Talk:Myofascial trigger point

First paragraph

Let's clean up the first paragraph and convince Mccready to rant on later paragraphs with relevant citations if he must. [psnack] Psnack 10:11, 3 June 2006 (UTC)

Suggested First Paragraph

Trigger point is the phrase coined by Dr Janet Travell (1942) to describe a clinical finding with the following chacteristics:

• Pain related to a discrete, irritable point in skeletal muscle or fascia, not caused by acute local trauma, inflammation, degeneration, neoplasm or infection.
• The painful point can be felt as a tumor or band in the muscle, and a twitch response can be elicited on stimulation of the trigger point.
• Palpation of the trigger point reproduces the patient's complaint of pain, and the pain radiates in a distribution typical of the specific muscle harboring the trigger point.
• The pain cannot be explained by findings on neurological examination.

Persons diagnosed with trigger points often first notice painful "bands", "knots" or "hard spots" in the affected muscles, and it is not unusual for them to undergo multiple tests and specialist referrals before the diagnosis is made.

This article summarises the history of the description of the disease, the symptoms and signs, treatments and the course of the disease. While mainstream medicine accepts the diagnosis as such, the average doctor has not been trained to make the diagnosis, and there is uncertainty and controversy about the causes and the appropriate treatment. These aspects will be discussed under the "Controversies" section.

Comments? I'll add the references when needed--Seejyb 00:07, 12 June 2006 (UTC)

Good start, but...

Good spinpet of information but it needs organize. Especially, it should say immediate what trigger points are. -- Hans Joseph Solbrig 03:53, 1 August 2005

Deleted rock band

I believe that the self-promotional reference to the band "Trigger Point" should be removed: The reference to the release of an album in the future: September 13, 2005 (it is August 7th at the time of this writing) is an inappropriate abuse of wikipedia. -- 70.113.30.152 21:13, 7 August 2005

PTs and trigger point treatment

I would also like to see the use of Massage Therapy explained in the treatment of Trigger Points. Considering that Physio/ Physical therapy was mentioned as a knowledgeable profession on the matter, it is glaringly absent in the treatment techniques. Instead, other more aggressive and invasive solutions are expounded first. Massage Therapy, whether provided by a Chiropractor, Physio/ Physical or Massage Therapist is most often the first point of call when dealing with Trigger Points. This omission detracts from the credibility of the article. -- Chops A Must 00:49, 1 March 2006

I wholeheartedly agree. As a PT I often deal with trigger points and referred pain problems using massage Skeptic Ring] - Ringmaster

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-- Fyslee 15:10, 8 May 2006 (UTC)

Thanks Paul "soon to be published", "soon" is unencyclopedic. I did not understand your removal of the external link. Did you read it. Don't you agree that it is pseudoscientific mumbo jumbo at its worst/funniest? Also, I think you may have broken 3RR on the page. Please be careful about that. :-) Mccready

Copied from Mccready's talkpage

Check out Bandolier on fibromyalgia and trigger points. Their existence is accepted, at least in the sense of diagnosis by palpation. The debate appears to be over whether treating them in some way is efficacious. From what I've seen there is some evidence to that effect, probably not to EBM criteria, but there is some. Jim Butler 21:05, 21 May 2006 (UTC)

Jim, this is a classic example of how pseudoscience works. The perpetrators pick something discussed scientifically (often on the fringe), elaborate from their imaginations, then presto (particularly if it's an area of real concern to a lot of people). In the article you cite the conclusion is The criterion of eleven painful trigger points looks a poor diagnostic bet. The problem with assessing painful trigger points are several. There is no gold standard against which they can be measured. Experts elicit different numbers [2] in the same patients. ... The evidence for the usefulness of trigger points is thin. The table was a stunner in showing lack of evidence.

For a particular lousy piece of "research" from mainstream medicine (lest I be imagined as biased towards them) check out this. And having checked out the American College of Rheumatology, I'm not convinced there isn't overservicing based on poor science[1]. Having said all that I'm willing to concede that yes there may be something in it. But the evidence is not there yet.

Seems to me that if you press points on a patient with chronic widespread pain - you'll inevitably find "trigger points". It might be slightly unfair, but the usual quack suspects are cited on the trigger point page. If people like Kelly had a decent research record you'd be inclined to take them more seriously. I'll copy this to tigger talk for ref. Mccready 02:16, 22 May 2006 (UTC)

Hi Kevin - some of the stuff you deleted sounds familiar, so I'll check and see if sources exist (e.g. the hypothesized pathology of damage to the SR). On what do you base your opinion of trigger points? Were they reviewed critically in some article or other? I do quite a bit of palpation in my practice, and though I haven't studied much of Travell, I think there is some validity to the idea (cf. ashi points in acu). Needling of small, palpable "knots" in muscles does seem to loosen them up and relieve pain.

Since that sort of treatment is individualized and depends on the skill of the practitioner, research has to be approached with due care. An obvious question that arises is intertester reliability and its dependence on how well-trained the testers are. It's facile for the skeptic to ridicule the idea of skilled testers, but it is still a valid hypothesis to check, and it has been looked at. A study from 1993 showed poor intertester reliability (abstract), but another from 1997 showed good intertester reliability once the testers were trained (abstract; article in PDF). Unless the latter study is fudging statistics in some way I'm missing, it appears to validate the concept of trigger points as clinically observable phenomena.

However, Bandolier is probably right that the evidence for their diagnostic usefulness is thin; this is probably true for treatment as well. As the second study suggests, it is possible that the lack of such evidence is due to inadequate agreement on the nature of trigger points and variability of palpatory skills among practitioners. I don't know to what extent the authors of that study followed up with such research. thx, Jim Butler 08:22, 22 May 2006 (UTC)

Hi Jim. I haven't seen a specific article. Just haven't seen any good evidence - so my quack antennas are twitching like the good scientist I am. No joy in the links I'm afraid. The first says 'usefulness of examining for the presence of trigger points in patients with LBP should be questioned.' The second was based on 10 patients for chrissakes and didn't I have to wade through tedium to learn this important fact (I hate badly written papers). How the authors can hold their heads up or how a journal can publish such thin stuff is beyond me. I've certainly learnt a painful lesson about the journal Pain published by the International Association for the Study of Pain. There goes another 15 minutes of my life. There were so many caveats and get out of jail cards, it wasn't funny. Most of them, it seems on a quick read, to revolve around - you poke something or stick a needle in it, especially if it's already painful and it's quite likely to contract (trigger). Presto again. If I'm missing something in this "study" I'd be happy to learn my error. Oh, and the use of kappa coefficients for this is questionable too] Mccready 10:24, 22 May 2006 (UTC)

Yes, I guess you didn't notice that the authors of the second paper noted the caveat about kappa coefficients. The results of the two studies were different. I guess you missed that as well. thx, Jim Butler 04:34, 23 May 2006 (UTC)

Sarcasm doesn't become you Jim. In fact I noticed both points. My conclusion remains unaltered at this stage. Mccready 01:45, 27 May 2006 (UTC)

Sure, why let pesky facts get in the way of conclusions? Jim Butler 03:56, 27 May 2006 (UTC)

The above interchange requires some comment:

• The Bandolier article is not pertinent to a discussion of trigger points (TrPs). The writer seems to imply that TrPs are somehow related to the diagnosis of fibromyalgia syndrome (FMS). They are as much needed for this diagnosis as they are for that of essential hypertension, colon cancer or leukemia. Discussing their finding in relation to the meaning of trigger points becomes irrelevant.
• The reference to the “National Survey of Pain Management Providers” as “a rather lousy piece of “research”” ignores the point of the article, which was that it was hoped that it would provide some impetus, and a general basis, for persons to start thinking about what the criteria for their diagnoses are. It’s a survey, nothing more, nothing less. It does not claim to define, approve or disprove any point about the issue of TrPs, except that there are certain aspects of the diagnosis and treatment which seem to be more common amongst those who work with myofascial pain than others.
• “And having checked out the American College of Rheumatology, I'm not convinced there isn't overservicing based on poor science”. A rather lame revelation. Overcharging based on poor science is common, a concern in all countries and businesses where this is practised, and it is encouraged by any system that guarantees payment “by number and procedure”, instead of for what is required: care, technical competence and scientific expertise. The point contributes nothing to the argument about whether the description, diagnosis and treatment of TrPs by different interest groups is scientific, valid or for other reasons worthy of inclusion in Wikipedia, except in reminding the unwary to remain skeptical of financial interest groups.
• “Quack suspects”: What would be the reason for not including persons often cited in articles on the history of the subject? Where does on find info on Michael Kelly’s non-“decent” research record.
• The comment “you poke something or stick a needle in it, especially if it's already painful and it's quite likely to contract” can be answered: No,“it’s” not “quite likely to contract”, and if it does, it does so in it’s own specific way. I’d love to see the evidence to the contrary.
• On Gerwin's article in Pain: The issue of publishing when one has such low numbers does puzzle me, it's shooting oneself in the foot, but that wil be addressed in another comment. --Seejyb 23:54, 11 June 2006 (UTC)

knots

When I massage my friends' shoulders I feel bumps with my fingers that I (and they) call 'knots'. a brief search of the internet suggests to me that they're actually called trigger points. Maybe that's something different from what this article is about. But I'd like to learn more about what they are, and what the effect of massaging them is.

Many things can cause knots- usually TrP's or some forms of trauma. Check out http://www.svacina.com/triggerpoints.html

Remember- it you press too little, too much, too short or too long, you may aggravate it. Sometimes a routine swedish massage aggravates TrP's. You can look up ABMP or other associations to find a massage practitioner or go to a Physical Therapist to try it. . Psnack 10:20, 3 June 2006 (UTC)

sources

The stuff on "contraction" vs "contracture" needs sourcing, and the latest round of edits by Psnack look highly dubious. No time to clean up now, but will have a go later. Jim Butler 21:44, 1 June 2006 (UTC)

OK, just did a first pass. Edits for NPOV, etc. The 2nd paragraph in the lead (on contracture, SR, etc) that's been deleted and reverted appears to be straight out of Simon, so I think that source suffices.

I'm new at this, so I'll try to cite more. I had no idea this would be so controversial! psnack [svacina.com]

added to Talk Page June 2006)

Not sure what this is in reference to, and some of the below is opinion needing citation:

(begin quote) Reference 1. Melzack R., Arch Phys Med Rehabil. 1981 Mar;62(3):114-7. "Myofascial trigger points: relation to acupuncture and mechanisms of pain." at www.ncbi.nlm.nih.gov

Reference 2. http://www.jsam.jp/english/journal/right.php?id=20

Despite the overwhelming evidence of its effectiveness in 60 years of medical journals (Reference: http://www.triggerpointbook.com/), the mainstream medical community does not promote Trigger Point Therapy. Also it is not patentable, and can't be administered with an oral drug.

A new theory is being studied by Dr. David Hubbard (Ref. http://www.trigger-point-injections.com/) which involves the muscle spindles rather than the neuromuscular junction theory. (end quote)

thx, Jim Butler 00:21, 2 June 2006 (UTC)

I added 1st reference due to "citation needed" for the claim of TrP's similarities to some acupuncture points. The Dr. Hubbard info is a recent theory which is being clinically tested, so I think that it should be included. I don't agree with Mccready's analogy of pregnancy and pain (written above somewhere); pain may be caused by many simultaneous factors, while pregnancy is due to getting screwed. Mccready should also relax and check spelling before he posts. [psnack]

psnack, personal attacks are not nice, particularly when based on erroneous assumptions. The misspelling of the orwd cmae frme the cut and paste elsewhere in the rtikal. The ref to preggers was being half preggers. ie not possible (you are either pregnint or not) ie something is either in causal relationship wif soefink or not. Hope that clears fings up. BTW, I think there is nuff stuff to keep the mainstream point uncited. What does other editors fink? Mccready 10:33, 3 June 2006 (UTC)

Melzack's postulate that acupuncture points and trigger point show correspondence has recently been disproven. The problem was apparently to a large extent in the interpretation of what the acupuncture points were in the first place. --Seejyb 18:12, 11 June 2006 (UTC)

Not understood claim - monthly statement

Fyslee I'm surprised at your edits on this occasion. The claim is part of the propaganda by the proponents. If you want it in you'll have to make this clear. The other editorialising about the education of physiotherapists etc falls into the same trap. We could easily say for the blue cheese pseudoscience(PS) that physiotherapists haven't been exposed to the moon is blue cheese theory as some sort of put down of the mainstream and some sort of twisted logic justification for the PS belief.

I also wanted to alert editors on this page that I edit many PS articles and am keen to discuss and reach consensus. Please see my statement about this on [[[User:Mccready my userpage]].Mccready 01:27, 3 June 2006 (UTC)

Dense re Gerwin; Simon as source

Hi Kevin, I noticed you cited Gerwin (incorrectly as Gerwina), but only his summary of previous negative research, and not his own positive findings. I'm including the latter. It wouldn't have been difficult for you to do so. Consider this facet of NPOV.

You questioned Simon in an edit summary - please give a more valid reason than the twitching of your PS antenna. He's cited with NPOV wording, the source is peer-reviewed and you can check his references and Pubmed for quite a bit of research along the lines he's discussing. -Jim Butler 23:17, 3 June 2006 (UTC)

Intro

Hey guys, just working my way through and made some intro changes to make this subject more encyclopedic. It would be nice if there were some citations. I am concerned about the self treatment section that "sells" the book. Also concerned about the section on treatment without references. Not saying it is wrong, but as a matter of responsibility, it sounds like Wikipedia is making an attempt at being a Merck Manual. Could get dicey if someone gets hurt following Wiki advice on any treatment protocol. We should leave this to the professionals. Otherwise, it is a very informative and interesting article. Good work! --Dematt 15:57, 5 July 2006 (UTC)

I did some work on the intro, but the second paragraph seems out of place. Does anyone have a problem with moving it into the theories section and using the second parargraph to describe who treats TP and why TP's are treated instead, then work into that third paragraph that explains what little controversy there is? --Dematt 18:45, 5 July 2006 (UTC)

Essay

I trained as a Massage Therapist and studied trigger points at length. This article reads (to me) like a compilation of essays I wrote about the subject. It sould be that I'm a little too close to the subject material so I am asking for other opinions. Naysie 13:18, 5 March 2007 (UTC)

is this science?

is this science or is this magic? I can't make heads or tails of the article. —Preceding unsigned comment added by 76.11.74.112 (talk) 17:37, 16 July 2008 (UTC)

Trigger point vs. trigger point

I'm starting to wonder if there aren't two different things we call "trigger points":

1. Travell's "tumor or band"-based, twitch-response trigger points
2. Fibromyalgia's "allodynic site" trigger points

I haven't seen any sources that acknowledge both types, but they all seem to assume one and be ignorant of the other. Type #1 aren't, I think, sensitive to light pressure; type #2 don't sound like they're palpable, lippery, taut or twitchy. They're different phenomena with the same name.

Am I right about this? Maybe someone who knows more can find some references. I've just come from a rather confused neuromuscular specialist, who only knew of type #2...

Answer: I think the confusion is "tender points" vs. "trigger points" - the tender points are a set of 9 points used for diagnosis of Fibromyalgia (see http://arthritis.about.com/od/fibromyalgia/g/tenderpoints.htm), where as trigger points cause characteristic pain referral patterns. There does seem to be an overlap with some of the "tender point" locations and the common locations of trigger points, which may be partly where the confusion arises. I personally don't believe using the "tender point locations" as the only diagnostic criteria for Fibromyalgia is that useful, as many conditions can cause widespread tenderness. Valerie DeLaune, LAc [2]