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Medical research has shown that many cases of chronic pain are actually caused by myofascial trigger points, or small contraction knots, in overused or otherwise traumatized muscles. Pain clinic doctors skilled at detecting and treating trigger points have found that they’re the primary cause of pain roughly 75% of the time and are at least a part of virtually every chronic pain problem.

These are some of the conclusions drawn by Doctors Janet Travell and David Simons in their widely acclaimed medical textbook, Myofascial Pain and Dysfunction: The Trigger Point Manual.

Referred Pain

According to Travell and Simons, trigger points are characterized by exquisite tenderness and referred pain. In other words, they hurt when pressed and they send their pain to some other site. The pain you feel usually comes from trigger points in nearby muscles, but not infrequently it comes from some distance away.

Headaches, for instance, are easily understood when you know that they come from trigger points in the muscle of the neck and upper back. Other examples of referred pain are: neck and jaw pain, low back pain, carpal tunnel syndrome, and all the various kinds of joint pain so often mistakenly ascribed to arthritis, tendinitis, bursitis, or ligament injury.

Diverse Symptoms

Decades of research by Doctors Travell and Simons have shown that trigger points cause problems as diverse as earaches, dizziness, nausea, heartburn, false heart pain, heart arrhythmia, tennis elbow, and genital pain. Trigger points are sometimes the cause of sinus pain and congestion. They may play a part in chronic fatigue and lowered resistance to infection. And because trigger points can be responsible for long-term pain and disability that seem to have no means of relief, they can cause depression.

Fibromyalgia Misdiagnosis

Even fibromyalgia, which is known to afflict millions of people, is thought to have its beginning with trigger points. In many instances, this mysterious diagnosis is applied incorrectly.

According to Dr. David Simons, the foremost living authority on myofascial pain, “It is becoming increasingly clear that nearly all fibromyalgia patients have myofascial trigger points that are contributing significantly to their total pain problem. Some patients are diagnosed as having fibromyalgia when in fact they only have much more treatable multiple trigger points.”

In other words, you may have myofascial pain syndrome, not fibromyalgia. Myofascial pain is much more easily treated.

Trigger points are often confused with “tender points,” one of the official criteria for a diagnosis of fibromyalgia. There are clear guidelines for distinguishing trigger points from tender points:
(1) A trigger point needs firm pressure to elicit pain, while a tender point is so painful it can hardly be touched.
(2) Tender points cause only local pain; they don’t refer pain to other sites as trigger points do.
(3) Trigger points are found predictably only in certain places; tender points can occur anywhere and everywhere.

Because genuine fibromyalgia sufferers usually have both types of “points,” their states of pain can be improved markedly by careful treatment of their trigger points. Unfortunately, fibromyalgia's tender points still elude an adequate explanation or reliable treatment.


Trigger points should be at the top of the list during any examination for fibromyalgia and chronic pain. When healthcare practitioners have had adequate training and experience, trigger points are easy to locate and treat. In fact, there are ways to treat them yourself, safely, conveniently, and without cost.

trigger points workbook

In The Trigger Point Therapy Workbook, nationally certified massage therapist Clair Davies has simplified Travell and Simons’s extensive research into myofascial pain and made it accessible to the layman. His innovative methods of self-applied trigger point massage will relieve pain in the lower legs, ankles, and feet when trigger points are the cause.

To find out more about the book and the method, please visit the homepage. To read a growing number of reviews by people who have been helped by the book, take a look at the book’s page at Amazon.com.

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