The Science of Trigger Points

Paul Ingraham

It’s a while since I posted anything on this site, but my reading of recent articles by Paul Ingraham prompted me to post a link to them on this site.

Many practitioners seem to accept as gospel the neat representations of Trigger Points (TrPs) as illustrated in by Travell & Simons in ‘Myofascial Pain and Dysfunction – The Trigger Point Manual’but I have always had my doubts. Other practitioners vehemently deny their existence with the suggestion that they are a figment of the practitioner’s imagination.

As Paul mentioned in a Twitter post:

‘Most patients and professionals are oblivious to the whole mess”

In my own work as an occupational physician expressing opinions for medico-legal purposes the issue of validity of the TrP concept does come into focus at times, with poloarised views expressed. My position on this topic has shifted from ignorance to conversion’ and back to healthy scepticism.

I don’t have any doubt there are tender points in muscles, relevant to chronic pain states. The question for me, is what do they represent and are these points in muscle a primary manifestation of muscle pathology, amenable to local treatment or do they reflect a more central neurally based phenomenon.

Paul had sensibly chosen to ‘fence-sit’ on this issue, cautiously examining the evidence before publicising an opinion. He seems to be coming out with some sympathy for the concept that they represent a ‘tiny cramp’ affecting a muscle, based on scientific evidence. He doesn’t support dry needling or intense massage, but other milder treatments are OK.

He states:

Screen Shot 2016-06-16 at 6.58.46 PM

I commend the article for those interested in this issue.

Have a read:

Trigger Point Doubts

The Trigger Point Identify Crisis


About Tasworkdoc

As an occupational physician in private medical practice in Hobart, Tasmania - the southernmost state of Australia, I see workers referred by their general practitioners with various types of work-related injuries and diseases. These are mostly musculoskeletal injuries, both of traumatic and gradual onset as well as various associated psychological disorders. With interaction with patients for treatment and providing advice about rehabilitation, I have the opportunity, first-hand, to observe interactions between individual patients and compensation systems. I also conduct independent medical assessments, including impairment assessments for musculoskeletal injuries and asbestos-related disease compensation. This provides another perspective of workers within compensation systems.
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1 Response to The Science of Trigger Points

  1. jqu33431quintner says:

    Peter, I believe that Paul Ingraham’s position (“sitting on the fence”) is indeed a very precarious one.

    The theory of “myofascial pain arising from trigger points” has been soundly refuted (Quintner et al. 2015; Quintner & Cohen, 2015). No “lesion” in muscle has ever been demonstrated.

    As it turns out, the original theory was no more than a brave conjecture made by Drs Travell & Simons. Sad to say, their followers have blithely carried on as if the original conjecture was established knowledge.

    Thus, the “integrated hypothesis” can now be discarded.


    Quintner J, Bove G, Cohen M. A critical evaluation of the “trigger point” phenomenon. Rheumatology 2015; 54: 392-399.

    Quintner JL, Bove GM, Cohen ML. Response to Dommerholt and Gerwin: Did we miss the point? J Bodyw Mov Ther 2015; 19: 394-395.

    Quintner JL, Cohen ML. Myofascial pain: a bogus construct. In: Hutson M, Ward A, eds. Oxford Textbook of Musculoskeletal Medicine, 2nd ed. 2015.


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