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To me it is not a relevant metric. I often come back and look at religious beliefs because many of them are rooted in fear, particularly Islam. Religious fears relate to judgment and retributive style karma. Therapy-linked beliefs are also rooted in fear…. These are not small fears we are dealing with. So I wonder how wise it is to expect people to be open to such confrontations.

EG, these are indeed important issues to consider. But science would never advance if all of us were so fearful of being wrong in our views that we closed our minds to advances in scientific knowledge. Milton, Geoff and I have been trying very hard over the last few decades to bring these important matters to the attention of the relevant health professionals. There has been and still is great resistance by some to even considering that our ideas might be useful. As you know, I am fond of reviving what I perceive as apt quotations from those whose wisdom is far greater than that which I shall ever attain:.

For nothing can be either loved or hated unless it is first known. You might also find solace in these words of Rene J Dubos [], a great scientist who lived closer to the present time:.

Could it be possible that there is no objective truth out there? Could it be that something becomes real when we believe it? What makes me consider this angle is the following, a passage from Alice in Wonderland. I find it really useful… but it certainly clashes with the idea of an objective truth in any field of study. Alice laughed. Hi EG. Pain is very complex and subjective, and people are far more so. People are highly open to suggestion, this could not be more clear.

critical evaluation of the trigger point phenomenon | Rheumatology | Oxford Academic

Your observations are open to scientific inquiry, in terms of outcomes. However, if you showed great outcomes with suggestion, we would celebrate that finding. And, it would discredit your observations. This happens all the time in our manual therapy world. With trigger points, it all started out pretty well. David Simons reached out to major physiologists and convinced them to design appropriate studies to develop an animal model.

Overall, the research has not supported the hypotheses. The field is stagnant because of this. So it is time to move on. This was our main message. But we have already clearly stated our views on Body in Mind, as well as in the journals Pain Medicine and, most recently, in Rheumatology. In fact they were first presented in our paper and were not challenged then by the proponents of the MTrP construct, one that harks back to the conjectures of Travell and Simons.

That is now history. We are grateful to Dommerhalt and Gerwin for reviewing our recent paper, which was shortened to meet the requirements of the journal. Our response to criticisms of the paper will soon appear in the correspondence section of Rheumatology.

Muscle Fiber Dysfunction and Trigger Points

I just read their paper and must admit that I find your comments rather inaccurate and strongly suggestive. I checked a few of the points Dommerholt and Gerwin made and there is no doubt that you and your colleagues are guilty of misquoting several references and not including others in support of your point of view. To dismiss their paper with references to religion and a lack of science is inaccurate and just silly and I would have expected a much more sophisticated response from you.

The authors make many excellent points. It is like you are saying that you would have made a better argument if you had been given more space. This seems like a lame excuse. Why did you not write your article with consideration of the space restraints? When Dommerholt and Gerwin point out that you missed pertinent references, you cannot excuse yourself by suggesting that you would have if you could have.

They could easily make the same argument. Maybe they left out some pertinent issues because of space restraints, so who are you for criticising them for not including all their pertinent points.

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After reading their article, I must agree that you did a pretty poor job in making your point. You accuse the trigger point folks as adhering to a religion with many holes, but after reading both articles, you seem to be guilty of the same. John Quintner Reply: February 8th, at am. Peter, only time and good science will tell if we are on the wrong track.

For your information, the article we originally submitted for publication contained over 5, words and references. Geoffrey Bove Reply: February 8th, at pm. Peter: Unless you have read the papers cited by both parties, and found inaccuracies, you have no right to make the statements you have made. John Quintner Reply: February 8th, at pm. I specifically mentioned the paper by Jafri because not only has it been published but also because Dommerhalt and Gerwin are holding it up as a good example of original work that supports their argument.

Of course it does, but only if you accept the premise that Jafri endorsed in the Introduction to his paper. Even then, I saw flaws in the explanation but had to accept it, I thought, as the best explanation we had. I never knew there were alternative explanations and when I found your paper a few years ago, it made more sense to me.


It offered a potential explanation that Travell did not — for instance, the apparent existence of TPs in non-muscular tissue. But what would cause inflammation in the first place? Could other factors, like compression, be responsible? A lot of people have a lot invested in perpetuating the current model. That plus fascia comprise a huge portion of what is taught to massage therapists in regards to pain management.


There is a small but growing number of us who are trying to inform our colleagues that what we were taught was hypothesis, not fact, that the hypothesis we were taught has some serious flaws, and that there are other hypotheses that may offer a better explanation. Thinking differently has shifted how I work with clients in pain.

I still seem to get at least as good outcomes as before. My clients probably thank you for that. Geoff would be in a better position to answer your question but I think he is away at the moment.

10 Best Trigger Point & Muscle Knot Stretches - Ask Doctor Jo

My understanding is that peripheral nerve trunks can become inflamed when their immediate environment is perceived as constituting a threat to their integrity. As you mention, compression with entrapment is one such possibility, as are mechanical traumata particularly if repetitive , invasion by tumour, and exposure to toxins or infective agents.

In addition, nerve trunks themselves can become hypersensitive to mechanical forces, however they may be generated. Toll-like receptor expression in the peripheral nerve. Glia ; To me, needling trigger points i. Diane, I do admit to a certain bias but heartily endorse your comment on the lack of rationale for needling trigger points. Let me once again bring this debate into focus by quoting from the introduction of a recent paper by Jafri :. Those who espouse the MTrP hypothesis which we still maintain is based upon conjecture have fallen into the trap of not considering alternative explanations for the observed clinical phenomena which are not in dispute.

Yes, it is difficult to decide in this particular case what the true explanation might be.