The Entity Formerly Known as the Trigger Point – The Semantics Problem in Manual Therapy.
I’m going to get a little philosophical. I really dislike naysayers- the ones you read or hear at a seminar making statements like, Trigger Points don’t exist or fascia cannot be released. I’ve heard establishment clinicians’ claim that the success of hands-on therapies are due solely to placebo. As a chiropractor, I’ve heard for years that subluxations are a figment of my profession’s imagination. Often naysayers are found within our own varied fields of manual therapy, practitioners claiming that one technique is valid while another is bunk- mostly based on the language used to describe findings and perform treatment.
I agree, there may be some approaches that sound wacky out there, but for the most part I think any hands-on practitioner that has established a steady practice is making positive changes in the neuro-myo-fascial systems of their patients- regardless of how they explain it.
If my practice is working, then why are the naysayers saying?
Most of us are getting our patients better, because whatever language we choose to use to describe our findings we are all actually treating the same thing. What is the thing or “entity” we are treating? Let’s start with Travell and the elusive Trigger Point. We all know what this means and we all know what they feel like- a local with more immobility, hypersensitivity, and/or pain referral than the surrounding tissue. Now, think about this… Do any of the following terms describe an entity fundamentally different than the definition above? Barrier, Fascial Restriction, Fibrous Tissue, Scar, Energy Blockage, Density, Subluxation, Tissue Tension, Pressure Point, etc.
But how do YOU explain the range of differences?
From a practical point of view they all are descriptors for dysfunction in the myofascial system. Here is where semantics comes in.
Each of these words can mean different things in the medical or manual therapy world when used in reference to different diagnostic approaches and treatments- hence the confusion and criticism between health professionals when using them.
Ironically, while the term Trigger Point is attacked quite often, it is the only definition that was created exclusively for a palpated soft tissue phenomenon that cannot be equivocated (and therefore misinterpreted) with other medical terms.
Can the term “Trigger Point” be transformed?
I think the term Trigger Point should be given new life- and made the standard “umbrella” term across manual therapy professions to describe soft tissue phenomenon diagnosed via palpation. With a general and accepted term, we can then dig deeper and ask…What kinds of dysfunction are involved in creating Trigger Points and associated myofascial syndromes? What are the physiological underpinnings? How can we make treatment approaches more successful? Ultimately it will be less naysaying, better communication, and more collaboration will move manual/soft tissue therapies forward in the health care arena.