Trigger point theory is wrong

The evidence against the theory of myofascial trigger points as proposed by Travell and Simons

‘‘Never be a spectator of unfairness or stupidity, the grave will leave plenty of time for silence’’ - Christopher Hitchens

I do not believe in the theory of myofascial of trigger points as proposed by Travell and Simons. Some people are surprised by this as in the majority of pelvic pain books trigger points are presented as scientific fact. This is far from the truth. Anyone suffering from pelvic pain deserves to know that the theory of myofascial trigger points as proposed by Travell and Simons has been comprehensively refuted by Dr John Quintner and Geoffrey Bove in their land mark paper – A Critical Evaluation of the trigger point phenomenon (ref, ref). 

Abandoning the belief that your pelvic floor or your body is full of trigger points is critical to recovery from pelvic pain. The idea of myofascial trigger points creates anxiety in pelvic pain patients and tends to make people fear movement.

In 2018 a meta anaylsis was conducted to assess the effectiveness of trigger point manual therapy treatment for chronic pain. A total of 19 trials were included in the anaylsis which included chronic pelvic pain. The conclusion of this anaylsis was definative - ‘‘Evidence for Trigger point manual therapy for chronic noncancer pain is weak and it cannot currently be recommended.’’ You can read the study by clicking here.

So what are these sore spots that pelvic pain patients often suffer from? Nearly everyone presenting with chronic pelvic pain or pelvic dysfunction will have a sore sport when pressed upon but this does not mean you have a 'trigger point' or 'taut band' in your muscle.  In fact you will be able to find sore sports on people who have no chronic pain or dysfunction.

A far better theory for the explanation of these sore spots is one proposed by Dr John Quintner in 1994. As explained in the following article by British physical therapist Adam Meakins.  

Soft tissue sore spots of an unknown origin

‘’There is an alternative theory about what causes soft tissue sore spots that is not as well-known as muscle knots. That is perhaps these sore spots are due to issues with the sub cutaneous peripheral nerves. A rheumatologist called John Quintner was the first to propose the idea of subcutaneous peripheral nerves as a source of these soft tissue sore spots in his 1994 paper freely accessible here.

Why these nerves are a source of pain isn’t fully understood, and recognised, but it is hypothesised that it could be either direct macro trauma, or micro trauma from repeated postures and stresses to the nerves blood supply which is vast and complex, as described in this paper here.

It should be remembered that our neural system, including our sub cutaneous neural system, requires a lot of fuel to keep it functioning effectively and it is a veracious consumer of energy. Therefore it needs a huge vascular supply to feed it, and any slight disruption to any nerves blood flow will soon cause the nerve to become distressed, and will soon be perceived as a threat, and so pain can quickly follow.''

With every client I worked with I have sent them a list of articles outlining the evidence against myofascial trigger points. It is my hope that you come to the same conclusion that I did which is that the theory of myofascial trigger points proposed by Travell and Simons is incorrect.  Once you realise that trigger point theory is wrong you will also realise that you do not require internal trigger point treatment to recover from pelvic pain and you certainly do not require a trigger point wand.

You can start with the following article by Dr Fred Wolfe entitled Travel Simons and Cargo cult science

Soft tissue sore spots of an unknown origin

An interview with Dr John Quintner on Pudendal Nerve available below.

''What might your research mean for someone who is having dry needling or trigger point therapy?''

''The evidence we have recently presented suggests to me that they may well be wasting their time and money. Trigger point therapists (with their techniques of “dry needling” and “myofascial release”) will of course disagree with me, but they are standing on rather loose ground (or perhaps are even standing on quick-sand). But the new view of “trigger points” that we have just published is well supported and more likely to be correct than that advanced some 50 years ago by the late Drs Janet Travell and David Simons. In my opinion, the question that needs to be answered by “trigger point” therapists becomes ''how on Earth could we ever have been so stupid as to hold our former beliefs in the first place''

The trigger point strikes out

‘‘To further confuse matters, it was later shown that “experts” in MPS diagnosis could not agree as to the location of or even the presence of individual MTrPs in a given patient. The mind-boggling list of possible causative and perpetuating factors for MTrPs was completely devoid of scientific evidence and therefore lacked credibility. But at least any of a myriad of factors could be drawn upon to exempt from blame those well-meaning therapists who were finding that the recommended treatment regimen was ineffective.’’ 

Behold the mighty trigger point

The Decline and Fall of the trigger point empire

Truthaches and trigger point therapy