[Ebook PDF] Travell, Simons & Simons’ Myofascial Pain and Dysfunction: The Trigger Point Manual, 3rd Edition

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Travell, Simons & Simons’ Myofascial Pain and Dysfunction: The Trigger Point Manual, 3rd Edition

ISBN-13: 978-0781755603
ISBN-10: 0781755603

Author: Joseph Donnelly (Author)

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This new edition of Travell, Simons & Simons’ groundbreaking work reflects the latest research and best practices associated with trigger points and updates the iconic pain point images that set the standard in the field. New lead editor Joseph M. Donnelly draws on his experience as both educator and physical therapy practitioner to integrate an evidence-based approach into this critical text. In addition, the new edition consolidates information to create a more intuitive user experience and features a completely new full color design to bring concepts to life.

FOREWORD
The publication of Travell 86 Simons’ first volume of Myofascial Pain and Dysfunction: The Trigger Point Manual, in 1982, followed 10 years later by the second volume, and in 1999 the second edition of volume one, created a revolution in the understanding and management of musculoskeletal pain, but also caused an eruption of critical comments of volcanic proportions.
The revolution amounted to a new way of looking at musculoskeletal pain via the concept of the myofascial trigger point, a concept introduced and expanded upon over the preceding three decades by Dr Janet G. Travell, later joined by Dr David G. Simons, but never before presented in a comprehensive text. Travell’s unique insight that was detailed in the first volume was the appreciation that muscle pain could present as pain referred to a distant site. Referred pain, now known to be mediated through the central nervous system and associated with visceral organs and joints as well as with muscle, was neither well understood at the time nor widely accepted. Moreover, Dr Travell identified the myofascial trigger point as the cause of local pain in muscle and the cause of pain referred to distant sites. She identified the trigger point on physical examination by manual palpation. There was no objective way to identify the trigger point by laboratory test, for example, by imaging or by electrodiagnostic examination. The idea that pain could be referred from one place to another was ridiculed at national medical meetings and dismissed as fantastical thinking. The storm that Travell created was largely due to the inability of the mainstream medical profession to understand the concept of referred pain from muscle, coupled with an inability to examine muscle as carefully and as well as she could. Lacking in the texts by Travell and Simons, however, was a critical, evidence-based approach to the descriptions of trigger point pain and their referred pain patterns. Dr Travell’s description of referred pain patterns was based on decades of meticulous record-keeping of patient’s reports and the drawings that Dr Travell made of her patient’s descriptions of their pain, but all of her descriptions were qualitative, not quantitative. Neither was the science of pain medicine advanced enough to understand referred pain. The pathophysiology of peripheral and central pain mechanisms had barely begun to be revealed by the time the single volume of the second edition appeared in 1999, and objective markers of the myofascial trigger point were only starting to appear, most notably an electrophysiologic change in the muscle of the trigger point that is now called endplate noise. Even that was controversial for decades, claimed by many to be nothing more than normal endplate electrical activity.
Despite these shortcomings, the texts by Travell and Simons were eagerly read by those who treated musculoskeletal pain.
With the passage of time, and more knowledge of the pathophysiology of muscle pain, the texts achieved an iconic status.
Almost 20 years have passed since the publication of the last edition of Myofascial Pain and Dysfunction: The Trigger Point Manual, 2nd edition, and medicine has advanced and changed greatly since then. Much more is known about the development of pain, about peripheral and central sensitization as it applies to muscle, with major contributions by Siegfried Mense and his colleagues, and central pain modulation is now an accepted phenomenon, thanks to the work of David Yarnitsky and others. Nociception is now understood to be a complex matter involving integration of multimodal sensory input, interconnectedness of cerebral centers, and functional coordination with the motor system. Furthermore, much more is known about myofascial trigger point anatomy and physiology through the studies using
microdialysis analysis of the trigger point milieu performed at the National Institutes of Health by Jay Shah and his associates, the ultrasound appearance of the trigger point that has been detailed by Sikdar and his colleagues in Northern Virginia, and the work done by Hubbard and his associates, and Hong and his colleagues on the electrodiagnostic features of the trigger point. The importance of fascia in pain of myofascial origin is undergoing its own revolution. Knowledge of fascial anatomy and physiology is rapidly increasing, though how fascia and muscle interact to produce pain is still not well explicated.
In addition, and most importantly, medicine has moved progressively toward an evidence-based, scientifically supported, practice, rather than so much an art that we used to emphasize, although this is not to denigrate the role of history and physical examination in defining a patient’s pain problem. There is still a need for an educated, intuitive evaluation of the patient that we call the art of medicine, both in diagnosis and in treatment. It is at this time of great change and expansion of knowledge that this new edition of Myofascial Pain and Dysfunction: The Trigger Point Manual appears.
The present volume, the third edition of Simons, Travell, and Simons’ text, brings the previous editions of this popular resource up to date. It is an evidence-based text where evidence is available. The  eferences to muscle function and anatomy are updated. The initial chapters in the text are a general introduction to myofascial pain, written by Jan Dommerholt, who is both clinically well acquainted with myofascial pain syndromes and extremely well versed in the current literature, having authored regular reviews of the literature in this field for over a decade.
Dommerholt provides the background of pain science, reviews what is currently known about the trigger point, and provides the basis for a proper understanding of the later chapters that detail diagnosis and treatment of particular muscle trigger points and of regional trigger point syndromes. He has also introduced for the first time in this text a detailed discussion of the anatomy and of the role of the fascia in myofascial pain. Of great importance is that the treatment modalities used in the management of myofascial pain that are described in the text, most importantly the technique of dry needling, are supported by the citation of randomized, controlled trials and by systematic reviews and meta-analyses. Gone are the detailed instructions of spray and stretch in favor of dry needling as a treatment of trigger points.
In keeping with David Simons’ inquisitive mind and drive to understand what underlies myofascial trigger points, a chapter is included that expands on Simons’ Integrated Hypothesis of the Trigger Point and presents new and novel hypotheses about the origin of the trigger point, but based on firm evidence of trigger point characteristics. Likewise, a chapter on perpetuating factors is included in recognition of treatment of a trigger point as being the beginning of management of myofascial pain syndromes, not the end. The chapter on perpetuating factors includes material that was not included in previous editions,
such as gonadal hormone and sex effects on pain, and integrated postural considerations involving motor control.
The text has, of necessity, many contributing authors. In this respect, it differs greatly from the first two editions, which spoke in the unique voices of Janet G. Travell and David G. Simons, with only six additional contributors in the second edition. In the previous editions, one can hear Travell’s admonitions and gems regarding the patient’s history that truly expressed the art of medicine, while Simons’ voice was grounded meticulously in the scientific literature. This volume, written by many authors, maintains a consistent approach as each chapter about a specific muscle follows a similar format that includes
anatomy, function, pain presentation, referred pain patterns, and perpetuating factors and conditions that are specific to a given muscle. The detailed reviews of the literature regarding these topics is left to the previous volumes, perhaps out of the recognition that a single volume of 77 chapters would otherwise become too unwieldy. The presence of many contributors means that each chapter reflects the interest and voice of the author(s) of that chapter. The chapters by Cesar Fernandez de las Pefias and Orlando Mayoral del Moral are models of detailed and well-documented discussions of their subjects, for example,
which is not to say that others do not also achieve their level of distinction. The editors and publishers have elected to keep the illustrations made by Barbara Cummings from the previous editions, a wise choice as they were made in close consultation with David G. Simons, who went to the anatomy laboratory in order to ensure accuracy in the illustrations. These illustrations are unequaled in their clarity and usefulness. Moreover, the X’s that Travell and Simons added, to signify the major sites in each muscle where trigger points can be found, have been removed from the figures in recognition of the fact that trigger points can be found elsewhere in the muscle, and the muscle must be systematically examined. It must be said, however, in recognition of the need to keep this volume to a usable size and affordable.
cost, that the previous editions of this text should be kept on the shelf as a reference for the greater detail of description that the previous format permitted, as well as for the unique voice of its authors, which is not found in this edition.
Finally, recognition and thanks must be given to Joseph M.Donnelly, who gamely undertook this rather daunting project. David G. Simons had planned to edit a third edition himself but was unable to do so during his lifetime. Donnelly accepted the arduous work of assembling a team of associate editors and a stable of writers, wringing the chapters out of them, writing chapters himself, shepherding the project with all of the delays, procrastination, and frustrations associated with such a project, and doing so for the first time in his career. This project has been an arduous task, one that I hope will be recognized as a labor of love, for the welfare of all of our patients everywhere, but most importantly for the love of David G. Simons, a man who taught us, cajoled us, nursed us, urged us to think clearly, and who was indeed responsible for getting the first two editions published. It is truly in gratitude to David G. Simons, and to Janet G. Travell, that Joe Donnelly and all of us associated with this project have worked together to produce this text, which we hope will serve as an indispensable guide for the next generation of myofascial pain practitioners.