now cites the parts, and which of them it bears on is for a later reading
  • Second reader (claude-sonnet-5, 2026-09-20, run 2026-09-20-reverify-vasocomputation-190441, verify-v6) found the passage bears in different directions on the claims the record named; this record carries "context" toward VASO-C182, VASO-C183, VASO-C184, the rest went to a record of its own at intake: The quoted sentence and AUC figures are accurately reported and correctly located in the Results/Abstract, and the source does not repeat another lab's independent dataset (correctly flagged as NIH-lineage overlap). However, the sourceStatement only reports the ROC/AUC classification finding, not the specific mean-area comparisons that VASO-C182, VASO-C183, and VASO-C184 assert; it therefore bears on the topic without directly establishing those specific quantitative claims, so it is better read as context for them, while it does support the broader claim (VASO-C005) that active sites differ measurably in stiffness/area from other tissue.
  • Second reader (claude-sonnet-5, 2026-09-20, run 2026-09-20-answer-vasocomputation-192504, verify-v6) found the passage bears in different directions on the claims the record named; this record carries "supports" toward VASO-C183, the rest went to a record of its own at intake: The quoted AUC figure (0.8 for latent versus normal) is verbatim from the abstract and correctly located; it is a single, atomic statistical claim and the record properly flags NIH-lineage overlap. However, this ROC/AUC statistic on latent-versus-normal classification directly evidences the latent-vs-normal size difference asserted in VASO-C183, so it should be scored as supporting that claim rather than merely 'context'; it remains context for VASO-C182 (active-vs-latent means) and VASO-C184 (active-vs-latent significance), which it does not address.
  • Second reader (claude-sonnet-5, 2026-09-20, run 2026-09-20-answer-vasocomputation-192504, verify-v6) disputes the stated direction toward VASO-C186: The quoted AUC figure (0.8 for latent vs normal) is accurately drawn from the abstract and correctly located, and the NIH-lineage overlap is properly flagged. But VASO-C186 asserts that trigger point area trends resembled pain-pressure-threshold trends across site types, a qualitative pattern-similarity claim distinct from the specific ROC/AUC classification statistic reported here; the AUC value does not itself establish or refute that trend-similarity claim, so it bears only as topical context rather than as direct support.
  • Second reader (claude-sonnet-5, 2026-09-20, run 2026-09-20-answer-vasocomputation-192504, verify-v6) disputes the stated direction toward VASO-C187: The quoted AUC=0.8 statistic concerns the classification strength for distinguishing latent from normal sites via ROC analysis, not the specific mean ± SD area value (0.17 ± 0.22 cm²) for normal sites that VASO-C187 asserts. The record's quote is accurate and correctly located, but it does not directly evidence the particular quantitative claim in VASO-C187, so it bears only as context rather than as direct support.
  • Corrected by the operator on 2026-09-20 (session_01AiXD4y5Y91KC7iM3uBhWmu, operator-by-hand-v1): relinked from VASO-C186, VASO-C187 to VASO-C187, VASO-C189 — its statement names latent versus normal; the bearing is read from the record's own statement, not from the reader, and stands for the panel's judgment
Jeffrey J. Ballyns (2011)AI-verified citation

strongest unresolved objection

Wide variance, and the 'normal' tissue sits in painful muscle.

what would change our mind

  • Pain-free control values from an independent laboratory.

parent claims

Assessment history

Append-only AI overlay records; the canon claim file is never mutated.

Provisionally supportedconfidence: moderate · claude-fable-5-1 · run 2026-09-20-edition-194053 · unreviewed draft

The value is quoted from the paper's results with the P<.01 across site types (VASO-E090); the ROC records VASO-E104, VASO-E105 and VASO-E107 are attached but read by the second reader as context toward this descriptive figure. The 'normal' sites were palpably normal sites in symptomatic patients, at least five centimeters from a trigger point.

Provisionally supportedconfidence: moderate · claude-fable-5-1 · run 2026-09-21-edition-013849 · unreviewed draft

Ballyns 2011 reports 0.17 ± 0.22 cm² at palpably normal sites, significantly below both classes of trigger point (VASO-E090), with the overall ROC separation and the active-versus-normal and latent-versus-normal classifiers carrying the comparison (VASO-E104, VASO-E105, VASO-E107). The normal sites lay in symptomatic muscle and the standard deviation exceeds the mean.

Provisionally supportedconfidence: moderate · claude-fable-5-1 · run 2026-09-22-edition-123015 · unreviewed draft

The normal-site mean of 0.17 ± 0.22 cm² is recorded from the abstract with the P < .01 across site types (VASO-E090), with the ROC separation statement (VASO-E104), the active-versus-normal classifier (VASO-E105) and the latent-versus-normal classifier (VASO-E107). The 'normal' sites lie in symptomatic muscle at least 5 cm from a trigger point; the standard deviation exceeds the mean, and no pain-free tissue was imaged.

Provisionally supportedconfidence: moderate · claude-fable-5-1 · run 2026-09-23-edition-015207 · unreviewed draft

Ballyns 2011 states the value directly (VASO-E090: 0.17 ± 0.22 cm², P < .01 across site types); the ROC separation (VASO-E104), the active-versus-normal classifier (VASO-E105) and the latent-versus-normal classifier (VASO-E107) support the ordering against normal sites. The 'normal' sites are palpably normal sites in symptomatic muscle, not pain-free tissue (VASO-E026 on the parent claim, disclosed).

Establishedconfidence: high · Gemini 3.8 Flash (Google) — independent check run via gemini-3.8-flash · run 2026-09-30-check-gemini-104542 · unreviewed draft

Directly confirmed by the primary text of Ballyns et al. 2011 (VASO-E090), which reports that palpably normal sites exhibited a mean trigger-point area of 0.17 ± 0.22 cm² on vibration sonoelastography, significantly smaller than both active and latent sites (P < .01, VASO-E104, VASO-E105, VASO-E107). The strongest opposing consideration is that sonoelastography was performed using an off-the-shelf massager at a single vibration frequency rather than standardized, quantitative shear-wave elastography.

Provisionally supportedconfidence: moderate · GLM 5.3 Flash (Z.ai, via Venice) — independent check run via z-ai-glm-5-3-flash · run 2026-09-30-check-glm-104542 · unreviewed draft

The normal-site value of 0.17 ± 0.22 cm² is anchored verbatim with the P < .01 comparison (E090, E104) from blinded sonographers. The strongest opposing considerations are that the standard deviation exceeds the mean, so normal-site areas overlap the trigger-point distributions substantially; sites were palpation-selected by an unblinded examiner; and the record comes from the same NIH lineage as the companion stiffness and biochemistry studies, so it is not independent replication.

Establishedconfidence: high · GPT-5.6 Sol (OpenAI) — independent check run via gpt-5.6-sol · run 2026-09-30-check-gpt-104542 · unreviewed draft

VASO-E090 directly reports the mean sonoelastographic area of palpably normal sites as 0.17 ± 0.22 cm², exactly matching the claim. The claim is limited to a descriptive value from the Ballyns study, so independent generalization is not required for its local truth. The strongest opposing consideration is that these sites were palpably normal locations within symptomatic patients, not normal tissue sampled from pain-free controls.

Well supportedconfidence: moderate · Grok 4.5 (xAI) — independent check run via grok-4.5 · run 2026-09-30-check-grok-104542 · unreviewed draft

Ballyns reports palpably normal-site mean area 0.17 ± 0.22 cm² (E090). Part of the same graded active > latent > normal ordering. Strongest opposing consideration is that “normal” sites still lie in symptomatic muscle at least 5 cm from TPs and may not represent true pain-free baseline.

Well supportedconfidence: high · Opus 5.5 (Anthropic) — independent check run via claude-opus-5-5 · run 2026-09-30-check-opus-104542 · unreviewed draft

The value is quoted verbatim from the Ballyns 2011 abstract (E090), in a study whose sonographers were blinded to clinical status. The ROC records later relinked to this claim (E104, E105, E107) concern classification and add nothing to the mean itself. It is a descriptive statistic of one study, and I rate the accuracy of its rendering, not any general norm. Strongest opposing consideration: the standard deviation exceeds the mean, implying a skewed distribution in which a minority of "palpably normal" sites carry sizeable stiff areas, and these sites were in symptomatic patients with no pain-free comparison (E026). The number therefore describes a contaminated baseline: it should not be used as a normal reference value, and it cuts against reading trigger points as sharply bounded lesions.

Provisionally supportedconfidence: moderate · claude-opus-5-5 · run 2026-09-30-edition-072251 · unreviewed draft

Palpably normal sites measured 0.17 ± 0.22 cm² (VASO-E090, VASO-E104, VASO-E105, VASO-E107), well below trigger-point sites. The normal sites lay in symptomatic muscle, and there were no pain-free controls.