Introduction: Why are Myofascial Pain and Trigger Points important to anyone with RSI? Anyone suffering from chronic pain will have trigger points due either to their lack of exercise or bad posture as a result of the pain. A study showed that 30% of normal people had trigger points in their shoulder muscles. Trigger points can cause pain a long way from the site of the trigger point. They are often overlooked in the diagnosis of many pain conditions and are mis-diagnosed as other pain conditions. Physicians in general have a poor understanding of trigger points.
For example: Trigger points can cause tennis elbow. The trigger points near the elbow which cause the actual tennis elbow pain can be set off by trigger points that are a long way from the elbow. If not all of the trigger points are erased then the ones causing the tennis elbow directly can re-appear. Unless the person treating you is aware of this then they may not treat all the trigger points (with acupuncture) and the treatment can fail. Here is a review of a couple of books that you may find useful. Read them, and then amaze your GP with your knowledge! There is a third book:
Pain Erasure The Bonnie Prudden Way.
This is a much simplified way of treating trigger points, which you might find easier to understand and apply than the J. Travell book. However your GP/physio may find it is not as academically rigorous as J. Travell.
Two books on Myofascial Pain and Trigger Points:
Myofascial Pain and Dysfunction; v.1: Trigger Point Manual
Travell, Janet G.; Simons, David G.
Published by Williams & Wilkins
700 pages, cost approx. 80ukp.
This is the first volume, covering the upper body. Volume 2 covers the lower body. First 200 pages describe what trigger points are and what causes them. The rest of the book is split into sections. Each section is on an area of the body. Each section starts with a diagram of the area of the body that that section covers. You can use this diagram to indentify which muscles cause pain in certain areas of the body. This makes it easy to look up all the muscles causing problems in one area of the body. This is important as the muscles may be a long way from the area of pain. Each muscle in the body has a separate chapter devoted to it. Each chapter has an anatomical diagram showing the muscle, and a diagram showing the referred pain pattern. The chapter then describes what the muscle does, how to diagnose that it is that muscle causes the pain pattern, how to find the trigger points in that muscle and how to treat the trigger points using injected anesthetic, or coolant spray. It finishes with a set of stretches to help alleviate the problem.
The anatomical diagrams are very clear, even for someone with no anatomical knowledge. The pain referral diagrams are also very clear; a lot of other books on trigger points copy these diagrams. A lay person could easily find and treat their own trigger points using this book (but not by injecting themselves of course!) Some of the stretches aren’t as good as they could be, but with the help of a good physiotherapist you should be able to work them out. My only reservation is the book was published in 1983, and some new techniques must have been discovered for treating trigger points by now. Rating: 9/10 (would be 10, but the book was published in 1983, so is slightly out of date). This is the definitive book on trigger points. Buy it or borrow it from your local lending library. But you MUST read it if you have diffuse RSI.
Acupuncture, Trigger Points and Musculoskeletal Pain, 2nd Ed.
P. E. Baldry
Published by Churchill Livingstone
350 pages, cost approx. 35 ukp
The book has three sections:
1. A historical overview of Acupuncture.
It covers the historical development of Chinese and Western acupuncture. Very interesting, 70% of Chinese acupuncture points lie on or very near to trigger point sites!
2. Principles of trigger point acupuncture.
This section explains the neurophysiology of pain (how we feel pain etc.) how acupuncture can reduce pain and deal with trigger points and what is myofascial pain (trigger points). This section is more up-to-date than Travell’s book. It also compares myofascial pain with other medical conditions, including fibromyalgia. Travell describes vapo-coolant spray and stretch or injecting local anesthetic to treat TPs. Local anesthetic is not a good idea, especially if you are treating a large number of TPs. Baldry explains how to treat TPs using acupuncture: you push the acupuncture needle in 5-10mm in the area over a TP (but not into the trigger point itself). This effectively turns off the trigger point. There are s lots of detail on the different nerve types and how they can be stimulated to produce chronic pain and how they can be turned off.
3. The practical application of trigger point acupuncture.
This section gives details of pain in areas of the body and how to treat them. Has very little anatomy, relies more on describing the muscles rather than illustrating them. Only really covers the trigger points and their referred pain patterns and how to stick a needle into the area over the trigger point. It does not cover the individual muscles as well as Travell.
This book is aimed at someone with knowledge of human anatomy and interested in acupuncture. Not as comprehensive as J.Travell but more up to date on the neurophysiology of pain. Rating: 7/10 Lend it to your GP/family doctor or physio if you have diffuse RSI.
Comment 1: I have been trying to obtain volume 1 through inter-library loans. The only copy they’ve found so far came from a Westminster medical library and had a substantial number of pages (several large chunks) neatly sliced out – sod’s law: these were the sections I most wanted. Since then, they appear to have located several copies of volume 2, but none of Volume 1. Has anyone succeeded in getting a complete copy of Volume 1 through ILL? If so, can you recall which library it came from?
Comment 2: When I got my copy through ILL it came from a library in Essex, not too far from London (i.e. not out in the sticks) can’t remember which one though.
Comment 3: I have both volumes of Travel and Simons, what exactly are you looking for in them. I have been recommending these books for years to practitioners who deal with musculoskeletal injuries, most Chiropractors would be familiar with Janet Travel’s techniques, she was the physical therapist to president JF Kennedy, a brilliant woman who sadly died recently, If I can be of assistance you can call me at my clinic 0181 286 2606.