Pseudo- science VS. real clinical phenomena.

Trigger Points

Usually, symptoms of painful skeletal muscular disorders, including to limited range of motion, are the results of tensions buildups within muscles and/or fascia/ connective tissue. Very often, in addition to tensions within fascia and/or muscles, trigger points would be developed. For sustainable and rapid results, it is equally important to address these tensions, as well as to handle/eliminate each trigger point.   Failure to adequately address all mentioned above abnormalities yields only temporary relief of symptoms without providing sustained results. Lastly, already for many years, often on, people in healthcare fields deny the existence of trigger points, as well as demote trigger point therapy as Pseudo-science.

Providing, of course, the similarity of the definition of what trigger points are, it is hard to understand people who are denying their existence.  Having met a person like this, I always wonder if he or she have had clinical experience.  Clinicians can argue the nature of trigger points, perhaps offer a different explanation for their existence, but not their very existence.

Only recently I started to understand the origin of the above-mentioned denial.

Here are a few quotes:

”In my opinion, the whole “trigger point” belief system launched by Travell & Simons, and perpetuated by their enthusiastic followers falls into this category.:” Travell & Simons, book represented the opinion, not science. None of the trigger points or their treatments were validated; none were tested for reliability.”

“There were almost no studies in the Travell & Simons book, just testaments. Most of the perpetuating factors were plain wrong, and represented outdated, overthrown junk science.”

It appears, all the denial of trigger points existence and the critique of the science behind it is based on Travell & Simons manual. I am familiar with this manual and believe that Travell & Simons did a good job presenting techniques for trigger points injections. This manual/instruction for MDs describes how to localize and administer mainly corticosteroids injections. They offer around 400 references, but again this is manual/instruction booklet for physicians, rather than a research paper.

In my opinion, the biggest confusion is based on a misconception that Travell & Simons work is a scientific paper rather than a clinical instruction manual. If one to criticize something about that manual, it would be the injection techniques described in there.

Now is the time to discuss trigger points as a clinical phenomenon, as well as consider the science behind the effect of the trigger point therapy.

In general, in the clinical setting, we define trigger points, as a pinpoint localization of pain. Many times, when we experience a painful sensation in a reachable area, by instinct, we palpate this localization and compress it.

So many people who experienced pain found those pinpointed painful localizations and compressed against them. If somebody will ever try to convince you that there is no such a thing as trigger points and will claim that there were no studies like this done, just offer them following information:

Trigger points as a painful formation in the skeletal muscles were described for the first time by German physician F. Froriep in 1843. Another German scientist Dr. H. Schade in 1921 examined them histologically and formed the concept of myogelosis. British physician Dr. J. Mackenzie in 1923 offered the first pathophysiological explanation of the mechanism of trigger point formation and formulated the concept of the reflex zones in the skeletal muscles where the central and peripheral nervous system play a critical role.

The reflex zones concept was further developed by American scientist Prof. I. Korr in1941 in a series of brilliantly designed experimental studies Awad (1973) examined biopsy tissues from trigger points using an electron microscope and detected a significant increase in the number of platelets, which released serotonin and mast cells which released histamine. Both substances potent vasodilators and their increase is a clear sign that body tries to fight with local ischemia in the trigger point area”

In his now classical work, Fassbender (1975) conducted a histological examination of the circulation around the area of the trigger point and proved once and for all that “… the trigger point represents a region of local ischemia”. The same results were obtained by Popelansky et al., (1986) who used radioisotope evaluation of blood circulation around the area of the trigger point.

Thus, trigger point concepts were developed much earlier than the work of Travell & Simons, who based their manual on this pre-existing knowledge.

Summary

The science-based concepts alone would not make a difference in a clinical situation.

Appropriately applied introductory massage, followed by connective tissue massage, muscular mobilizations, periosteum massage, including Ischemic compression of trigger points, would make a difference.

It is extremely easy to perform techniques, that helping us to sustain results in cases of painful skeletal muscular disorders.

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