State, Not Scar · source record · paper

Objective Sonographic Measures for Characterizing Myofascial Trigger Points Associated With Cervical Pain

Jeffrey J. Ballyns; Jay P. Shah; Jennifer Hammond; Tadesse Gebreab; Lynn H. Gerber; Siddhartha Sikdar · 2011

AI-verified citationSRC-BALLYNS-2011

identifier / locator: doi:10.7863/jum.2011.30.10.1331
url: https://pmc.ncbi.nlm.nih.gov/articles/PMC3493620/
verification note: text retrieved and shown to the drafter on 2026-09-09 (run 2026-09-09-draft-vasocomputation-040754); passages checked by the verify verb
reliability notes: Peer-reviewed primary study, J Ultrasound Med 30(10):1331–1340; text read from the NIH author manuscript (PMC3493620, NIHMSID 415997), not the publisher's version.
n = 44 patients with acute cervical pain and at least one palpable trigger point; 169 sites imaged; sonographers blinded to clinical status, examiner not.
No pain-free control group: 'normal' sites were palpably normal sites in symptomatic patients, at least 5 cm from trigger points; the authors state the blood-flow findings do not represent normal variation.
Same NIH lineage (Shah, Gerber) as SRC-SHAH-2008; not independent of that record.
The report omitted Hammond from the author list; the retrieved text names six authors.

Evidence drawn from this source

Supports· moderateVASO-E022

Ballyns 2011: arteries near active trigger points show higher pulsatility and more frequent retrograde diastolic flow — but 31% of palpably normal sites show it too

what the source states: The source states that on colour Doppler prominent vessels were seen close to trigger points and that "vessels near active sites had a significantly higher pulsatility index" (median 8.3) than normal sites (median 3.0, P < .05). It states that in 27 of 49 active sites (55%) "retrograde diastolic flow was observed compared to 21 (40%) and 15 (31%)" for latent and normal sites, with the occurrence significantly higher in active and latent than normal sites (P < .01).
what we infer: This is the primary behind the 'abnormal local hemodynamics' the ledger previously held only via the Mazza review. It supports VASO-C005 as a measurable blood-flow difference, but the difference is graded: nearly a third of palpably normal sites in these patients show the same waveform, so the signature is a gradient across symptomatic muscle, not a marker. The interrogated vessels are pulsatile arteries or enlarged arterioles typically >1 mm, within 1–2 cm of the point, not the microvessels the latch attribution names.
limitations: Within-patient 'normal' sites in symptomatic patients; no pain-free control group.
Pulsatility index was not a good classifier of site type because of large variance, per the source's ROC analysis.
Vessel caliber (>1 mm, 1–2 cm from the point) is far from the arteriolar compartment VASO-C020 requires.

Jeffrey J. Ballyns (2011)AI-verified citationVASO-C005 VASO-C031 VASO-C032

Supports· moderateVASO-E024

Ballyns 2011: resistivity index did not differ between active, latent and normal sites

what the source states: The source states that "No differences in RI values were detected between normal", latent and active sites, and that "the PI was not a good classifier of active, latent, or normal sites because of the large variance."
what we infer: A negative result recorded in its own right: one of the two Doppler indices shows no difference, and the other does not classify sites. The vascular signature at trigger points is partial, not categorical.
limitations: Within-patient comparison in symptomatic subjects; the authors attribute the similarity partly to proximity of normal sites to trigger points.

Jeffrey J. Ballyns (2011)AI-verified citationVASO-C036

Qualifies· weakVASO-E025

Ballyns 2011: the Doppler indices do not cleanly separate sites

what the source states: The source states that "No differences in RI values were detected between normal", latent and active sites, and that the pulsatility index "was not a good classifier of active, latent, or normal sites" because of large variance; it adds that blood-flow measures "did not perform well as classifiers of the site type".
what we infer: Narrows VASO-C005: blood flow differs on one index at group level but does not distinguish individual sites, and a second index shows no difference. The claim's 'measurably differ' survives in the weak group-level sense only.
limitations: Same subjects and sites as VASO-E025; not an independent observation.

Jeffrey J. Ballyns (2011)AI-verified citationVASO-C005

Qualifies· moderateVASO-E026

Ballyns 2011: no pain-free control group; 'normal' sites sit in symptomatic muscle

what the source states: The source states as a limitation that "our study did not include a control group of pain-free patients", that pain-free sites were instead marked at least 5 cm from latent and active sites, and that because all patients had at least one palpable trigger point the observed blood-flow characteristics "do not represent the normal variation".
what we infer: Every comparison in this source is within symptomatic patients. The 31% retrograde-flow figure at 'normal' sites may therefore be either a true baseline rate or spillover from neighbouring points; the source itself cannot say which. This caps the strength of VASO-E025 and VASO-E026.
limitations: Author-stated limitation; no external data on pain-free variation was shown.

Jeffrey J. Ballyns (2011)AI-verified citationVASO-C005 VASO-C031 VASO-C032

Supports· weakVASO-E027

Ballyns 2011: high-resistance flow near trigger points is compatible with compression by contracture, inflammation, or transducer pressure as much as with distal constriction

what the source states: The source reports that arteries near active and latent sites had highly pulsatile flow with retrograde diastolic flow more often than normal tissue, and that "prominent blood vessels were observed in the close vicinity of trigger points". It offers two explanations for pulsatile flow — increased compliance/volume of the vascular compartment, or increased outflow resistance — and lists possible causes of the latter: "muscle contracture at the trigger point that compresses the capillary/venous bed", anatomic geometry of the trapezius apex, local vasoconstriction due to inflammation, or externally applied pressure from the transducer. It frames its integrated-hypothesis discussion around capillary constriction, ischemia and hypoxia and notes increased vessel presence as a possible angiogenic response.
what we infer: Recorded as supporting because increased downstream resistance near trigger points is what VASO-C020's 'chronic local ischemia' predicts — but at effectively zero diagnosticity: the source itself names skeletal-muscle contracture compressing the bed (the conventional account) as a candidate cause and does not mention smooth-muscle latch. Nothing here separates arteriolar smooth muscle from mechanical compression, and the vessels observed are conduit-scale, not microvascular.
limitations: Vessels interrogated were pulsatile arteries or enlarged arterioles typically >1 mm, 1–2 cm from the point.
Alternative mechanical explanations are given equal standing by the authors.
No perfusion measurement in the muscle bed itself; Doppler waveform only.
Second reader (claude-sonnet-5, 2026-09-09) disputes the stated direction: The quotes and paraphrases accurately reflect the Doppler paragraph and Discussion text, including the equal-standing alternative explanations for pulsatile flow. However, labeling this 'supports' VASO-C020 is questionable: the source explicitly treats compression by contracture, inflammation, or transducer artifact as equally plausible alternatives to a latch-bridge vascular-autonomic mechanism, so the passage more properly qualifies or contextualizes the claim rather than affirmatively supporting it—this is registered as dissent rather than grounds for rejection. All other elements (quote fidelity, statement scope, locator accuracy, independence, relevance to the claim) check out.

Jeffrey J. Ballyns (2011)AI-verified citationVASO-C020

Supports· weakVASO-E029

Ballyns 2011: palpation is the reference standard and remains subjective

what the source states: The source states that although most trigger points are located and classified from history and physical examination, "results can vary depending on the clinician’s training and experience", and that the visual analog scale, pressure-pain threshold and palpation are the reference standards "but they are still subjective measures".
what we infer: A proponent group conceding the point the critics press: the reference standard is examiner-dependent. Weak because it is an assertion in a discussion section rather than a reliability measurement; the ledger already holds the systematic review (VASO-E011).
limitations: Statement, not measurement; this source did not test inter-examiner reliability.

Jeffrey J. Ballyns (2011)AI-verified citationVASO-C030

Context· weakVASO-E030

Ballyns 2011 pilot: trigger-point area and pulsatility index fell over follow-up visits after dry needling in three active cases

what the source states: The source reports a pilot of three active cases and one latent case imaged at later time points after dry needling: "The trigger point area and PI decreased for all 3 active cases" with time and increased slightly for the latent case; the authors state there were too few cases to draw conclusions.
what we infer: Background only for VASO-C011: an imaged change in stiffness and Doppler indices after an intervention, but over visits, not seconds, and after needling, not pressure or breath. It shows the measures move; it does not bear on the seconds-scale timescale argument.
limitations: n = 3 active cases, uncontrolled, author-flagged as too few for conclusions.
Timescale of visits, not of a release event.

Jeffrey J. Ballyns (2011)AI-verified citationVASO-C011

Supports· moderateVASO-E087

Ballyns 2011: vibration sonoelastography stiff-area measurements separate active, latent and normal sites — part 1.1

what the source states: On sonoelastography, active sites (spontaneously painful with palpable myofascial trigger points) had larger trigger points, with a mean ± SD area of 0.57 ± 0.20 cm², as stated: "active sites (spontaneously painful with palpable myofascial trigger points) had larger trigger points".
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-C182, VASO-C184 and not on VASO-C183; the link dropped at intake: The quoted phrase and the 0.57\u00b10.20 cm\u00b2 active-site value are accurately drawn from the Results/Abstract and are at the stated locator, and the statement is a fair, non-inflated account of that value, so it supports the general difference claim (C005) and, since the active value matches exactly what is needed for the active-vs-latent comparison, also bears on C182 and C184. But it says nothing about the normal-site value (0.17\u00b10.22) needed to support C183's active-and-latent-vs-normal comparison, so that claim is not borne on by this passage. Independence is properly flagged in the limitations, and the record is a single atomic proposition.

Jeffrey J. Ballyns (2011)AI-verified citationVASO-C005 VASO-C182 VASO-C184

Context· moderateVASO-E088

Ballyns 2011: vibration sonoelastography stiff-area measurements separate active, latent and normal sites — part 1.2

what the source states: Latent sites (palpable trigger points painful on palpation) had a mean trigger point area of 0.36 ± 0.16 cm², as stated: "latent sites (palpable trigger points painful on palpation; 0.36 ± 0.16 cm²)".
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-C182 and not on VASO-C183, VASO-C184; the links dropped at intake: The quote and locator are accurate and the record fairly reports the latent-site mean area (0.36 ± 0.16 cm²). This number directly matches and supports VASO-C182 (which states both means), but the record contains no normal-site value or significance test, so it does not itself bear on VASO-C183's normal-comparison claim or on VASO-C184's active-vs-latent significance claim. It only generally bears on VASO-C005's broad claim of measurable differences, so that is context rather than direct support. Independence is properly noted given shared NIH lineage.
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-C005, the rest went to a record of its own at intake: The quote and locator are accurate and the record fairly reports the latent-site mean area (0.36 ± 0.16 cm²). This number directly matches and supports VASO-C182 (which states both means), but the record contains no normal-site value or significance test, so it does not itself bear on VASO-C183's normal-comparison claim or on VASO-C184's active-vs-latent significance claim. It only generally bears on VASO-C005's broad claim of measurable differences, so that is context rather than direct support. Independence is properly noted given shared NIH lineage.

Jeffrey J. Ballyns (2011)AI-verified citationVASO-C005

Supports· moderateVASO-E089

Ballyns 2011: vibration sonoelastography stiff-area measurements separate active, latent and normal sites — part 1.2 — toward VASO-C182

what the source states: Latent sites (palpable trigger points painful on palpation) had a mean trigger point area of 0.36 ± 0.16 cm², as stated: "latent sites (palpable trigger points painful on palpation; 0.36 ± 0.16 cm²)".
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 "supports" toward VASO-C182, the rest went to a record of its own at intake: The quote and locator are accurate and the record fairly reports the latent-site mean area (0.36 ± 0.16 cm²). This number directly matches and supports VASO-C182 (which states both means), but the record contains no normal-site value or significance test, so it does not itself bear on VASO-C183's normal-comparison claim or on VASO-C184's active-vs-latent significance claim. It only generally bears on VASO-C005's broad claim of measurable differences, so that is context rather than direct support. Independence is properly noted given shared NIH lineage.

Jeffrey J. Ballyns (2011)AI-verified citationVASO-C182

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 citationVASO-C005 VASO-C187

Supports· moderateVASO-E091

Ballyns 2011: vibration sonoelastography stiff-area measurements separate active, latent and normal sites — part 2.1

what the source states: Trigger point areas assessed by vibration elastography were significantly higher at active and latent sites than at normal sites (P < .01), with "significantly higher areas compared to normal sites" as the reported finding.
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 sourceStatement only reports that active and latent sites had significantly larger areas than normal sites, which matches VASO-C183 and generally supports VASO-C005's claim of measurable differences; it says nothing about the specific active-vs-latent mean values (VASO-C182) or the active-vs-latent significance comparison (VASO-C184), which are separate findings in the source not captured by this quote.
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 and not on VASO-C185, VASO-C186, VASO-C187; the links dropped at intake: The sourceStatement only reports that active and latent sites had significantly larger trigger point areas than normal sites, which generally supports VASO-C005's claim of measurable tissue differences. It does not address the active-vs-latent comparison (VASO-C185), the trend-similarity-to-PPT observation (VASO-C186), or the specific normal-site mean value (VASO-C187), so the passage bears on none of those three.
Corrected by the operator on 2026-09-20 (session_01AiXD4y5Y91KC7iM3uBhWmu, operator-by-hand-v1): relinked from VASO-C005 to VASO-C005, VASO-C188, VASO-C189 — its statement names both active and latent sites as significantly higher than 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 citationVASO-C005 VASO-C188 VASO-C189

Supports· moderateVASO-E092

Ballyns 2011: vibration sonoelastography stiff-area measurements separate active, latent and normal sites — part 2.2

what the source states: By vibration elastography, "active sites were significantly larger than latent sites" (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-C182, VASO-C184 and not on VASO-C183; the link dropped at intake: The quoted sentence accurately reports the active-versus-latent size comparison (P<.01) from the Results section, and its statement is a fair, narrow account of that specific finding. It directly supports VASO-C184 (active > latent) and generally supports VASO-C005's broader claim about stiffness differences, but it says nothing about the specific magnitude values in C182 (0.57 vs 0.36 cm²) or about the active/latent-versus-normal comparison in C183, so it only bears as context on C182 and not at all on C183.
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 "supports" toward VASO-C005, VASO-C184, the rest went to a record of its own at intake: The quoted sentence accurately reports the active-versus-latent size comparison (P<.01) from the Results section, and its statement is a fair, narrow account of that specific finding. It directly supports VASO-C184 (active > latent) and generally supports VASO-C005's broader claim about stiffness differences, but it says nothing about the specific magnitude values in C182 (0.57 vs 0.36 cm²) or about the active/latent-versus-normal comparison in C183, so it only bears as context on C182 and not at all on C183.

Jeffrey J. Ballyns (2011)AI-verified citationVASO-C005 VASO-C184

Context· moderateVASO-E093

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

what the source states: By vibration elastography, "active sites were significantly larger than latent sites" (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 in different directions on the claims the record named; this record carries "context" toward VASO-C182, the rest went to a record of its own at intake: The quoted sentence accurately reports the active-versus-latent size comparison (P<.01) from the Results section, and its statement is a fair, narrow account of that specific finding. It directly supports VASO-C184 (active > latent) and generally supports VASO-C005's broader claim about stiffness differences, but it says nothing about the specific magnitude values in C182 (0.57 vs 0.36 cm²) or about the active/latent-versus-normal comparison in C183, so it only bears as context on C182 and not at all on C183.

Jeffrey J. Ballyns (2011)AI-verified citationVASO-C182

Supports· moderateVASO-E096

Ballyns 2011: vibration sonoelastography stiff-area measurements separate active, latent and normal sites — part 4.1

what the source states: Trigger point area measurements were "excellent classifiers of active versus normal sites" (cutoff point 0.35; AUC 0.9; 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 classifier statistic (AUC 0.9 for active vs normal, cutoff 0.35, P<.01) is accurately quoted and located, and it supports the general claim of measurable biochemical/stiffness/blood-flow differences (C005) and the specific active-vs-normal size difference claim (C183). But it says nothing about the active-vs-latent mean areas (C182) or the active-vs-latent significance test (C184), which concern a different comparison (AUC 0.8, not the AUC 0.9 quoted here); those two claims are not addressed by this particular passage.
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 and not on VASO-C185, VASO-C186, VASO-C187; the links dropped at intake: The quoted AUC 0.9 classifier statistic for active-versus-normal sites is accurately quoted, correctly located, and supports the general claim that active sites differ measurably from normal tissue (C005). But it says nothing about the active-versus-latent size comparison (C185), the trend similarity to pain pressure threshold scores (C186), or the specific normal-site mean area value (C187), which are distinct data points not addressed by this active-vs-normal classifier statement.
Corrected by the operator on 2026-09-20 (session_01AiXD4y5Y91KC7iM3uBhWmu, operator-by-hand-v1): relinked from VASO-C005 to VASO-C005, 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 citationVASO-C005 VASO-C188

Context· moderateVASO-E097

Ballyns 2011: vibration sonoelastography stiff-area measurements separate active, latent and normal sites — part 4.2

what the source states: Trigger point area measurements were "fair classifiers of latent versus normal sites" (cutoff point 0.27; AUC 0.79; 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 classifier statistic concerns only the latent-versus-normal ROC comparison (AUC 0.79), which partially supports the latent-vs-normal portion of VASO-C183 but says nothing about the active-vs-latent mean difference in VASO-C184 or the specific active-vs-latent area values in VASO-C182; it also only tangentially bears on the broader active-site claim VASO-C005 since it addresses latent, not active, sites. The quote and locator are accurate and the record properly notes shared NIH lineage, but the blanket 'supports' direction for all four claims is too broad.
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-C005, the rest went to a record of its own at intake: The quoted classifier statistic concerns only the latent-versus-normal ROC comparison (AUC 0.79), which partially supports the latent-vs-normal portion of VASO-C183 but says nothing about the active-vs-latent mean difference in VASO-C184 or the specific active-vs-latent area values in VASO-C182; it also only tangentially bears on the broader active-site claim VASO-C005 since it addresses latent, not active, sites. The quote and locator are accurate and the record properly notes shared NIH lineage, but the blanket 'supports' direction for all four claims is too broad.

Jeffrey J. Ballyns (2011)AI-verified citationVASO-C005

Supports· moderateVASO-E098

Ballyns 2011: vibration sonoelastography stiff-area measurements separate active, latent and normal sites — part 4.2 — toward VASO-C183

what the source states: Trigger point area measurements were "fair classifiers of latent versus normal sites" (cutoff point 0.27; AUC 0.79; 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 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 classifier statistic concerns only the latent-versus-normal ROC comparison (AUC 0.79), which partially supports the latent-vs-normal portion of VASO-C183 but says nothing about the active-vs-latent mean difference in VASO-C184 or the specific active-vs-latent area values in VASO-C182; it also only tangentially bears on the broader active-site claim VASO-C005 since it addresses latent, not active, sites. The quote and locator are accurate and the record properly notes shared NIH lineage, but the blanket 'supports' direction for all four claims is too broad.
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
Refused at re-verification 2026-09-20 (2026-09-20-reverify-vasocomputation-193207): second reader rejected (relevant): The quoted statistic (AUC 0.79, fair classifier of latent vs normal sites) is accurately quoted and located, but it does not bear on any of the three newly split claims: it says nothing about the active-vs-latent area difference (C185), nothing about the normal-site mean area value of 0.17±0.22 cm2 (C187), and it is a classifier-performance statistic rather than a statement about trend similarity to pain pressure threshold scores (C186). Since the passage bears on none of the named claims, the record should be refused rather than linked with 'supports.'
Corrected by the operator on 2026-09-20 (session_01AiXD4y5Y91KC7iM3uBhWmu, operator-by-hand-v1): the refusal of 2026-09-20-reverify-vasocomputation-193207 reverted — the record was read against VASO-C185, C186 and C187, none of which is the latent-versus-normal comparison its statement names; it now cites VASO-C189, the bearing read from its own words, and stands for the panel's judgment

Jeffrey J. Ballyns (2011)AI-verified citationVASO-C189

Supports· moderateVASO-E099

Ballyns 2011: vibration sonoelastography stiff-area measurements separate active, latent and normal sites — part 4.3

what the source states: Trigger point area measurements were "fair classifiers of active versus latent sites" (cutoff point 0.4; AUC 0.8; 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-C184 and not on VASO-C182, VASO-C183; the links dropped at intake: The quoted ROC statistic (fair classifier, cutoff 0.4, AUC 0.8, P<.01) is accurately quoted and correctly located in the Results section, and it does support the general finding of measurable differences (C005) and corroborates that active sites are distinguishable in area from latent sites (C184). However, it does not report the specific mean ± SD area values for active vs latent (C182) nor the active/latent-vs-normal comparison (C183), so the passage does not bear on those two split claims. The record correctly notes shared NIH lineage with the Shah 2008 source.

Jeffrey J. Ballyns (2011)AI-verified citationVASO-C005 VASO-C184

Supports· moderateVASO-E100

Ballyns 2011: vibration sonoelastography stiff-area measurements separate active, latent and normal sites — part 3 — 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 "supports" toward VASO-C005, 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.

Jeffrey J. Ballyns (2011)AI-verified citationVASO-C005

Context· moderateVASO-E101

Ballyns 2011: vibration sonoelastography stiff-area measurements separate active, latent and normal sites — part 3 — part 2.1

what the source states: Trigger point area measurements from ROC analysis yielded an area under the curve of "0.9 for active versus latent" 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 "supports" toward VASO-C005, 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 "context" (from "supports") by the second reader (claude-sonnet-5, 2026-09-20, run 2026-09-20-answer-vasocomputation-192504, verify-v6) at intake: The quoted AUC=0.9 figure is accurately reported and correctly located in the Results/Abstract; it reflects the active-versus-latent ROC classification, not a comparison to normal/control tissue. VASO-C005 specifically asserts that active sites differ from control (normal) tissue, so this active-vs-latent discrimination statistic does not itself establish that comparison—it bears on the general topic of trigger-point area discriminability but only as context for C005 rather than direct support. The NIH-lineage overlap with other records is properly flagged, and the statement is a single atomic proposition.

Jeffrey J. Ballyns (2011)AI-verified citationVASO-C005

Supports· moderateVASO-E102

Ballyns 2011: vibration sonoelastography stiff-area measurements separate active, latent and normal sites — part 3 — 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 "supports" toward VASO-C005, 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.

Jeffrey J. Ballyns (2011)AI-verified citationVASO-C005

Context· moderateVASO-E103

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

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 "supports" toward VASO-C005, 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 "context" (from "supports") by the second reader (claude-sonnet-5, 2026-09-20, run 2026-09-20-answer-vasocomputation-192504, verify-v6) at intake: The quoted AUC figure (0.8) for latent-versus-normal classification is accurately reproduced from the abstract and correctly located; the source does note the NIH-lineage overlap with other Ballyns/Shah records. However, VASO-C005 asserts that active trigger-point sites differ measurably from control tissue, while this record's statement concerns only the latent-versus-normal comparison, not active-versus-normal; it therefore does not directly evidence the active-site claim and should be read as context rather than support for VASO-C005.

Jeffrey J. Ballyns (2011)AI-verified citationVASO-C005

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 citationVASO-C182 VASO-C187 VASO-C184 VASO-C188 VASO-C189

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 citationVASO-C187 VASO-C188

Context· moderateVASO-E106

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

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 "context" toward VASO-C182, VASO-C184, 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.

Jeffrey J. Ballyns (2011)AI-verified citationVASO-C182 VASO-C184

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 citationVASO-C187 VASO-C189

Context· weakVASO-E108

Ballyns 2011 introduction: 'muscle knots' as a common condition with a cited prevalence estimate — part 1

what the source states: Myofascial pain syndrome is a substantial health problem in the United States, "believed to affect about 23 million Americans" (citing Fishbain et al. 1986, reference 1).
what we infer: Secondary, uncritical framing in an introduction; the prevalence figure is a 1986 clinic-population estimate cited at second hand, not a census. Enters at near-zero weight as one more instance of the research literature treating the palpable knot as a common phenomenon.
limitations: Prevalence estimate is cited, not measured, and refers to a pain syndrome rather than to tender points in the general population.
Introductory framing by proponents of the construct.
Relinked at the answer's re-reading 2026-09-21 (2026-09-21-answer-vasocomputation-021449): VASO-C001 was split into VASO-C190, VASO-C191; this record now cites the parts, and which of them it bears on is for a later reading
Second reader (claude-sonnet-5, 2026-09-21, run 2026-09-21-reverify-vasocomputation-021624, verify-v7) found the passage bears on VASO-C191 and not on VASO-C190; the link dropped at intake: The quote is accurately reproduced and properly attributed as a cited estimate from Fishbain et al. 1986 about the prevalence of myofascial pain syndrome broadly, not about palpable tender points specifically, so it does not bear on VASO-C190 (existence of palpable tender points). As a pointer to an unretrieved cited study, per the citation rule it can at most provide context for the population-prevalence claim VASO-C191, not direct support, so the stated 'supports' direction is too strong for both. The quote is a single atomic proposition (the prevalence figure) and matches one of the propositions bundled in the original compound record, so it is properly a part of that compound.
Direction set to "context" (from "supports") by the second reader (claude-sonnet-5, 2026-09-21, run 2026-09-21-reverify-vasocomputation-021624, verify-v7) at intake: The quote is accurately reproduced and properly attributed as a cited estimate from Fishbain et al. 1986 about the prevalence of myofascial pain syndrome broadly, not about palpable tender points specifically, so it does not bear on VASO-C190 (existence of palpable tender points). As a pointer to an unretrieved cited study, per the citation rule it can at most provide context for the population-prevalence claim VASO-C191, not direct support, so the stated 'supports' direction is too strong for both. The quote is a single atomic proposition (the prevalence figure) and matches one of the propositions bundled in the original compound record, so it is properly a part of that compound.

Jeffrey J. Ballyns (2011)AI-verified citationVASO-C191

Context· weakVASO-E109

Ballyns 2011 introduction: 'muscle knots' as a common condition with a cited prevalence estimate — part 3

what the source states: Myofascial pain syndrome "is commonly recognized as “muscle knots.”"
what we infer: Secondary, uncritical framing in an introduction; the prevalence figure is a 1986 clinic-population estimate cited at second hand, not a census. Enters at near-zero weight as one more instance of the research literature treating the palpable knot as a common phenomenon.
limitations: Prevalence estimate is cited, not measured, and refers to a pain syndrome rather than to tender points in the general population.
Introductory framing by proponents of the construct.
Relinked at the answer's re-reading 2026-09-21 (2026-09-21-answer-vasocomputation-021449): VASO-C001 was split into VASO-C190, VASO-C191; this record now cites the parts, and which of them it bears on is for a later reading
Direction set to "context" (from "supports") by the second reader (claude-sonnet-5, 2026-09-21, run 2026-09-21-reverify-vasocomputation-021624, verify-v7) at intake: The quoted phrase merely notes that myofascial pain syndrome is colloquially called 'muscle knots'; it is a naming/recognition remark, not an assertion that discrete tender points exist or are common in the population. It therefore bears on the topic only as background framing (context) rather than as support for either C190 or C191. The quote is faithfully reproduced and in context, the locator is broad but still correctly within the Introduction, and the part does restate one of the compound's bundled propositions.

Jeffrey J. Ballyns (2011)AI-verified citationVASO-C190 VASO-C191