Getting to the point: an osteopathic appreciation of Janet Travell

Abstract

Janet Travell dedicated her medical career to the diagnosis and treatment of myofascial dysfunctions, culminating in the two-volume ‘red bible’ that she coauthored with David Simons, The Trigger Point Manual. She defined trigger points as tender nodules in taut bands of sketetal muscle that have the ability to refer pain, motor dysfunction, and autonomic phenomena. The ability of these points to refer (‘trigger’) pain into characteristic distribution zones contrasts with ‘tender points’ described by osteopathic authors (e.g., Chapman, Jones), where tenderness remains local. A recently published second edition of the Manual proposes a new hypothesis regarding the etiology of trigger points. This new hypothesis is reviewed, along with studies regarding the prevalence of trigger points, and their precipitating and perpetuating factors, and a differential diagnosis of factors causing point tenderness (e.g., fibromyalgia). Methods for diagnosing and treating trigger points are discussed, with an emphasis on new treatments that have evolved with Travell and Simons' new focus on dysfunctional motor end-plates as the source of trigger points. The convergent evolution between Travell and Simons' approaches and osteopathic approaches is highlighted.