Abstract The proposed etiology of Travell trigger points (TrPs) has undergone a fundamental revision in recent years. New research results suggest that TrPs are evoked by the abnormal depolarization of motor end plates. This article expands the proposed etiology to include presynaptic, synaptic, and postsynaptic mechanisms of abnormal depolarization (ie, excessive release of acetycholine [ACh], defects of acetylcholinesterase, and upregulation of nicotinic ACh-receptor activity, respectively).

This working hypothesis regarding the etiology of TrPs has changed the approach to treating TrPs. As an example, Travell and Simons abandoned the application of ischemic compression to TrPs; instead the authors adopted several techniques associated with osteopathic medicine (ie, muscle-energy, myofascial, counterstrain; high-velocity, low-amplitude). Scientists are now proposing and reporting the results of new approaches using capsaicin, a vanilloid-receptor agonist, and ACh antagonists (eg, dimethisoquin hydrochloride, botulinum toxin, quinidine, linalool). The purpose of this article is to review these new concepts and describe new resulting approaches to the treatment of TrPs.

Cardiology and Myofascial Trigger Points. Travell was treating a steady stream of grate. PDFCreator converts every printable document to PDF and many other formats. Download Free Out Of My Comfort Zone Steve Waugh Ebooking. Create professional PDFs with a few clicks and it's free. With many Professional Features. Suggested Reading & Products. This Travell & Simons, 2-volume set is required reading for those who are serious about learning comprehensive TP therapy. PDFCreator converts every printable document to PDF and many other formats. Create professional PDFs with a few clicks and it's free. With many Professional Features.

Travell, MD, (1901–1997) was an internist in general medicine who developed an interest in spinal manipulation in the 1940s, but later shifted her focus to myofascial trigger points (TrPs). In 1955, she relieved then–Senator John F.

Kennedy of disabling back pain (after he endured a failed diskectomy in 1944 and laminectomy in 1954). Travell's ensuing post as White House physician, followed by the publication of her two-volume “Red Bible,” Myofascial Pain and Dysfunction: The Trigger Point Manual,, coauthored with David G.

Simons, MD, brought prominence to her approach for treating TrPs. Palpation is a reliable diagnostic criterion for locating TrPs in patients. The reliability of diagnosing TrPs is similar to the reliability of diagnosing tender points in the counterstrain system developed by Lawrence H. An interrater-reliability study of this counterstrain system demonstrated that clinicians agreed 73% of the time (κ = 0.45); the palpation of patients' TrPs proved more reliable than the standard osteopathic TART examination.