Trigger Point Therapy
Trigger points are overly irritable spots in muscles
that are associated with palpable nodules in taut bands of
muscle fibers. The palpable nodules are said to be small knots
of contracted muscle fiber or hyperirritable areas and are
a common cause of pain. Pushing on a trigger point may elicit
local tenderness, referred pain, or local twitch response.
Since most unexplained pain radiates from trigger points, should
be treated. Many chiropractors and massage therapists find
this model useful in practice.
The therapy was originated by Dr. Janet Travell, M.D., the White House physician credited with successfully treating President John Kennedy’s back pain. The main innovation of Travell's work was the introduction of the myofascial pain syndrome concept (myofascial - the combination of muscle and fascia). This is described as a focal hyperirritability in muscle that can strongly affect central nervous system functions.
Travell and her followers distinguish this from
fibromyalgia, characterized by widespread pain and tenderness
and a central increase in pain experience giving rise to deep
tissue tenderness. Studies estimate that in 75-95 per cent
of cases, myofascial pain is a primary cause of regional pain.
How do Fibromyalgia and Myofascial pain
resulting from Trigger points differ?
Perhaps one of the most popular enigmatic pain conditions
to affect the lives of human beings worldwide is fibromyalgia.
Fibromyalgia is a condition that, because of its symptom expression,
has baffled many practitioners. There are no current diagnostic
tests available to confirm a diagnosis. There is only a list
of symptoms to look for – which lead to an educated guess.
For this reason, many people consider fibromyalgia a “wastebasket
Other conditions, in fibromyalgia patients, may persist such
as subclinical hypothyroidism, a systemic infection, or other
environmental factors that cause many of the symptoms of fibromyalgia.
These are, but are not limited to, myofascial pain syndrome
(MPS), chronic fatigue syndrome (CFS), and a host of other
medical conditions that relate to other organs of the body.
When a systemic condition occurs it affects every cell of the
body, there are many different symptoms. It is of utmost importance
that a person receives an accurate diagnosis to avoid years
of needless suffering.
Dr. John C. Lowe, DC published a research oriented
text titled The Metabolic Treatment of Fibromyalgia.
Since the text is very medically oriented, he and his wife,
Dr. Gina Honymann-Lowe, published a text for the patient titled, Your
Guide to Metabolic Health. In this text, Dr.
Lowe explains how the thyroid affects the human body and why,
many times, patients are misdiagnosed. This book is a must
read if you feel you may have a thyroid condition or if you
are on T4 therapy and it has not alleviated.
The American College of Rheumatology (ACR) defines
fibromyalgia as, “...a clinical syndrome defined by chronic
widespread muscular pain, fatigue and tenderness. Many people
with fibromyalgia also experience additional symptoms such
as fatigue, headaches, irritable bowel syndrome, irritable
bladder, cognitive and memory problems (often called “fibro
fog”), temporomandibular joint disorder (TMJD), pelvic
pain, restless leg syndrome, sensitivity to noise and temperature,
and anxiety and depression. These symptoms can vary in intensity
and, like the pain of fibromyalgia, wax and wane over time.”
In their text, Myofascial Pain and Dysfunction:
The Trigger Point Manual, Drs. Janet
Travell and David Simons alert us to be sure that
we have differentiated between fibromyalgia and MPS.
They state that trigger points (TrPs) are present
in the majority of people who suffer with fibromyalgia
and that it is easier to distinguish which is the
Clinical Features Distinguishing Myofascial
Pain Due to
Trigger Points from Fibromyalgia
Myofascial Pain (TrPs)
1 female: 1 male
Local or Regional pain
Muscle feels tense (taut bands)
Restricted range of motion
Examine for trigger points
Immediate response to injection of TrPs 20% also have fibromyalgia
4-9 females: 1 male
Widespread, general pain
Muscle feels soft and doughy
Examine for tender points
Delayed/poorer response to TrP injection
72% also have active TrPs