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Further research is needed to test the reliability and validity of diagnostic criteria. We conclude that there is as yet limited consensus on case definition in respect of MTrP pain syndrome. The great majority of studies cited publications by Travell and more recently Simons as a principal authoritative source for MTrP pain syndrome diagnosis, yet most of these studies failed to apply the diagnostic criteria as described by these authorities. However, one pair of criteria "tender point in a taut band" and "predicted or recognized pain referral" were used by over half the studies. The 4 most commonly applied criteria were: "tender spot in a taut band" of skeletal muscle, "patient pain recognition," "predicted pain referral pattern," and "local twitch response." There was no consistent pattern to the choice of specific diagnostic criteria or their combinations.
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The review identified 19 different diagnostic criteria. We recorded (1) the individual criterion and criteria combinations used to diagnose MTrP pain syndrome (2) the cited "authoritative" publications and (3) the criteria recommended by the authoritative publications as being essential for MTrP pain syndrome diagnosis. Of 607 possibly relevant publications 93 met our inclusion criteria. We searched electronic databases to identify relevant empirical research (excluding studies not in English and those relating to dental pathology).
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Experts were defined as being either researchers investigating MTrP pain syndrome or the "authority" the researchers cited as a source of reference for MTrP pain syndrome diagnosis. To check availability and book and appointment please check here.The aim of the literature review was to investigate the criteria adopted by "experts" to diagnose myofascial trigger point (MTrP) pain syndrome. The misdiagnosis of pain is the most important issue taken up by Travell and Simons. In my experience it has not always been 100% accurate – but it is a great starting point to begin assessment and treatment of muscular pain.ĭuring a treatment session we may incorporate trigger point therapy into sports or remedial massage therapy as an effective way to relieve a variety of pain complaints. With over 80 years of clinical experience between them Travell & Simons developed ‘pain pattern’ maps of the body which indicate where myofascial TrPs are more likely to be depending where you have pain (which I think was their original intention). The referral pain patterns may not correspond to any dermatome or neuroanatomy lines, so there must be another explanation. If in pain, pressure on the TrP will invariably recreate your pain (which maybe in a completely different place to where pressure is applied). However clinical experience makes me and many, many other professionals believe Trigger Point therapy can affect pain (relief) in a mechanical and neurological way – one cannot treat/affect one without the other – and is part of the biopsychosocial approach to successful treatment of pain and dysfunction. This is only a theory that has been strongly refuted by some researchers and clinicians claiming the effects are purely neurological and/or placebo. Localised tension pressure in and around a nodule or ‘knot’ can create a “energy crisis” meaning starvation of oxygen and accumulation of waste products within the muscle fiber, without innervation from motor units (nerve signals). TrPs can be active (producing pain) OR latent (no pain) but will always be self-perpetuating to some degree – depending on how long the TrP has been activated. Travell & Simons hypothesized that trigger points occur when muscle fiber sarcomeres are either acutely, sustained and/or repetitively overloaded. Within muscles are thousands if not millions of microscopic muscle fibers which contract independently to make a muscle/joint move.
#Travell and simons trigger pain point patterns manual#
A trigger point (TrP) was first defined by Dr Travell & Dr Simons as “a highly irritable localized spot of exquisite tenderness in a nodule in palpable taut band of muscle tissue”. Travell Charts These charts are essential for every Manual Therapist’s office and you also will find them in many physician offices who are dealing with Myofascial Pain patterns. The 1999 edition of Travell and Simons Myofascial Pain and Dys- function: The Trigger Point Manual5 proposes an integrated hypothesis regarding the etiology.