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.
I commend the article for those interested in this issue.
Have a read: