Rheumatology – A Critical Evaluation of the Trigger Point Phenomenon
Back in 1994, the West Australian John Quintner et al, mounted a peremptory attack on trigger points. It went nowhere. Two decades later, Quintner, Bove and Cohen revived their trigger point stance with a paper published in the journal Rheumatology (December 2014) entitled ‘A Critical Evaluation of the Trigger Point Phenomenon’. The paper had been rejected by many other journals, and had undergone many revisions before publication in Rheumatology. The conclusion starts off, “The construct of MPS (which, to explain is Myofascial Pain Syndrome) caused by trigger points remains conjecture. All working hypotheses derived from this conjecture have been refuted and therefore the theory can be discarded.” (The authors have mixed up conjecture, hypothesis, and theory. Three entirely different things! Losing me.)
“The trigger point strikes ….out”
A month later, Quintner found another outlet for his viewpoint in fellow Aussie, Lorimer Moseley’s Bodyinmind.org website. The blog post was titled “The trigger point strikes ….out“. In this post he mentions taut bands: “The existence of such bands had never been demonstrated.” He also maintains “no one has ever succeeded in demonstrating nociceptive input from putative myofascial trigger points.” Wrong on both counts, but only if you have read recent research papers. See, it’s dead easy to criticize the Travell and Simons Trigger Point Manuals because the most recent of their texts is now 16 years old. So much has happened since then. Quintner’s post generated hundreds of comments, which also made for great reading, until like many other online discussions it went a bit ‘ad hominen’ and personal.
The Trigger Point Strikes Back in the Outback
Curiously enough, Quintner’s host, Moseley, himself wrote the excellent chapter on pain in the equally excellent 4th edition of the text Clinical Sport Medicine(2012). Here are some Moseley excerpts: “Trigger points are present in all patients with chronic pain and are thought to reflect sensitization of nociceptive processing in the central nervous system… Patients with active trigger points present with persistent regional pain… These patterns clearly reflect central convergence of peripheral inputs, which further implicates the central nervous system in their generation and contribution to a pain state.”
A Critical Evaluation of Quintner et al: Missing the Point
Leon Chaitow. the editor of the Journal of Bodywork and Movement Therapies, invited Drs. Jan Dommerholt and Robert Gerwin to write a rebuttal to the original Quintner article. Quintner et al were also invited to participate but turned down the offer over some perceived slight. The Facebook reason for this can be found here, somewhere. Without summarizing the Quintner article or Dommerholt rebuttal, I recommend you read them both and decide for yourselves. I know what camp I’m in, because it’s the one supported by the best currently available science.
The myth that really hurts
It would be good to have this ‘against and for’ discussion continued in bodyinmind.org, allowing someone like Jan Dommerholt to be able to post his rebuttal. Not likely to happen, mate. I’ll quote from a man who is admired in both camps, Neuroscientist Patrick Wall; “If pain is a puzzle, we should not throw away pieces of the jigsaw just because we are obsessed with a preconceived single solution.” I was telling one of my patients, herself a psychologist, about the people who don’t believe in the trigger point. As I worked my way through her various scapulohumeral muscles at one point she said ‘That myth is really painful.” That’s the point.