To a National Board Certified Myofascial Trigger Point Therapist,
Myofascial Trigger Point Therapy (or, as it is sometime mistakenly
called, myofascial release) is not just a treatment modality,
but an entire treatment protocol. The first step of that
protocol is an in-depth history of all relevant traumas experienced
by a person’s body. To what degree is trauma relevant?
Briefly, I’ll site an example.
Physical Therapist, John, suffered with chronic right knee
pain. In taking an initial history, John insisted he never
suffered any trauma to the right knee. I persisted.
Later, as he lay on my treatment table visibly perturbed by my
persistence, he explained that when he was 12 years old, he fell
off his bicycle and landed on his right knee. “But that
was over thirty years ago. What’s that got to do with my
A very close examination of the texture of the skin over the
patella revealed a tiny scar of approximately 1/8 of an inch in
diameter. With the leg fully extended, I began to test the
mobility of the patella. I found that it moved about an
axes whose center was that tiny scar. As I held the patella
superior to the knee joint, I had him slide his heel towards his
buttocks. With knee flexion at approximately 20°,
a loud “click” was heard.
The adhesion that was created when John fell on his knee at
12 years old had caused his patella to track incorrectly for these
many years. His knee pain was significantly decreased after
one or two treatments to inactivate trigger points laid down in
the quadriceps due to a dysfunctional patella. In the case
histories that follow, the “mysteries of the histories” were not
always revealed until after much client/therapist interaction
had taken place.
After an in-depth history is taken, a charting of the patient’s
pain is completed. Pain, referred by an active myofascial
trigger point in a muscle, is the “signature” or pain pattern
of an effected muscle. Based on analysis of the history
and careful review of pain patterns, ROM testing is employed to
locate restriction in a muscle or muscle group. This restriction
is further verification of myofascial trigger point activity.
Another objective sign is observed when palpation of a myofascial
trigger point in a taut band of muscle elicits a local twitch
Treatment involves a variety of techniques that include but
are not limited to ischemic compression and Fluori-Methane Spray
and Stretch. A home exercise program is prescribed, including
stretching and appropriate strengthening, to maintain functional
release achieved during treatment. During each treatment,
continuous inquires by the therapist begin to uncover perpetuating
factors such as inappropriate ergonomics, poor nutrition, inadequate
water intake, activities of daily living and more.
Myofascial Trigger Point Therapy is not a cure for all pain.
However, the authors of Myofascial Pain and Dysfunction, The Trigger
Point Manual, Janet Travell and David Simons, MD’s, report that
“voluntary skeletal muscle is the largest single organ of the
human body and accounts for 40% or more of body mass.” They
go on to say that there are “347 paired and 2 unpaired muscles
for a total of 696 muscles” in the human body. Further,
they state “any one of these muscles can develop myofascial trigger
points that refer pain and other distressing symptoms usually
to a remote location.” In spite of this,” the muscles receive
little attention in modern medical school teaching and medical
More than 40% of the mass of the human body, consisting of
muscle tissue, is capable of developing active myofascial trigger
points. Myofascial trigger points, in turn, refer pain to
a location other than the site of the lesion, often confounding
conventional models. Is it any wonder why this treatment
protocol is effective with pain patients who have had no relief
from pain pills and muscle relaxers? It is my hope that
the following case studies will shed light on the efficacy of
Myofascial Trigger Point Therapy, by a board-certified practitioner,
for the treatment of both acute and chronic pain.