Myofascial Pain: You Can Erase It in 3 Seconds with 90% Certainty Without Knowing Even A Single TrP

The trigger point (TrP) theory has been widely adopted by many musculoskeletal clinicians in treating pain using TrP massage or TrP dry needling since 1980s. But unfortunately, half century having past, no remarkable and reliable clinical benefits have been identified yet by randomly controlled trials (RCTs) (Read this).

Dr Andrew Leaver, Senior Lecturer in Physiotherapy at the University of Sydney, Australia, provided his view on the effectiveness of the current interventions for pain provided by physiotherapy, chiropractic and osteopathy (Olivia Willis, 2017), the three fields where TrP theory prevails:

• "We don't have robust clinical trials that prove the efficacy of every single thing that we do, but neither does any profession – a lot of medicine is not backed up by robust randomized controlled trials."

In 2018, the British Journal of Sports Medicine published an editorial titled:

"Is it time to reframe how we care for people with non-traumatic musculoskeletal pain?" (Lewis J et al, 2018). The editorial loudly voiced:

“...current approach to musculoskeletal pain is failing …”.

The leading author of the editorial is Professor Jeremy Lewis, who is also a consultant physiotherapist working in the UK-NHS.

The Myofascial Bible

Dr Travell and Simons' book “Myofascial pain and dysfunction: the trigger point manual” is the bible in musculoskeletal medicine world. According to Travell and Simons, myofascial pain syndromes are caused by trigger points in taut bands of muscles, thus MTrPs are central to the myofascial pain syndrome (Travell and Simons, 1983).

Debates and Controversies

Not everyone of clinicians and researchers agree with the bible. Quintner et al (2015) argued that the TrP theory is no more a conjecture from circular reasoning: TrP causes muscle abnormality, muscle abnormality induces TrP.

The phenomenon of a tiny cramp (taut band-related MtrP) observed in muscles may be true. “...but are they necessary [for the muscle pain to happen and for an effective treatment]?” Jay Shah, a senior staff physiatrist in the NIH Clinical Center questioned (Shah J et al, 2015).

The Answer to The Question

The answer, though few in the world are aware of, is “hidden” in an ancient healing art – the acupuncture widely practiced 2000 years ago in China -- Neijing acupuncture. This healing art works for pain (not limited to myofascial pain) like a magic bullet: it can precisely shut down the pain at any spot on the body, with instant effect at 95% certainty, no MTrPs whatsoever as defined in the myofasical bible involved.

Using this ancient healing art, we can easily conduct tests on 2 key questions:

• Are myofascial pain syndromes caused by TrPs?
• Are TrPs necessary for treatment of myofascial pain?

Put the Bible to The Test

Let's do some testing to find out whether the bible book MtrPs are needed or not in treatment of the myofascial conditions described in the bible.

We will use Neijing acupuncture to treat the “referred pain” which, according to the bible, is caused by a specific TrP. In the treatment, we will avoid doing anything that may form a stimulus to that specific TrP.

If the test treatment can effectively knock out or relieve that “referred pain” consistently and reliably, we should be able to conclude that the bible book TrPs are not necessary for treatment of that specific “referred pain”, thus the statement MTrP is central to mysofasial pain should be questioned.

There are hundreds “referred pain” syndromes and hundreds of corresponding MtrPs. In this post just a few are discussed as a case study.

Front Shoulder Pain (FSP)

In the bible, 2 TrPs related to FSP were described as located on infraspinatus.

If indeed “MTrPs are central to the myofascial pain syndrome”, then we can anticipate that the intervention not targeting these 2 FSP-related TrPs will not work, or work very poorly if they do. If the test can effectively relieve FSP consistently and reliably, we should be able to conclude that the bible book MtrPs are not necessary for treatment of FSP, thus FSP may have nothing to do with MtrPs.

For the details of the procedure and the outcomes of this test, read my earlier post (https://lnkd.in/gWEKKtNW). This post compared the efficacy of Trp dry needling, TCM acupuncture with Neijing acupuncture for a most commonly seen FSP, the pain located at short head of biceps.

Levator Scapulae Pain (LSP)

In the bible book, 2 TrPs related to LSP were described as located around the insertion of levator scapulae muscle.

If indeed “MTrPs are central to the myofascial pain syndrome”, then we can anticipate that the intervention not targeting these 2 FSP-related TrPs will not work, or work very poorly if they do. If the test can effectively relieve LSP consistently and reliably, we should be able to conclude that the bible book MtrPs are not necessary for treatment of LSP.

For the details or the test and the outcomes, read my Newsletter (https://www.dhirubhai.net/pulse/levator-scapulae-pain-dry-needling-can-erase-10-min-without-cheng). This Newsletter post compared the efficacy of TrP dry needling with Neijing acupuncture for treatment of LSP.

Trapezius Pain/Tightness (TP/T)

In the bible book, 2 TrPs related to TP/T were described as located on trapezius muscle close or on the scapulae.

If indeed “MTrPs are central to the myofascial pain syndrome”, then we can anticipate that the intervention not targeting these 2 FSP-related TrPs will not work, or work very poorly if they do. If the test can effectively relieve TP/T consistently and reliably, we should be able to conclude that the bible book MtrPs are not necessary for treatment of TP/T.

For the details of how to conduct the test to generally treat the entire upper trapezius, read my Newsletter (https://www.dhirubhai.net/pulse/how-knock-out-devil-breeze-tight-upper-traps-puzzle-bedeviling-cheng. This Newsletter post compared the efficacy of stretching & massage with Neijing acupuncture for treatment of TP/T.

Note that for TP/T, the bible book described a referred pain spot close to spine at level of T2 to T3. To instantly shut down or reduce this specific pain at 95 % certainty, you need to put needles far away from trapezius muscle. There are at least 8 optional locations for needle insertion to instantly and consistently take this referred pain spot away, all of them are outside of body trunk, none related to whatsoever MTrPs (I will discuss this in oncoming posts),

Low Back Pain at SI Joint (LB/SI)

In the bible book, one TrP related to LB/SI was described as located on or close to PSIS (see the image from Travell et al).

If indeed “MTrPs are central to the myofascial pain syndrome”, then we can anticipate that the intervention not targeting this TrP close to PSIS will not work, or work very poorly if they do. If the test can effectively relieve LB/SI consistently and reliably, we should be able to conclude that the bible book MtrPs are not necessary for treatment of LB/SI.

For the details of how to conduct the test, read my Newsletter at https://www.dhirubhai.net/pulse/low-back-pain-sacroiliac-joints-relief-within-5-seconds-brook-cheng.

The Value of The Bible Book

Actually, we can instantly at 95% certainty shut down or greatly reduce all of those referred pains described in the bible with no need to know anything about the bible book MtrPs, and with no need to do anything on the bible book MtrPs either.

Here we need to note that this does mean the bible book MtrPs has no value at all. Actually, there is possibility the bible book MtrPs may produce instant and reliable results, but the odds is extremely slim. This is because on the body, everywhere (any spot on the body except nails) can be a magic spot which is corresponding to another specific spot, including the spots which contain the bible book MtrPs. The size of such spot can be as small as a nociceptor terminal.

The number of spots represented by the bible book MtrPs is merely an extremely tiny portion of the number of all the spots on and in the entire body.

More importantly, the magic effect of the bible book MtrPs, if it ever happened, is not necessarily due to the presumed "release" of that tiny muscle cramp as defined by Travell and Simons, but due to the flip of action potential of nociceptor terminals located at or close to that tiny cramp.

Travell and Simons conjectured that the MtrPs are located at motor end plates. But do you think motor end plates plays a role in sending the nerve action potential back to the brain?

The Biggest Flaw in The Bible

The biggest flaw in the TrP bible is: hypothesis used like a fact. Psychology professor Grant discussed what is scientific thinking (Grant A, 2021). The most fundamental scientist's thinking is:

• Seeing your ideas as hypothesis that require testing and retesting.

I particularly noticed the word “appears to be” used by Travell et al (1983) when they assumed where MtrP is located. Clearly, these brilliant minds themselves were not very certain whether the trigger point abnormality is indeed a neuromuscular dysfunction: it just "appears to be” so, in other words, these experts' claim was merely a conjecture or a hypothesis at the best.

Paul Ingraham, a well-known science writer on pain medicine, questioned these experts' handling of such a hypothesis:

• Although they called it a “hypothesis,” they used it more like a fact: it is stated repeatedly with considerable confidence in both texts, old and new, and is then used freely as a major premise for other lines of reasoning.

By inflating a conjecture or a hypothesis into a fact, Dr Travell and Simons, unintentionally and unknowingly, enclosed themselves and consequently their loyal followers, into a very small and cozy cage, which tightly isolated them from the true pain mechanism world -- neural network running through out the human body with brain as headquarter office (Neijing acupuncture is demonstrating many tips of the iceberg - neural network in the brain).

Nevertheless, Dr Travell and Simons are among those brilliant minds in the modern medicine history, although nature has shown over and over again that the kinds of truth which underlie nature transcend the most powerful minds (Judith Curry, 2012). And psychological research has shown that even scientists are not immune to confirmation bias: The tendency of people to favor information that confirms or strengthens their beliefs or values and is difficult to dislodge once affirmed.

Science Advances in Errors & Tests

Science always develops and advances in errors, mistakes, skeptics, debates and controversies. Science does not move forward if we blindly accept everything of what we see, hear or read (including this post). Instead, we need to keep thinking, testing and retesting.

• “A hallmark of wisdom is knowing when it’s time to abandon some of your most treasured tools – and some of the most cherished parts of your identity.” – Adam Grant, organisational psychologist at Wharton
• “Science is the belief in the ignorance of experts…The experts who are leading you may be wrong…” – Richard Feynman, Quantum Physicist

Epilogue

Anyone who has read this post can do the tests following the procedures as I presented, for you to verify whether the outcomes I got is true or untrue (note: you need to be a health professional and are legally allowed to do dry needling or acupuncture). Don't blindly accept anything of what you see, hear and read including this post!

If your tests can disprove the outcome I got, I'm eagerly to know your results. Science needs testing, retesting … to get closer and closer to the absolute truth. Note that for each referred pain in the bible, there are at least 10 options to do the test. If the first one did not relieved the referred pain by more than 50% instantly, you will have 2nd, 3nd ... options. If by any chance your test completely failed to instantly relieve a specific referred pain, I will provide you more options for you to do more tests. But the complete failure (no instant response at all from the patients) happened in less than 0.1% of cases based on the records in my clinic.

Working together, we can build a global research network on Neijing acupuncture to revolutionize at least the pain medicine (the vast data I collected so far makes me believe Neijing acupuncture can make today's entire first line medicine into a magic bullet medicine).

Finally, we may also be able to provide new evidences for the two brilliant minds to rewrite the bible, if they like.

References

Aidan Helfant, Think Again (Adam Grant) 2022 https://www.aidanhelfant.com/think-again-book-summary/

Elizabeth Kolbert, Why Facts Don’t Change Our Minds. February 19, 2017

https://www.newyorker.com

Grant, Adam, Think Again: The Power of Knowing What You Don't Know. 2021

Judith Curry, How might intellectual humility lead to scientific insight. December 26, 2012 https://judithcurry.com/

Olivia Willis, Physiotherapy, chiropractic, and osteopathy: What's the difference? 2017, abc.net.au

Quintner JL et al, A critical evaluation of the trigger point phenomenon, Rheumatology, Volume 54, Issue 3, March 2015, Pages 392–399

Paul?Ingraham ? Sep 2, 2023 , Trigger Point Doubts. https://www.painscience.com/articles/trigger-point-doubts.php

Shah JP et al, Myofascial Trigger Points Then and Now: A Historical and Scientific Perspective. PM R. 2015 Jul;7(7):746-761.

Travell JG, Simons DG, Myofascial pain and dysfunction: the trigger point manual, 1983

James Clear, Why Facts Don’t Change Our Minds.

https://jamesclear.com/why-facts-dont-change-minds (accessed 2023)

Masic I et al, Evidence based medicine - new approaches and challenges. Acta Inform Med. 2008;16(4):219-25.

#triggerpoints #myofascialpain #mps #shoulderpain #lowbackpain #sijoint #sacroilliacjoint #travellandsimons #levatorscapulae #neckpain #upperbackpain