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The Evolution of Trigger Point Therapy
Until the first edition of Travell and Simons' groundbreaking work came out in 1983 there was no source physicians could turn to to learn how common myofascial pain is, how many other conditions it mimics, and how to treat it. A trigger point is a verfiable organic condition, but it cannot be detected by the instruments a physician typically has in his office. If the pain the patient describes doesn't stem from an organic problem detected through the usual methods the physician may think it is sciatica, arthritis, tendonitis, bursitis or some other '-itis' that is difficult to verify. Occasionally trigger point pain is identified as psychosomatic, which can be very discouraging to the patient. Trigger point pain has been something of an enigma, so much so that the term 'enigmatic pain' is also sometimes applied to it.
THE EFFORT TO UNDERSTAND MYOFASCIAL PAIN. Prior to 1940 there were scattered efforts by physicians to understand muscle tender points and referred pain. Research broadened and became more systematic in the middle of the twentieth century, particularly through the work of Janet Travell MD. She later entered a productive decades-long cooperation with David Simons MD and together they produced the systematic work Myofascial Pain and Dysfunction. An interesting footnote to this history is that Dr. Travell served as the White House physician under Presidents Kennedy and Johnson. Travell's trigger point work was the only therapy Kennedy could find to alleviate his severe back pain. Dr. Simons was originally a NASA Flight Surgeon who had distinguished himself earlier by being the first man into space (in a balloon).
NON-PHYSICIAN BECOMES INVOLVED. A few years prior to the publication of the first edition of Travell and Simons' text a woman named Bonnie Prudden published a useful do-it-yourself book entitled Pain Erasure. Prudden, who enjoyed close working relationships with doctors, was not a physician herself. Though her book presents a simplified "X marks the spot" version of what Travell and Simons showed to be a much more complex topic, she nevertheless helped many people reduce their pain.
THE DISCOVERY OF MANUAL PRESSURE. Prudden's first encounter with a trigger point came while on a hike with Dr. Hans Krauss. He "squashed" a lump on her neck to relieve painful stiffness. His treatment was painful (probably unnecessarily painful), but it worked. Then she met Dr. Travell who was developing the new discipline of myofascial medicine and treating myofascial pain using injections and cold spray. Prudden worked with doctors to provide exercises after operations or trigger point injections. She eventually learned to find trigger points herself and began to mark the spots for the doctor to inject. She describes how one day she accidentally discovered that the manual pressure technique Dr. Kraus had used on her neck could relieve pain from muscle trigger points all over the body:
”My next appointment was with a woman who had a painful tennis elbow. Ordinarily I would have tried to improve the range of the joint with resistance exercises. This time I didn't. I warned her that trigger points are very tender and I sought them as though she were being mapped for injection. But instead of marking the arm I held the trigger point. It was painful. Instead of settling for one trigger point I probed up and down the entire arm, pressing trigger points as I found them. In about 15 minutes there was no pain, and both elbow and shoulder had full range of movement. I really was onto something important!
”As soon as the patient left, I raced for the phone and called Washington to tell Dr. Travell about my exciting discovery....
”In my Myotherapy Institute, we worked at first mainly with backs. Instead of taking weeks to get rid of pain with exercise and injections, it was taking only a few sessions, often only one. Arm pain, shoulder and neck pain, all surrendered. We even had several stroke patients who were being given stretch and strengthening exercises. Two of them had severely contracted arm muscles. Soon they too were free of pain and their limbs of contracture.” (Prudden B 1980 P5.)
At one point Bonnie Prudden became a patient of Dr. Travell. Manual trigger point therapists have since learned that the most effective pressure to use in treating trigger points is less than the level that creates unpleasant discomfort.
THE PROFESSION OF TRIGGER POINT THERAPIST was founded by non-physicians who were personally influenced by Bonnie Prudden and Dr. Travell. The training involves anatomy, physiology and palpation training and careful study of Travell and Simons' Myofascial Pain and Dysfunction. Other texts are used as well, depending on the school.
Manual trigger point therapists help fill a gap in our formal system of medical education and practice. Treatment of the vast numbers of people suffering from myofascial pain is not as yet being adequately provided by the traditional medical professions. Beyond this fact, in many cases treatment of this condition by manual techniques is preferable even when injection by a knowledgeable doctor is available. It is difficult for the physician to needle all of the dysfunctional fibers without causing the patient considerable discomfort. Sometimes he or she has to poke around to find the spot causing the pain. In addition there are important muscles so near the lungs or other vital organs that it can be dangerous to inject them. A manual therapist also has the advantage of not having to stop after treating just a few trigger points. He or she can treat many in one session when this is appropriate. Injections in skilled hands can be quite effective, but this form of trigger point therapy has limitations and need not be relied on exclusively when less invasive options are available.
I offer myofascial treatment and pain management services for the Belleville, East Rutherford, Garfield and Wallington area of northern NJ, though I am not immediately nearby. If you live in a town such as Hackensack, Nutley, Passaic or Teaneck NJ I would still be the closest certified therapist. Carlstadt, Cliffside Park Edgewater and Fort Lee NJ also fall into this category, as do Leonia, Lyndhurst, Maywood and North Bergen NJ, and much of the rest of New Jersey. Somewhat distant towns are mentioned because I have seen many times that people are glad to travel even several hours to get rid of pain. If you live elsewhere you may be able to find a practitioner nearby.
Copyright 2007 Joseph Hoane