State, Not Scar · source record · paper

Ultrasound elastography to guide compression therapy for gastrocnemius trigger points in runners

Ingrid C. Landfald; Michał Podgórski; Łukasz Olewnik · 2025

AI-verified citationSRC-LANDFALD-2025

identifier / locator: doi:10.1038/s41598-025-25902-8
url: https://pmc.ncbi.nlm.nih.gov/articles/PMC12647689/
verification note: text retrieved and shown to the drafter on 2026-09-20 (run 2026-09-20-draft-vasocomputation-113013); passages checked by the verify verb
reliability notes: Peer-reviewed primary (Scientific Reports 15:41950, 25 Nov 2025), full text read at PMC12647689; the publisher DOI page served a bot-challenge page.
Prospective, single-centre cohort of 30 amateur runners with gastrocnemius trigger points (from 44 screened); no control, sham or comparison arm; strain (compression) elastography, not shear-wave.
The radiologist was blinded to treatment outcomes but not to the initial palpation findings; elastography cine loops were not archived; no colour/power Doppler was performed; imaging plane at follow-up may have differed (authors' own limitations).
The methods describe compression in 30-s bouts with 10-s rests; no breathing instruction is described or recorded anywhere in the text.
Independent of the NIH (Shah/Ballyns) and Hubbard/Gevirtz lineages; the Mazovian Academy in Płock and Medical University of Łódź.
Licence stated in the text: Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International; © The Author(s) 2025.

Evidence drawn from this source

Context· moderateVASO-E067

Landfald 2025: the pressure-only compression protocol carried no breathing instruction, recording or manipulation — part 3

what the source states: No breathing instruction, recording or manipulation appears anywhere in the methods or results; the method is described only as "Trigger points were eliminated with compression".
what we infer: What the record establishes is an absence in the method: the protocol's compression was applied with no breathing instruction, recording or manipulation anywhere in the methods or results. It does not by itself establish what the protocol achieved; the immediate elimination and 24-hour non-recurrence figures proposed as records on VASO-C039 were refused at review as bundled, and the pressure-only outcomes the ledger does hold sit on the claims they are attached to (VASO-E072 on VASO-C005, VASO-E074 on VASO-C033). The bearing on VASO-C039 is context: a pressure-only protocol exists in the literature, and its subjects' breathing was neither instructed nor recorded — 'no breath instruction' is not 'breath held constant'.
limitations: Breathing uncontrolled and unrecorded, so a spontaneous slow exhale under pressure cannot be excluded.
The endpoint is palpation and elastography, not the felt release the two-key protocol describes.
Different muscle (gastrocnemius) and population (symptomatic amateur runners) from the practitioner reports behind the claim.
Direction set to "context" (from "undermines") by the second reader (claude-sonnet-5, 2026-09-20, run 2026-09-20-answer-vasocomputation-124732, verify-v6) at intake: The sourceStatement accurately reports that the Methods and Abstract nowhere mention breathing instruction, recording, or manipulation, and the locator (MTrP release section / Abstract) is correct. But this bare methodological absence, by itself, does not establish that pressure alone achieved release — that would require the outcome data (elimination rates), which per the review record was split off and not admitted here. Without a paired outcome, the statement only characterizes the study's method as a naive comparison point, so it bears on VASO-C039 as context rather than as undermining it.

Ingrid C. Landfald (2025)AI-verified citationVASO-C039

Context· moderateVASO-E068

Landfald 2025: active trigger points larger, stiffer and more painful than latent ones; latent ones cleared more often after one round — part 1

what the source states: Among the 103 identified MTrPs, 67 were classified as active and 36 as latent; the source states that "67 were classified as active (ATrPs), based on the presence of referred pain, and 36 as latent".
what we infer: A second laboratory, a second muscle (gastrocnemius) and a second elastography method (strain rather than vibration) reproduce the graded finding that palpated points are measurably stiffer than surrounding tissue and that the more symptomatic class is stiffer still. The record has no palpably normal control sites and no biochemistry or Doppler, so it supports the stiffness component of the claim only.
limitations: No palpably normal or pain-free control sites; the comparison is active versus latent within symptomatic runners.
Subgroup analyses described by the authors as exploratory and underpowered.
Strain elastography stiffness ratios are relative, operator-dependent measures.
Direction set to "context" (from "supports") by the second reader (claude-sonnet-5, 2026-09-20, run 2026-09-20-verify-vasocomputation-113521, verify-v6) at intake: The quoted sentence only reports the classification counts (67 active, 36 latent MTrPs) and does not itself contain the stiffness/biochemistry/blood-flow comparison to control (non-trigger-point) tissue that VASO-C005 requires; moreover the comparison in the paper is active vs latent trigger points within symptomatic runners, not trigger points vs control tissue, so it cannot be said to 'support' that claim directly. The passage is accurately quoted and located, but its bearing on VASO-C005 is at most contextual (establishing that active/latent subtypes exist and differ from each other), not supportive of a control-tissue comparison.

Ingrid C. Landfald (2025)AI-verified citationVASO-C005

Context· moderateVASO-E069

Landfald 2025: active trigger points larger, stiffer and more painful than latent ones; latent ones cleared more often after one round — part 2

what the source states: Active points had significantly higher VAS scores than latent points, "mean 8.9 vs. 6.1, p < 0.001".
what we infer: A second laboratory, a second muscle (gastrocnemius) and a second elastography method (strain rather than vibration) reproduce the graded finding that palpated points are measurably stiffer than surrounding tissue and that the more symptomatic class is stiffer still. The record has no palpably normal control sites and no biochemistry or Doppler, so it supports the stiffness component of the claim only.
limitations: No palpably normal or pain-free control sites; the comparison is active versus latent within symptomatic runners.
Subgroup analyses described by the authors as exploratory and underpowered.
Strain elastography stiffness ratios are relative, operator-dependent measures.
Direction set to "context" (from "supports") by the second reader (claude-sonnet-5, 2026-09-20, run 2026-09-20-verify-vasocomputation-113521, verify-v6) at intake: The quote is accurate and the locator is correct, but the claim concerns whether active trigger-point sites differ from control (non-trigger-point) tissue in biochemistry, stiffness, and blood flow; this record instead reports a subjective pain-score (VAS) difference between active and latent trigger points, not a comparison against control tissue and not a biochemical, stiffness, or blood-flow measure. It therefore bears on the general active-vs-latent theme but does not support the specific comparison the claim makes, so it is better read as context than as direct support.

Ingrid C. Landfald (2025)AI-verified citationVASO-C005

Qualifies· moderateVASO-E070

Landfald 2025: active trigger points larger, stiffer and more painful than latent ones; latent ones cleared more often after one round — part 3

what the source states: Active points had a significantly larger cross-sectional area than latent points, "28 mm 2 vs. 17 mm 2 , p = 0.014".
what we infer: A second laboratory, a second muscle (gastrocnemius) and a second elastography method (strain rather than vibration) reproduce the graded finding that palpated points are measurably stiffer than surrounding tissue and that the more symptomatic class is stiffer still. The record has no palpably normal control sites and no biochemistry or Doppler, so it supports the stiffness component of the claim only.
limitations: No palpably normal or pain-free control sites; the comparison is active versus latent within symptomatic runners.
Subgroup analyses described by the authors as exploratory and underpowered.
Strain elastography stiffness ratios are relative, operator-dependent measures.
Direction set to "qualifies" (from "supports") by the second reader (claude-sonnet-5, 2026-09-20, run 2026-09-20-verify-vasocomputation-113521, verify-v6) at intake: The quote and figures (28 mm2 vs 17 mm2, p=0.014) are accurately reported from Table 2/Results as an active-vs-latent MTrP comparison. However, VASO-C005 concerns differences between active trigger-point sites and control (non-trigger-point) tissue, whereas this data compares active to latent trigger points within symptomatic runners, with no palpably normal control tissue as the record's own limitations note. This makes the finding a qualification rather than direct support of the claim about trigger point vs control tissue differences.

Ingrid C. Landfald (2025)AI-verified citationVASO-C005

Context· moderateVASO-E071

Landfald 2025: active trigger points larger, stiffer and more painful than latent ones; latent ones cleared more often after one round — part 4

what the source states: Active points had significantly "greater stiffness ratios (mean 8.5 vs. 6.1, p = 0.006)" compared to latent points.
what we infer: A second laboratory, a second muscle (gastrocnemius) and a second elastography method (strain rather than vibration) reproduce the graded finding that palpated points are measurably stiffer than surrounding tissue and that the more symptomatic class is stiffer still. The record has no palpably normal control sites and no biochemistry or Doppler, so it supports the stiffness component of the claim only.
limitations: No palpably normal or pain-free control sites; the comparison is active versus latent within symptomatic runners.
Subgroup analyses described by the authors as exploratory and underpowered.
Strain elastography stiffness ratios are relative, operator-dependent measures.
Direction set to "context" (from "supports") by the second reader (claude-sonnet-5, 2026-09-20, run 2026-09-20-verify-vasocomputation-113521, verify-v6) at intake: The quote is accurately reproduced from Table 2/Results and correctly located, but the comparison is between active and latent trigger points within the same symptomatic cohort, not between trigger-point tissue and normal/control tissue as VASO-C005 requires. This internal subgroup contrast (active vs latent) does not itself establish that active sites differ from control tissue, so it bears on the claim only as context rather than as direct support.

Ingrid C. Landfald (2025)AI-verified citationVASO-C005

Context· moderateVASO-E072

Landfald 2025: active trigger points larger, stiffer and more painful than latent ones; latent ones cleared more often after one round — part 6

what the source states: After the first round of compression, "60% of ATrPs and 86% of LTrPs were no longer detectable sonographically" (p = 0.021).
what we infer: A second laboratory, a second muscle (gastrocnemius) and a second elastography method (strain rather than vibration) reproduce the graded finding that palpated points are measurably stiffer than surrounding tissue and that the more symptomatic class is stiffer still. The record has no palpably normal control sites and no biochemistry or Doppler, so it supports the stiffness component of the claim only.
limitations: No palpably normal or pain-free control sites; the comparison is active versus latent within symptomatic runners.
Subgroup analyses described by the authors as exploratory and underpowered.
Strain elastography stiffness ratios are relative, operator-dependent measures.
Direction set to "context" (from "supports") by the second reader (claude-sonnet-5, 2026-09-20, run 2026-09-20-verify-vasocomputation-113521, verify-v6) at intake: The quote is accurate and correctly located, reporting differential post-treatment detectability of active versus latent trigger points. However, VASO-C005 concerns whether active trigger-point sites differ from control (non-trigger-point) tissue in biochemistry, stiffness, and blood flow, whereas this passage compares active to latent trigger points' response to compression therapy, not either to control tissue baseline measures. That makes the passage background/contextual to the claim rather than direct support for it.

Ingrid C. Landfald (2025)AI-verified citationVASO-C005

Context· weakVASO-E074

Landfald 2025: active/latent differences in a second muscle as context for the graded-stiffness and fresh/old claims — part 2

what the source states: Latent points responded more readily to compression and "were more often resolved after the first treatment" (86% of latent vs 60% of active MTrPs no longer detectable sonographically, p = 0.021).
what we infer: For the trapezius vibration-elastography gradient this is a parallel from another muscle and method, not a replication. For the fresh/old claims it is the nearest instrumented cousin — the more symptomatic point is harder to switch off — but active/latent is a clinical classification, not the age of the knot, so the record carries no weight for or against those claims.
limitations: Different muscle, method and site classes from the trapezius sonoelastography study.
Active/latent is not the fresh/old axis; the authors' 'earlier or less fibrotic' reading is their conjecture.
Second reader (claude-sonnet-5, 2026-09-20, run 2026-09-20-answer-vasocomputation-172213, verify-v6) found the passage bears on VASO-C075, VASO-C076 and not on VASO-C033; the link dropped at intake: The quote and 86%/60% figures are accurately drawn from the Discussion/Table 2 and the locator is correct, but this passage concerns active-vs-latent resolution speed in the gastrocnemius, not trapezius sonoelastographic lesion area, so it has no bearing on VASO-C033 despite being labeled 'context' for it. For the fresh/old claims (C075/C076) it offers only a weak, self-acknowledged analogy (active/latent is not the fresh/old axis, and the 'earlier/less fibrotic' reading is the authors' own speculation), which is fairly characterized as context. The record is otherwise atomic and does not need an independence note since it directly cites the primary study rather than repeating another cited source.

Ingrid C. Landfald (2025)AI-verified citationVASO-C075 VASO-C076

Context· weakVASO-E075

Landfald 2025: active/latent differences in a second muscle as context for the graded-stiffness and fresh/old claims — part 3

what the source states: Active points required more sessions to deactivate than latent points, with "sessions required for elimination" averaging 1.4 ± 0.5 for active versus 1.1 ± 0.3 for latent MTrPs (p = 0.038).
what we infer: For the trapezius vibration-elastography gradient this is a parallel from another muscle and method, not a replication. For the fresh/old claims it is the nearest instrumented cousin — the more symptomatic point is harder to switch off — but active/latent is a clinical classification, not the age of the knot, so the record carries no weight for or against those claims.
limitations: Different muscle, method and site classes from the trapezius sonoelastography study.
Active/latent is not the fresh/old axis; the authors' 'earlier or less fibrotic' reading is their conjecture.
Second reader (claude-sonnet-5, 2026-09-20, run 2026-09-20-verify-vasocomputation-113521, verify-v6) found the passage bears on VASO-C075, VASO-C076 and not on VASO-C033; the link dropped at intake: The quote and locator are accurate, and the record's own caveat about active/latent not being the fresh/old axis is fair. But this active/latent sessions-to-elimination datum from gastrocnemius compression therapy has no bearing on C033, which concerns sonoelastographic lesion area in the upper trapezius from a different study entirely; that claim link should be dropped. For C075/C076 the weak, self-flagged, speculative analogy to lesion age supports treating it only as context, which the record already does.

Ingrid C. Landfald (2025)AI-verified citationVASO-C075 VASO-C076

Context· weakVASO-E077

Landfald 2025: active/latent differences in a second muscle as context for the graded-stiffness and fresh/old claims — part 5

what the source states: The faster short-term response of latent points to pressure-release therapy is a suggested pattern for which "confirmation in controlled studies is needed".
what we infer: For the trapezius vibration-elastography gradient this is a parallel from another muscle and method, not a replication. For the fresh/old claims it is the nearest instrumented cousin — the more symptomatic point is harder to switch off — but active/latent is a clinical classification, not the age of the knot, so the record carries no weight for or against those claims.
limitations: Different muscle, method and site classes from the trapezius sonoelastography study.
Active/latent is not the fresh/old axis; the authors' 'earlier or less fibrotic' reading is their conjecture.
Second reader (claude-sonnet-5, 2026-09-20, run 2026-09-20-answer-vasocomputation-172213, verify-v6) found the passage bears on VASO-C075, VASO-C076 and not on VASO-C033; the link dropped at intake: The quote and locator are accurate and the statement fairly reflects the source's own hedged language about latent points' faster response needing controlled confirmation. But this observation concerns active/latent trigger-point response speed in the gastrocnemius, not the trapezius stiffness-area comparison that VASO-C033 addresses, so it does not bear on C033 at all. For C075/C076 it is only weak context since active/latent is explicitly not the same axis as fresh/old and the 'earlier or less fibrotic' reading is the authors' own speculation, not a finding about knot age.

Ingrid C. Landfald (2025)AI-verified citationVASO-C075 VASO-C076

Supports· weakVASO-E078

Landfald 2025: no gold standard for detecting trigger points; palpation variability the authors' stated reason for adding imaging — part 1

what the source states: There is no gold standard technique for detecting myofascial trigger points: "there is no gold standard technique for detecting them".
what we infer: A proponent-side clinical group states the reliability problem in its own words and reports a concrete palpation–imaging discrepancy. Weak because the reliability statement is a citation of others rather than a new measurement, and because the authors did not test their own inter- or intra-observer reliability.
limitations: The inter-observer-variability statement is secondary (cites earlier work).
No formal reliability testing of the sonographic assessment was performed (authors' limitation).

Ingrid C. Landfald (2025)AI-verified citationVASO-C030

Supports· weakVASO-E079

Landfald 2025: no gold standard for detecting trigger points; palpation variability the authors' stated reason for adding imaging — part 2

what the source states: Manual palpation, despite its use in clinical practice, "has significant inter-observer variability that cannot be meaningfully improved after training", per cited reliability work.
what we infer: A proponent-side clinical group states the reliability problem in its own words and reports a concrete palpation–imaging discrepancy. Weak because the reliability statement is a citation of others rather than a new measurement, and because the authors did not test their own inter- or intra-observer reliability.
limitations: The inter-observer-variability statement is secondary (cites earlier work).
No formal reliability testing of the sonographic assessment was performed (authors' limitation).

Ingrid C. Landfald (2025)AI-verified citationVASO-C030

Context· weakVASO-E080

Landfald 2025: no gold standard for detecting trigger points; palpation variability the authors' stated reason for adding imaging — part 4

what the source states: Because of these limitations, the authors "combined B-mode ultrasonography and strain elastography, which provide high-contrast imaging" between tissues of differing stiffness, alongside palpation.
what we infer: A proponent-side clinical group states the reliability problem in its own words and reports a concrete palpation–imaging discrepancy. Weak because the reliability statement is a citation of others rather than a new measurement, and because the authors did not test their own inter- or intra-observer reliability.
limitations: The inter-observer-variability statement is secondary (cites earlier work).
No formal reliability testing of the sonographic assessment was performed (authors' limitation).
Direction set to "context" (from "supports") by the second reader (claude-sonnet-5, 2026-09-20, run 2026-09-20-verify-vasocomputation-113521, verify-v6) at intake: The quoted text is accurately reproduced and correctly located in the Discussion/Limitations passage, and the sourceStatement fairly summarizes it as the authors' methodological response (combining imaging with palpation). However, this particular quote itself only describes what the authors did in response to the reliability problem, not the inter-observer-variability/no-gold-standard finding itself (which is stated in the preceding, unquoted sentence); as such it does not itself assert or support the claim that manual palpation lacks reliability, so it functions as context for VASO-C030 rather than direct support.

Ingrid C. Landfald (2025)AI-verified citationVASO-C030

Supports· weakVASO-E081

Landfald 2025: no gold standard for detecting trigger points; palpation variability the authors' stated reason for adding imaging — part 5

what the source states: In this study elastography primarily served to verify MTrP presence: it "confirmed 71.5% of palpated hard spots as MTrPs", with the remainder corresponding to tendinous cores or musculotendinous junctions.
what we infer: A proponent-side clinical group states the reliability problem in its own words and reports a concrete palpation–imaging discrepancy. Weak because the reliability statement is a citation of others rather than a new measurement, and because the authors did not test their own inter- or intra-observer reliability.
limitations: The inter-observer-variability statement is secondary (cites earlier work).
No formal reliability testing of the sonographic assessment was performed (authors' limitation).

Ingrid C. Landfald (2025)AI-verified citationVASO-C030

Context· weakVASO-E085

Landfald 2025: active/latent differences in a second muscle as context for the graded-stiffness and fresh/old claims — part 2

what the source states: Active gastrocnemius MTrPs had a "larger cross-sectional area (28 mm² vs. 17 mm², p = 0.014)" than latent points; Table 2 gives 28 ± 6 against 17 ± 5 mm².
what we infer: Size by clinical class in a second muscle; the same parallel, carrying no weight for or against the fresh/old claims.
limitations: Different muscle, method and site classes from the trapezius sonoelastography study.
Active/latent is not the fresh/old axis; the authors' 'earlier or less fibrotic' reading is their conjecture.
Second reader (claude-sonnet-5, 2026-09-20, run 2026-09-20-verify-vasocomputation-113521, verify-v6) found the passage bears on VASO-C033 and not on VASO-C075, VASO-C076; the links dropped at intake: The quoted active-vs-latent comparison (VAS, cross-sectional area, stiffness ratio) is accurately drawn from Table 2/Discussion and is genuinely a different-muscle analogue that can serve as context for the trapezius active/latent claim C033. But the quoted statement says nothing about session counts, duration, or knot age/freshness, so it does not bear at all on the fresh-knot (C075) or ancient-knot (C076) claims about time-to-release, despite the record listing 'context' for all three.
One clause of a three-part comparison the source reports in one sentence and one table; the sibling parts carry the other two.

Ingrid C. Landfald (2025)AI-verified citationVASO-C182 VASO-C184