To a National Board Certified Myofascial Trigger Point Therapist, Myofascial Trigger Point Therapy (or, as it is commonly known, myofascial release), is not just a treatment modality, but an entire treatment protocol. The first step to that protocol is an in-depth history of all relevant traumas to a person's body. To what degree is a trauma relevant? Briefly, I'll site an example. Physical Therapist, Mr H., suffered with chronic right knee pain. In taking an initial history, Mr. H. insisted he never suffered any trauma to the right knee. I persisted. Later, as he lay on my treatment table visibly perturbed by my persistence, he explained that when he was 12 years old, he fell off his bicycle and landed on his right knee. "But that was thirty years ago. What's that got to do with my knee pain"? A very close examination of the texture of the skin over the patella revealed a tiny scar of approximately 1/8 of an inch in diameter. With the leg fully extended, I began to test the mobility of the patella. I found that it moved about axes whose center was that tiny scar. As I held the patella superior to the knee joint, I had him slide his heel towards his buttocks. With knee flexion at approximately 20 degrees, a loud "click" was heard. The adhesion that was created when Mr. H. fell on his knee at 12 years old had caused his patella to track incorrectly for these many years. His knee pain was significantly decreased after one or two treatments to inactivate trigger points laid down in the quadriceps that were due to a dysfunctional patella. In the case histories that follow, the "mysteries of the histories" were not always revealed until after much client/therapist interaction had taken place. After an in-depth history is taken, a charting of the patient's pain is completed. Pain, referred by an active myofascial trigger point in a muscle, is the "signature" or pain pattern of an affected muscle. Based on analysis of the history and careful review of pain patterns, ROM testing is employed to locate restriction in a muscle or muscle group. This restriction is further verification of myofascial trigger point activity. Another objective sign is observed when palpation of a myofascial trigger point in a taut band of muscle elicits a local twitch response. Treatment involves a variety of myofascial release techniques including but not limited to ischemic compression and Fluori-Methane Spray and Stretch. A home exercise program is prescribed, including stretching and appropriate strengthening, to maintain functional release achieved during treatment. During each treatment, continuous inquiries by the therapist begin to uncover perpetuating factors such as inappropriate ergonomics, poor nutrition, inadequate water intake, ADL's and more. Myofascial Trigger Point Therapy is not a cure for all pain. However, the authors of Myofascial Pain and Dysfunction, The Trigger Point Manual, Janet Travell and David Simons, MD's report that "voluntary skeletal muscle is the largest single organ of the human body and accounts for 40% or more of body mass." They go on to say that there are "347 paired and 2 unpaired muscles for a total of 696 muscles" in the human body. Further, they state that "any one of these muscles can develop myofascial trigger points that refer pain and other distressing symptoms usually to a remote location." In spite of this, "the muscles receive little attention in modern medical school teaching and medical textbooks." More than 40% of the mass of the human body, consisting of muscle tissue, is capable of developing active myofascial trigger points. Myofascial trigger points, in turn, refer pain to a location other than the site of the lesion, often confounding conventional models. Is it any wonder why this treatment protocol is effective with pain patients who have had no relief from pain pills and muscle relaxants? It is my hope that the following case studies will shed light on the efficacy of Myofascial Trigger Point Therapy, by a board-certified practitioner, for the treatment of both acute and chronic pain. Case History 1 Case History 2 Case History 3 Case History 4 Epilogue Although these four case histories show remarkable results in alleviating pain, there are those cases where relief of pain and recovery is not as dramatic. Often times, when there is a patient that is refractory to treatment, there are systemic perpetuating factors. These perpetuating factors can be but are not limited to structural variance, nutritional inadequacies, metabolic and endocrine inadequacies including sub-optimal thyroid, hypoglycemia, and hyperuricemia. Other perpetuating factors include depression, anxiety, and chronic infection due to either viral or bacterial disease, parasitic infestations, allergy, impaired sleep and chronic visceral disease. Although the therapeutic procedures performed by a Board Certified Myofascial Trigger Point Therapist can appear to work miracles, this does not take place in a vacuum. Human physiology is a very complex and often times quite perplexing. It is only through the combined efforts of other disciplines and the patient's commitment to resolving their pain that they can truly be restored. George S. Pellegrino, CMTPT strhoppr@spinn.net Victoria L. Magown, CMTPT vmagown@aol.com Vicky and George are National Board Certified Myofascial Trigger Point Therapists. They are Co-Directors of MyoRehab and can be reached at 505-872-3100.

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