These results indicate that the critical therapeutic factor in both cases is mechanical disruption by the needle. The soreness of the patients treated by dry needling had significantly greater intensity and duration than the soreness of lidocaine-injected patients." (pp. However, within 2-8 hours, 42% of the lidocaine-injected patients and 100% of the dry-needled patients developed local soreness. In the Hong stud圓 of the response of trapezius muscle trigger points to 0.5% lidocaine or to dry needling, both groups experienced essentially the same amount of improvement immediately and 2 weeks later. "In comparative studies,3,4 dry needling was found to be as effective as injecting an anesthetic solution such as procaine or lidocaine in terms of immediate inactivation of the trigger point. In Myofascial Pain and Dysfunction: The Trigger Point Manual, Volume 1, Travell and Simons stated, 16)Īlthough these observations are still applicable today, an increasing number of clinicians of different medical disciplines are now successfully treating myofascial pain syndrome by using dry needling.Īnother important clinical observation should be mentioned. Agreement on diagnostic criteria is also confounded by the many variations in structure and accessibility of some 500 individual muscles no one examination applies to all muscles"2 (p.
.jpg "internal oblique travell and simons")
These interrater reliability studies make it clear that for many clinicians it takes training and much experience to develop adequate skills for diagnostic reliability and therapeutic competence. This is in part because clinicians depend heavily on the history as well as the physical examination, but interrater reliability studies to date have addressed only the physical examination. In the absence of an established gold-standard diagnostic test, appropriate specific diagnostic tests and appropriate diagnostic criteria remain controversial and unresolved. Diagnosis can be made only through physical examination and patient history.ģ. At present, there is no recognized laboratory test or imaging technique to serve as an objective standard for diagnosing trigger points. There is no generally accepted account of the pathophysiology of trigger points, which prevents the establishment of authoritative diagnostic criteria, and this in turn inhibits research.Ģ. In other words, trigger points are very complex." We are now becoming aware of several factors that may account for this slow progress.Īlthough the core of trigger points lies in skeletal muscle, all branches of the nervous system and several endocrine systems interact with them. "Despite the fact that an increasing number of clinicians and scientists believe that most common enigmatic unexplained musculoskeletal pain comes from trigger points, mainstream medicine has yet to accept or incorporate them as an integral part of its teaching, research and practice. Although this book is authoritative in its field, Simons's observation2 is noteworthy:
#INTERNAL OBLIQUE TRAVELL AND SIMONS MANUAL#
Simons published their two-volume work, Myofascial Pain and Dysfunction: The Trigger Point Manual, which is now the classic clinical manual in trigger-point medicine. She introduced the terms myofascial pain and zones of pain referral and also named the disorder myofascial pain syndrome. She soon discovered that this referred pain is triggered by neural hyperactivity at the points in muscle and its surrounding fascia, Kellgren had referred to as "tender points" she gave them the name trigger points. He also observed that this pain is not generally felt at the tender point itself but is referred to an area of the body some distance from it.1 Kellgren's work prompted Janet Travell to study patients with muscu-loskeletal pain. He found that he could reproduce this spontaneously occurring pain by applying sustained pressure to these points and could alleviate it by injecting those points with procaine hydrochloride (Novocain). A British physician was working as a young research assistant under Sir Thomas Lewis at University College Hospital in 1938, John Kellgren-later to become professor of rheumatology at Manchester University in the United Kingdom-observed that the pain in myalgia, or what is currently known as myofascial pain syndrome, originates in small, circumscribed, exquisitely tender points in muscle. Trigger-point therapy was developed in modern times as a clinical technique for myofascial pain syndrome.
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