Cinderella at the Examination

Let me start by saying that the reason for writing this particular blog is to introduce you to something that started over twenty years ago, is mostly unknown, but has great possibilities. I’m talking about a National Board Examination to certify Myofascial Trigger Point Therapists (CMTPTs).

The Examination Board has been around since 1989. It produced its first exam in 1991. Since then 259 applicants have sat the exam and 175 have passed to become CMTPTs. That’s a 68% pass rate. (Many more have been grandfathered into the National Association (NAMTPT.) This two/third’s pass rate makes the exam nothing to be sniffed at.

As mentioned in a previous blog I only became recently aware of the Board and the Examination’s existence. In my attempt to clarify their position to you readers I apologize to any past and present board members for anything that I write that is not fully accurate.

Many people have been on the Examination Board, but the one constant is Alyce DeChant from Albuquerque. Alyce trained directly with Janet Travell. She is currently studying to become a Physician’s Assistant (this may well lead to her into the Trigger Point Dry-Needling world). Despite these busy times she still has time to devote to improving the CMTPT exam.

The Board’s obvious aims are to develop and administer a nationwide exam that reflects a suitably high industry standard for Myofascial Trigger Point Therapy. The roots for most of the questions are most obviously found in Travell and Simons’ two volume set ‘Myofascial Pain and Dysfunction: the Trigger Point Manual’. But these two volumes are now ten and twenty years old and a lot has happened in that time.

I was invited to attend a review meeting at the New York branch of the Professional Testing Center (PTC). I met up with Alyce, plus in-coming NAMTPT President Jeff Lutz, past NAMTPT President Tanya Chaney (both from the Pittsburgh School of Pain Management), local New Yorker Debbie Moran and myself, the token Kiwi from Boston. We five were guided, fed and kept on track throughout by Vicki B. of the Professional Testing Center (PTC).

We met to review potential new examination questions which we got to decipher, dissect, modify or outright discard. Not many escaped some form of surgery. As soon as we finished a page or two the hard copy was whisked away by Vicki, never to be seen again (unless we ourselves choose to sit a later exam). The body of questions is constantly growing. There are now some 500 questions, 250 of which will be used in 2011 should you plan to sit.

Here’s the thing, anyone, I repeat, anyone can submit exam questions to the PTC. The Board especially encourages students of Myofascial Trigger Point courses to submit questions. These questions provide a reflection of the student understanding. The PTC presents them to us reviewers at twice-yearly meetings.

My understanding is that this process needs to be this regular to keep up with the explosion of new research. For example; Simon’s proposed ‘end plate damage’ theory and ‘energy crisis’ theory were combined to form an ‘Integrated Hypothesis’ which were then expanded upon by Gerwin and Dommerholt in 2004. These recognized hypotheses can now be joined by Henneman’s ‘Size principle’, Hägg’s ‘Cinderella hypothesis’, Shah’s ‘Biochemical milieu’ and Sikdar’s ‘Vibration Sonoelastography’ (VSE).

If you aren’t familiar with some of these concepts above you may need to update your knowledge. They are valid and bona fide principles published in reputable medical journals that totally prove that the Myofascial Trigger Point concept can be related to causality, and that a trigger points themselves can be undeniably sampled and imaged. Because I’m unashamebly pushing my own barrow I would like to point out that these principles are all covered in the Manual Trigger Point Therapy (MTT) seminar series as found on the web site

We clinical therapists can use the proof from the research above to improve the effectiveness of our trigger point deactivation techniques.

The clients that present with myofascial pain and dysfunction will always appreciate an up-to-date explanation of their soft tissue-based pain, especially if Cinderella is involved.

Cheerio for now,