BLOG: Why I am No Longer Using the Term "Trigger Point"
Myofascial trigger points have been described as bands of taut, sensitive fascia (connective tissue that wraps and interlaces everything in the body), that when pressed on can radiate pain to another part of the body. Trigger points have been cited as possible causal factors in numerous ailments, including myofascial pain syndrome, fibromyalgia, chronic pain and much more.
Trigger Point Therapy was coined by Dr. Janet Travell (John F. Kennedy’s personal physician) and Dr. David Simons, who together developed the trigger point model and authored two volumes of Myofascial Pain and Dysfunction: The Trigger Point Manual, originally published in the 1990s.
This set of techniques has become a primary go-to treatment by many physical therapists, massage therapists, osteopaths, physicians, etc. I’m a clinical massage therapist and 95% of my clients first come to me for pain and mobility issues. I have offered Trigger Point Therapy since learning the technique through my Orthopedic Massage training in 2009, followed by further study.
While this topic remains hotly contested by trigger point devotees and evangelists, I have become convinced Quintner, et al. are correct in their assessment. Understanding of medicine and science changes over time. As a non-scientist and non-doctor, I am somewhat at the mercy of trained pain scientists and researchers to inform me, but it does make sense to me that Travell and Simons made some assumptions to explain their model, rather than doing rigorous studies themselves.
How Do We Explain Trigger Point-Type Pain?
“I have yet to find any better proposal for what ‘they’ are, than Quintner and Cohen’s paper suggesting peripheral nerve pain, plain and simple. WAY higher plausibility.
The hypothetical roots of trigger point-type pain is more likely to be PERIPHERAL NERVE PAIN. This needs further examination and testing of course. This is not the only hypothesis, but it is promising.
I look forward to those tests!
It is no surprise that there has been a lot of opposition to this news, most notably, A critical evaluation of Quintner et al: Missing the point by Dommerholt and Gerwin.
Since Quintner and colleagues’ paper came out, it has had a ripple effect in some massage forums and communities, and I’ve reflected on the effectiveness of my treatment. I can’t discern if client improvement was because of Trigger Point Therapy or other techniques I used … or simply because they liked me, my touch and found me credible in my professionalism, i.e. the placebo effect.
I believe Fred Wolfe is right when he says the “cause” and model of trigger points are pseudo-pseudo evidence based medicine. I believe Dr. Quintner and colleagues.
I am no longer calling the treatment I offer Trigger Point Therapy.
Myofascial Release (MFR) is also being questioned and is under investigation by Quintner, in relation to fibromyalgia. I do still offer so-called Myofascial Release because I often see benefit to clients in slow, gentle (to firm, but not extra deep) “fascial” treatment, though I don’t buy into some of the explanations of that model either, a la some of what teacher John Barnes espouses. (I didn’t study under Barnes, MFR was one of the three modalities taught in my basic massage school education). For years people like Ida Rolf (the inventor of Rolfing) thought that fascia could be stretched, but that too has been disproven. When it comes to health care, there is still so much we don’t know. But just because an explanatory model gets busted, it doesn’t necessarily mean that treatment techniques aren’t effective. I have definitely seen more clients benefit from MFR than Trigger Point Therapy.
That said, last year (2014) I studied DermoNeuroModulation (DNM, developed by Diane Jacobs) under Jason Erickson (DNM is a technique I now offer to my clients to help reduce their pain. I am increasingly of the belief that the type of MFR I practice may more closely resemble DNM, i.e. the effect of my MFR technique may be to calm the nervous system. (I’m not saying MFR and DNM are the same thing, they’re vastly different in concept and application.) Beyond that, I also follow Dr. Lorimer Moseley’s BodyInMind.org publications on pain science (here’s a further explanation by Quintner published there) and believe in the BioPsychoSocial model of pain as a more well-rounded concept than the old BioMechanical model. So I’m moving on to other techniques and modalities to see if they work better than Trigger Point Therapy.