What's In a Word?

MANY TERMS.  Over the course of the last 150 years a number of astute physicians have published information about patients with pain that seemed to arise in soft tissue but which they couldn't explain.  They coined a variety of terms for what they observed, including "fibrositis", "muskelhaerten", "myofascial pain syndrome", "myofascitis", "myogeloses", "nonarticular rheumatism", "osteochondrosis", "soft tissue rheumatism" and "tendomyopathy". (Travell and Simons 1999 Vol.1:18-19)  This list of different terms for the same thing is not exhaustive.  Terminological confusion contributed to the difficulty of investigating this muscle-based pain that exhibits no organic lesion.  The various clinical observations about pain caused by muscle tender points were scattered throughout decades of medical literature, in journals serving different specialities, and using various different terms for the condition.

A COMPREHENSIVE DEFINITION.  Travell and Simons' work provides a systematic treatment of this soft tissue pain condition. They defined it comprehensively, and the names they adopted for the condition and its cause, "myofascial pain" and "trigger point", respectively, fairly quickly superceded the various other terms used historically.  It's now established knowledge that this commonly occurring pain condition ("myofascial pain") arises specifically in muscle tissue, that a muscle with this condition has an area of compressed sarcomeres at the point where the motor nerve enters the muscle fiber, that this compressed area forms a highly sensitive nodule, that as a result of the compressed area the muscle fiber as a whole becomes taut, and that this sensitive nodule (the trigger point) frequently refers pain to other locations in the body in a characteristic pattern.

NEW FOCUS.  Historically speaking, myofascial pain syndrome was difficult to understand because trigger points usually refer pain elsewhere in the body, and because pain they cause can masquerade as pain from other tissues (including viscera).  The fact that clinicians gave different names to the entity they were trying to describe may have kept them from realizing they were studying the same syndrome that others in different specialities had worked on.  So an important part of Travell and Simons' achievement is simply that the medical community now agrees to call this condition "moyfascial trigger point pain".  With this focus, effective, coordinated research can proceed.  Perhaps a new medical speciality will evolve with muscle tissue as its subject.  Muscles, after all, make up 50% of the body, cause much pain, and deserve attention.

THE TERM "MYOFASCIAL".  "Myo" refers to muscle and "fascial" refers to fascia. Fascia is the connective tissue that surrounds all structures of the body, including muscles, organs, bones, nerves, etc.  Muscles attach to bones and other structures by tendons located at the ends of muscles where the fascia surrounding and permeating the muscle becomes thick and strong and connects with the fascia surrounding the bone in question.  Tendons can become tense and develop their own tender points in response to trigger points in the muscle.  Conversely, trigger point pain may in some cases be aggravated and perhaps caused by unhealthy fascia.  Fascia is unhealthy when it has become immobile, too fibrotic and/or adhered to other structures.  In this state it ties down the related muscles and otherwise limits their mobility.  Problems in the fascia can normally be relieved by accurate bodywork that stretches fascia and helps bring moisture and flexibility back. 

At the October 2007 First International Fascia Research Congress in Boston several papers reported research showing that fascia frequently has contractile properties of its own ( Schleip et.al.2007; Fournie 2007) .  Some researchers suggested that fascia may assist with movement because of its springy quality (Zorn et.al. 2007).  The propriosensory role of Golgi tendon organs has been understood for a long time.  (Golgi are tiny sensory cells in tendons that provide feedback when the tendon is stretched too tightly, feedback that can cause the nervous system to inhibit the muscle's action.)  Fascia is no longer viewed as something that just links or protects other tissues, but as an active system whose role needs much more research.

LIST NOT EXHAUSTIVE:  In an instructive example, a physician named Adler wrote in 1900 about a pain condition originating in muscle in which a hardened tender point develops that frequently refers pain elsewhere.  He named the condition "muscular rheumatism" (Adler 1900).  He went on to complain:

But notwithstanding all that has been said and written about these things ... the great majority of practitioners have kept entirely aloof and have persistently ignored all advance in this direction.  With some practice in palpating muscles, and after attention has once been directed to these muscular lesions, it is not very difficult to convince one's self of the existence of these infiltrations, indurations and swellings in every case of muscular rheumatism."  (Adler 1900, V57-13:530)

SARCOMERES:  On microscopic examination muscle fibers have a striated appearance, with tiny lines perpendicular to the fiber all along its length.  The muscle tissue between two of these tiny lines is a sarcomere.  The sarcomere is the basic contractile unit of muscle tissue.

PROPRIOSENSORY:  The ability of the body to sense various conditions within itself.

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This page is part of a larger website intended to educate people about trigger point bodywork and other methods of non-invasive, drug-free pain relief.  Myofascial therapy was developed by physicians in the last few decades.  Its primary purpose is to eliminate myofascial pain, but it also improves movement and posture.

I offer myofascial treatment and pain management services for the Far Hills, Lamington, Gilette and Green Village area of central NJ, though I am not immediately nearby. If you live in a town such as Martinsville, Millington, Oldwick or North Branch NJ I would still be the closest certified therapist. New Vernon, Pottersville, North Branch and Whitehouse NJ also fall into this category, as do Gladstone, Oldwick and Annandale 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.