Hi Travellians! As we continue our work of preserving and advancing the clinical legacy of Janet Travell, we are pleased to share several important updates from the Janet Travell Foundation.

We are honored to announce that the Foundation has received a grant to begin the digitization of archival materials from the Janet G. Travell Papers, housed at the George Washington University Gelman Library. This summer, we will begin working with an approved researcher to scan and photograph both two-dimensional and select three-dimensional materials from the collection. These materials—many of which exist only in paper form—will be carefully formatted and added to the Foundation’s growing digital archives, making Dr. Travell’s research, lectures, and clinical insights more accessible to practitioners worldwide. With the Gelman Library closing for the summer, the project is scheduled to begin in August.

In parallel, we are excited to share that the new Janet Travell Foundation website will be launching later this summer. This custom-built platform will serve as a central hub for the Foundation’s archives, educational programs, and ongoing research initiatives, offering a more dynamic and searchable experience for our community.

We are also pleased to feature a review of Pain Relief in 4 Easy Steps by Jacob Teitelbaum, M.D.—known to many as “Dr. T.” Drawing on decades of clinical experience in treating chronic fatigue syndrome, fibromyalgia, sleep disorders, and pain, Dr. Teitelbaum presents a clear, patient-friendly framework for addressing the root causes of chronic pain. His emphasis on identifying and correcting perpetuating factors—a concept central to the work of Janet Travell—offers a modern continuation of this foundational clinical approach. We invite you to read our full review and explore how these principles can be applied in both clinical practice and self-care.

Looking for The Trigger Point Manuals in PDF format?

Here are the links below.

Travell & Simons' Trigger Point Manual, Upper Half of Body, 1999, PDF Format (1,052 pages)

Click on the link, then download the PDF file.

Travell & Simons’ Trigger Point Manual, Lower Half of Body, 1993, PDF Format (576 pages)

Click on the link, then download the PDF file.

Visit our Vimeo Channel to stream our video series, “Myofascial Pain Syndromes: The Travell Trigger Point Tapes. Janet Travell, M.D., shares her knowledge of myofascial trigger point therapy.

Visit our website at JanetTravell.org

Follow us on Facebook

Much love,

Janet Street, Co-founder

Janet Travell Foundation

Book Review

Pain Relief in 4 Easy Steps

by Jacob Teitelbaum, M.D.

In the evolving landscape of pain management, few concepts remain as clinically essential—and as underrecognized—as perpetuating factors. In his forthcoming book, Pain Relief in 4 Easy Steps, Dr. Jacob Teitelbaum brings this foundational principle to the forefront in a clear, accessible, and actionable way.

For readers of Perpetuating Factors, this work will feel both familiar and refreshingly expansive.

A Direct Line to Travell

Dr. Teitelbaum’s connection to Janet Travell traces back decades. Like Travell, he recognized early that treating pain requires more than addressing symptoms—it requires identifying and resolving the underlying conditions that allow pain to persist.

This is the essence of perpetuating factors.

Rather than viewing chronic pain as a static diagnosis, Teitelbaum follows Travell’s model: pain is dynamic, multifactorial, and often reversible when the right variables are addressed.

The Four-Step Framework

In Pain Relief in 4 Easy Steps, Dr. Teitelbaum distills complex clinical insights into a structured, patient-friendly system. While grounded in integrative medicine, the framework strongly echoes Travell’s comprehensive treatment philosophy:

• Identify and eliminate perpetuating factors

• Restore metabolic and physiological balance

• Support sleep and energy systems

• Address pain directly with targeted therapies

This approach reinforces a key truth: trigger points do not exist in isolation—they are sustained by systemic and environmental influences.

Why This Book Matters Now

At a time when chronic pain, fatigue syndromes, and post-viral conditions (including Long COVID) are increasingly prevalent, Teitelbaum’s work offers a bridge:

• Between conventional and integrative medicine

• Between symptom management and root-cause resolution

• Between patient empowerment and clinical precision

For clinicians trained in the Travell tradition, this book provides a modern continuation of that legacy. For patients, it offers clarity, hope, and practical steps forward.

A Shared Mission

At the Janet Travell Foundation, we recognize in Dr. Teitelbaum’s work a shared commitment:
to move beyond isolated treatments and toward a complete, individualized understanding of pain.

His emphasis on perpetuating factors aligns directly with Travell’s original vision of “an entire treatment program”—a vision that remains as relevant today as ever.

Recommendation

We encourage our readers—clinicians and patients alike—to explore Pain Relief in 4 Easy Steps, available in paperback and Kindle editions on Amazon, with the audiobook format in the works.

It is not only a useful guide, but a meaningful continuation of a clinical lineage rooted in careful observation, systems thinking, and compassionate care.

About the book

Are you tired of living with pain that never fully goes away?

If you’ve been struggling with chronic pain and feel like you still haven’t gotten clear answers, this book offers a fresh and practical path forward. In PAIN RELIEF in 4 simple steps, Jacob Teitelbaum, MD breaks down a powerful, research-based approach to understanding what may really be driving your pain — and what you can do to begin addressing it.

The truth is, chronic pain is often not caused by just one thing. Most ongoing pain involves several overlapping problems in the body, and lasting relief often requires a simple but comprehensive approach.

In this eye-opening guide, Dr. Teitelbaum shows you how to identify and address four of the most common drivers of chronic pain:

1. Muscle pain

One of the most overlooked causes of chronic pain is muscle dysfunction. When muscles don’t have the energy they need, they can tighten, shorten, and become painful. This book explains why that happens and what simple steps may help your muscles relax and recover.

2. Inflammation

Too much inflammation can fuel pain throughout the body. Dr. Teitelbaum highlights practical lifestyle strategies and natural approaches that can help calm this hidden pain trigger.

3. Nerve pain

Burning, stabbing, tingling, or hypersensitive pain can often point to irritated nerves. This book provides an organized, easy-to-understand approach to supporting nerve health and reducing this kind of suffering.

4. Brain-amplified pain

When pain continues for too long, the nervous system itself can become overactive, causing the brain to amplify pain signals. This is a major reason chronic pain can persist even after the original trigger has changed. This book explains how to address this critical piece of the puzzle.

Because many people are dealing with three or even all four of these factors at the same time, PAIN RELIEF in 4 Simple Steps gives you a clear, structured roadmap instead of one more confusing theory. You’ll also discover guidance for many of the most common pain problems, helping you better understand what may be contributing to your symptoms and how to begin taking smart, supportive action.

Written in plain English and designed for everyday readers, this book is short, accessible, and filled with practical insights you can start using right away.

If you are ready to better understand your pain, take back a sense of control, and explore a simple path toward real relief, this book will show you where to begin.

Available now in paperback and Kindle editions on Amazon.

Audiobook edition coming soon!

About the Author

Jacob Teitelbaum, M.D. is one of the most frequently quoted post viral CFS, fibromyalgia, energy, sleep and pain medical authorities in the world. He is the author of 12 books including his new “Pain Relief- in 4 Easy Steps (available 3-25-26 on Amazon) , You Can Heal from Long Covid, the best-selling From Fatigued to Fantastic!, Pain Free 1-2-3, The Complete Guide to Beating Sugar Addiction, Real Cause Real Cure, The Fatigue and Fibromyalgia Solution, and the popular free Smart Phone app Cures A-Z. He is the lead author of eight research studies and three medical textbook chapters on effective treatment for fibromyalgia and chronic fatigue syndrome. Dr. Teitelbaum appears often as a guest on news and talk shows nationwide, including past appearances on Good Morning America, The Dr. Oz Show, Oprah & Friends, CNN, and FoxNewsHealth. www.EndFatigue.com www.Vitality101.com

Facebook Support Group: Recovering from Fibromyalgia, Chronic Fatigue, and Long COVID
Facebook Page | Instagram

Publications

You Can Heal from Long COVID
A Clinically Proven Program to Regain Your Health. DEVA Press, 2024. Coauthored by Mary J. Shoman.

From Fatigued to Fantastic!
Dr. T’s best-seller on living with, and overcoming, CFS and fibromyalgia. Avery Penguin Group, 1996 and 2020, fourth revised edition.

The Fatigue and Fibromyalgia Solution
The Essential Guide to Overcoming Chronic Fatigue and Fibromyalgia, Made Easy! Penguin Group, 2013.

Diabetes is Optional: Hintonia: The Natural Way to Control Type 2 Diabetes
Many of us think diabetes is an inevitable part of aging. Nothing could be further from the truth! To Your Health Books, 2018.

Beat Sugar Addiction Now!
Learn about the exploding health risk sugar poses to our diet. Find out if you’re 1 of the 4 types of sugar addicts, and learn how to break the addiction! Fair Winds Press, 2011. Co-authored by Chystle Fiedler.

Beat Sugar Addiction Now! Cookbook
Recipes That Cure Your Type of Sugar Addiction and Help You Lose Weight and Feel Great! Fair Winds Press, January 2012. Co-authored by Deirdre Rawlings, Ph.D., ND, and Chrystle Fiedler.

Beat Sugar Addiction Now! for Kids
The cutting-edge program that gets kids off sugar safely and easily. Fair Winds Press. Coauthored by Deborah Kennedy.

Real Cause, Real Cure
Discover highly effective, safe and low-cost natural approaches to improving your health — from arthritis to zits! Rodale, June 2011. August 2012. Coauthored by Bill Gottlieb. (Available at Amazon and bookstores.)

Pain Free 1-2-3
Discover natural and alternative approaches to promoting pain-free living. McGraw-Hill, 2005 and 2006 revised.

Three Steps to Happiness! Healing Through Joy
By applying the simple three-step principles in this book, you can develop the ability to be happy whenever you choose! Deva Press, 2003.

Cures A-Z
A smartphone app that guides you in effectively and safely treating most common health issues using the best of the natural and prescription tools available! Available on iPhone and Android.

EndFatigue.com

Vitality101

Subscribe to Dr. T's Newsletter

Hi Travellians,

It is with immense sadness that I write these words: My mother, Virginia Powell Street, passed away on December 18, 2025, at age 90. This month’s newsletter is dedicated to my mother Virginia, because she dedicated many years of her “golden years” to writing about her mother, Dr. Janet Travell. Without Virginia’s diligent work in preserving Dr. Travell’s research, papers, letters, photos and memorabilia, there would be no foundation and no collection of Janet Travell’s papers at the Gelman Library. From 2014-2022, Virginia published a weekly blog on our Facebook page, Janet Travell MD, which will be presented here and on JanetTravell.org. Her biography, “Janet Travell, M.D., White House Physician and Trigger Point Pioneer,” was published in 2014 on Blurb. Virginia left me with many boxes of materials that she has kept over the years, including hundreds of photos, and an unfinished project she called, “The Letters Book,” a collection of personal and professional letters written by and to Janet Travell. Those letters will be published here, and included in the foundation’s archives. Although the focus of this newsletter is in sharing Dr. Travell’s pioneering research in myofascial trigger point therapy, the human experience is complex and nonlinear. Janet Travell’s life as a daughter, wife, mother, grandmother, animal lover, tennis player, trail blazer, yodler, knitter, poet, tree climber, trigger point pioneer and White House physician is all part of the story.

Rest in Peace, Virginia Powell Street (1935-2025)

Looking for The Trigger Point Manuals in digital format? Here are links to the PDF versions in Google Drive, see below.

2nd_Ed_Vol_1_Upper_Body.pdf

https://drive.google.com/file/d/129rIn54IqRj87Z2ymSqxmsv-D_n2skiY/view?usp=sharing

1st_Ed_Vol_2_Lower_Body.pdf

https://drive.google.com/file/d/1s5dZtBzXq_EmGjiWNveusdNiZBQz2n1B/view?usp=sharing

Visit our Vimeo Channel to stream our video series, “Myofascial Pain Syndromes: The Travell Trigger Point Tapes. Janet Travell, M.D., shares her knowledge of myofascial trigger point therapy, from head to toe.

Click here to go to our Vimeo Channel: https://vimeo.com/ondemand/481264/

Visit our website at JanetTravell.org

Follow us on Facebook

Much love,

Janet Street, Co-founder

The Janet Travell Foundation

Note: This article; Travell, W. and Travell, J., “Technic for Reduction and Ambulatory Treatment of Sacroiliac Displacement,” Archives of Physical Therapy, April 1942, 23:222-245., is currently unavailable online, however the original paper is in the Janet G. Travell Papers, Gelman Library, and will be reproduced and included in our foundation’s archives.

Medicine, Marriage and Motherhood

When Janet Travell was eighty-one years old, she asked a young friend of hers, Peter Costa, who was living with her at the time, how she could improve the remarks she had prepared for the Keynote Address that she was going to give at the upcoming Celebration of Women in Medicine at Hahnemann University in Philadelphia in March of that year, 1983.

She was satisfied with the speech she had written but wanted to add something extra to make it more meaningful to herself and to her audience. The Keynote Address was entitled “The Woman Physician of Yesterday and Today.” It was divided into three main sections, “Medicine, Marriage and Motherhood.”

Peter suggested that she bring onto the stage with her three props representing the most important aspects of her life, those that she had tried the hardest to balance successfully.

As she was giving the address, when she was speaking about her career in the field of medicine, she should pick up a stethoscope from the lecturn and place it over her shoulder. Then, when she was talking about her husband, the late John W.G. “Jack” Powell, she should take up a pearl necklace and place it over her shoulder next to the stethoscope. Finally, when she was referring to her two daughters, Janet and Virginia, (who were married and the mothers of her six grandchildren), she should hold up a camera and lay it, by the strap, over her shoulder next to the other two objects.

As she was reaching the end of her address, she should purposefully twist the three props until they were hopelessly entwined and, as she talked, she should struggle to get them untangled. She did just that and the talk was a great success!

Here is her keynote address.

The Woman Physician of Yesterday and Today — A keynote address by Janet G. Travell, M.D., given to women doctors on March 6, 1983 at the Celebration of Women in Medicine, Hahnemann University, Philadelphia, PA

I am privileged to speak to you today. It is an honor which stems, I know, from my years in the White House with President Kennedy and President Johnson.

In the Author’s Note to my autobiography, OFFICE HOURS: DAY AND NIGHT, published in 1968, I raised these questions:

“What inner drives and forces of circumstance had molded me? Where did I acquire my energy? Had the rewards outweighed the regrets and personal sacrifices of my demanding profession” (1) of medicine? I will try to answer these questions today and to give you some guidelines for happiness in the combined professions of medicine, marriage and motherhood.

Part One — Medicine

Concerning your professional goals, the basic objective is: BE YOURSELF. Do not compare yourself with anyone else. No two people in the world have the same thumb print, not even identical twins. You are unique.

I was never a rebel. From childhood on, my world was filled with love, understanding and the support of family, friends, teachers, and later, of my husband. When I was seven years old, I said that I wanted to be a doctor and no one discouraged me from that goal, especially not my physician-father.

I had no desire to be different from my peers and I was a conformist whenever I could be. However, my long-range goals held top priority. When I was a senior in high school (I graduated in 1918), and we were at war with Germany, I elected to study German which was offered in the curriculum. I thought that I would later need to read the German medical literature. A special German teacher was finally assigned to me at my insistence. My classmates called me a traitor to my country!

My mother used to say that I was the most stubborn child she ever knew; eventually I got what I wanted.

I was never a truly competitive person. I enjoyed playing tennis and wanted to play well. I was a college champion at Wellesley in doubles with my sister and in singles. I played in the Women’s Nationals at Forest Hills but tournament competition never really commanded my interest. Winning was incidental to the fun of playing the game.

Nor was the winning of top academic grades in high school, undergraduate college or medical school ever one of my major goals. In fact, at Cornell University Medical College we were never told our marks in any course (only passed or failed) until we graduated. I was astonished to learn that academically I ranked first in my class. It seems that I was endowed with a good computer inside my skull, and it was well-programmed.

At medical school, I never felt discriminated against by our male faculty nor by any of the men students in my class. Neither did my sister who was a year ahead of me at Cornell.

At that time, about 20% of the medical students entering Cornell were women because so many of this country’s young men were still on military duty overseas in the Army of Occupation after the first World War. Nor did the men seem to feel threatened by the women students. We all worked together for the same goals. We worked for the joy of learning and to equip ourselves for the career of medicine.

Later, when I asked Dr. Harry Gold, my pharmacologist colleague at Cornell, whether I should undertake a certain project, he advised me, “Would you lie awake at night dreaming about it? If not, it isn’t worth doing.” I realized then that this had always been my guiding rule; I pursued what interested me.

But to tread this primrose path, you must know where your interests and talents lie and what you ultimately want, at least in the overall plan.

When I was a full-time instructor in the Department of Pharmacology at Cornell, I was given a year’s leave of absence during the latter part of my first pregnancy and for several months after the birth of our first daughter, Janet, in December 1933. I returned to the department part-time, for a short period, at the end of the academic leave. Then I realized that that was what I wanted - a permanent part-time plan. I applied for this just when the entire New York Hospital - Cornell Medical institution was converting to a full-time system. Clinical staff members who refused to change from part-time to full-time appointments were being fired. Of course, my request was refused.

So what did I do? I resigned my full-time faculty post. I would devote more time to motherhood and also to clinical practice from my father’s convenient office in New York City. Research and teaching could wait. (I soon had a second daughter, Virginia, born in 1935).

Dr. Hatcher, chairman of the Pharmacology Department, asked me if I would reapply in a year. The climate for a part-time position might be better then, he said, and in the meantime, he would not appoint anyone to take my place. The department staff would assume my teaching duties and work harder during that year.

I agreed. A year later I reapplied for a half-time position and my request was granted. It was a unique appointment in a basic science. Many colleagues warned me that by electing this course I had ruined my future in medicine. Fortunately, it did not work out that way.

Part Two — Marriage

Marriage came at a good time in my life. I had already completed my two-year internship in medicine at the old New York Hospital on 16th Street. (I was the second woman intern in the second oldest hospital in this country). The combination of hospital internship and a pregnancy creates many problems for women physicians which I did not have to solve.

When Jack Powell, the handsome, genial, Tar Heel, man-of-business and I were married in 1929, I held a research Fellowship at Bellevue Hospital, sponsored by the Rockefeller Institute, to conduct a collaborative, controlled study of the value of digitalis in lobar pneumonia. Twice daily, I made rounds on the ten medical wards of three university services - Cornell, Columbia and New York University - dragging an early Einthoven electrocardiograph on wheels (with the aid of a technician) and analyzing the yards and yards of the tracings that we took. The startling findings were that the full digitalizing dose, which was given routinely, was toxic and increased the mortality in lobar pneumonia, and the drug was not indicated unless congestive heart failure was a complication. I learned to deal with many points of view among the attending staffs of the different universities.

Jack and I had met at a dance while I was a New York Hospital intern and we danced through life together. Nothing marred our marriage. A poem I wrote was titled, Our Love Would Stand the Test of Time; I will read it to you.

Our Love Would Stand the Test of Time

My Jack was different: he married me.

He recognized better than I what sort

Of love was relevant to the full free

Union of our lives. Bitter jealousy

Had no home with us. I need not resort

To feuds of dominance since I could see

That I had his heart. He gave me support

To reach for excellence; hours I worked he

Did not resent -- he held my heart, you see.

The love we wrought the years would not distort. (2)

During our courtship, while I was an intern, Jack had learned that medicine was an integral part of me and he did not intend to dismember me.

My two-year New York Hospital appointment had included several months of service as ambulance surgeon, with the rank of Police Lieutenant, on a New York City ambulance. Once, when Jack and I could not see enough of each other, I put an ambulance surgeon’s cap on his head, gave him an emergency medical bag to carry, told him to behave like a doctor, and he went with me.

I rode about a thousand ambulance calls in mid-town Manhattan with both heart-breaking and amusing experiences. A man whom I was called to see had been in a fight with razors and had suffered ten clean long slits on his chest and back. I brought him in to the Emergency Room at the Hospital and neatly repaired the two yards of lacerations with 123 stitches. My mother had taught me well how to sew.

One Sunday morning, I was called to Madison Square Garden at Fifth Avenue and 23rd Street. Police escorted me through a crowd of neck-craning spectators to a park bench where a little old man was hiccuping at a rate of about one per second. He had been hiccuping for a week, he said, and was exhausted. According to the technique of Sir William Osler which my father had taught me when I hiccuped as a child, I wrapped a square of sterile gauze around his tongue and pulled on it with steady traction for about a minute, until his hiccups stopped. The crowd applauded. My problem was that I had taken along for the ride a friend, a free-lance writer, who published the story. After that, whenever a patient on any of the wards or in the private pavillion had persistent hiccups, a call would be sent out, “Get Dr. Travell. She does something.” My know-how never failed me!

My interest continued and, in 1977, I finally published a paper, “A Trigger Point for Hiccups,” (3) which I discovered lies in the uvula palatine, the pendulum-like tissue which hangs down in the back of the throat. All that I had to do was to use the handle of a fork, or spoon, or a tongue depressor, to lift the uvula backward. The earlier technique of pulling on the tongue (which was painful) accomplished the same change in the position of the uvula.

Medicine fascinated Jack and it became part of his life, as well as mine. We hosted many an elegant party but never invited solely physicians. His business and artistic friends made an exciting mix with my scientific colleagues.

Part Three — Motherhood

Motherhood did not change Jack’s and my relationship, except to make our love stronger. Jack shared equally the joys and chores of parenthood. Without his constant help, I could not have accomplished all that I succeeded in doing in my profession. When the children entered our lives, every moment of time became incredibly precious to me. Friends asked Jack how his wife could write so many papers. He replied, “Ask her what she does between midnight and bedtime!”

My hostility towards clocks led me to write a poem:

The Clock God: A Lament

The time of my life is ruled by a clock

Authoritarian as a traffic cop.

The moving hands direct the pace. Tick, tock,

Tick, tock, counts down the race. . . Oh, stop!

Delay! Alas, we can not stop the clock.

The future’s hours are not ours to unlock.

We bow to the Clock God, image enshrined

In every home on mantel, table, wall,

Atop of buildings, billboards to remind

Us fools: Jump, run obey the Clock God’s call.

The clock face grins but it is deaf and blind.

Not mute, its voice repeats alarms unkind.

The calendar is its high priest supreme.

Each day we’re boxed in little squares of time.

Their prison walls shut out the right to dream,

To seek the truth in beauty. The gods chime;

We see the calendar and clock, a team,

Drag past the days, months, years of life’s mainstream. (4)

Every professional person lives by a schedule and I put our children into my schedule. During their school days, I made sure to attend their performances and special events. Janet starred as an opera singer, and Virginia, as a modern ballet dancer. Other mothers, with less demanding schedules than mine, were often absent from their youngsters’ performances.

I learned that the quantity of time which you spend with your children is less important that its quality. Give them your individed attention. Turn off the telephone (get an answering service) and listen, listen to what they want to tell you. Lose track of the clock temporarily and avoid the sense of hurry like the plague.

Do not be a compulsive perfectionist in matters of secondary importance like housework. If your child does not make up his or her bed occasionally in the rush to get off to school, do not scold. Actually, paid domestic help is usually essential to combined motherhood and medicine, but the regular help of an older retired member of the family may suffice.

Children should not come home from school to an empty house. Jack and I were fortunate in securing reliable domestic employees and one of them was always there at night. Until our girls went to college, Jack and I never traveled away from home together unless they went along with us to share in our holiday merrymaking.

One Sunday in 1949, I read in the Westchester Medical Bulletin the results of a poll taken of 100 hospital chiefs of staff - all male, of course, to answer the question whether women should study medicine. Some of the views were: “Women talk too much...They are always on the defensive...If they are childless, they are frustrated...If they become mothers, they neglect either their practice or their children.” I handed the article, without comment, to Virginia. The next afternoon, when I returned from work, I found her reply on my bed. I will read it to you.

“Are the Children of Women Doctors Neglected?

I am the daughter of a woman doctor, and I couldn’t say that I have been neglected during one of my fourteen years, or my sister during any of her fifteen. Nor can I say that our mother neglects her practice. The truth is, she practices on us. She turns us into guinea pigs with as much loving care as the housewife changes milk and flour into a cake. If any one is neglected in our family, it’s Daddy, but he is Pappa Guinea Pig when he is needed.

I suppose we have turned out to be almost normal children, despite what some people think is a great barrier to contend with. Although, sometimes I wonder. I’ve learned to dislike bubble gum because it is ‘bad for my jaws’ and murder mysteries on the radio because ‘they poison my mind,’ and I admit my friends sometimes get annoyed when I say, ‘You’ll get a stiff neck sitting like that,’ but they forgive me because I’m a doctor’s daughter. I get stuffed with huge pills for the slightest ache or pain, but I can go barefoot and step on all the rusty nails I want because Mom will fix me up! And I guess I go to as many dances and picnics, and talk on the phone as long as any average teen-age girl.

I admit we aren’t ‘Mamma’s little pets’ like some - who I think see too much of their parents and become pampered babies who never grow up. We are on our own most of the time, we have much more freedom than most, and I guess we learn responsibility earlier, but I’m not complaining! I don’t feel neglected!

And we are one up on most children. Mom takes vacations from her work, not from us, and we go along on those Family Honeymoons.

In answer to the question, ‘Do I wish Mom was not a doctor?’ I say, ‘Don’t be silly! I wouldn’t change places with anybody on earth. I like being a guinea pig!’

by Virginia Powell, September 13, 1949

At my suggestion, Virginia sent her reply to the Editor of the Westchester Medical Bulletin and it was published two months later in the November 1949 issue. Years later, it was reproduced in my autobiography. (5) Her composition is one of my most prized possessions.

To meet the challenges of these three combined careers, you cannot be a Superwoman without optimal health. Your greatest enemy is usually not disease, but fatigue, and a large part of that is muscular fatigue combined with tension.

This is not a new problem. In 1831, Dr. James Johnson, whose title was “Physician Extraordinary to the King of England,” wrote about what he called the Wear and Tear Syndrome. He said:

“There is a condition, or state, of body and mind intermediate between that of sickness and that of health which is daily and hourly felt by tens of thousands of people, but I do not know that it has ever been described. It is the wear and tear of the living machine which results from over-strenuous exertion of the intellectual faculties conducted in a state of anxiety of mind and bad air.” (We now say: “stress” and “pollution” and the “sedentary life”).

Dr. Johnson adds, “The Wear and Tear Syndrome makes much work for the doctor ultimately, if not for the undertaker.”

All of us have experienced this lack of stamina. We forget the difference between getting up tired every morning and waking with a wonderful feeling of well-being. All too often people put up with average rather than optimal health.

In some people, skeletal asymmetry, such as shortness of one leg, of even small degree, may be a major cause of muscular strain and fatigue of the back and neck muscles. The tendency, when standing, is to bear more weight on the shorter leg and, in walking, an abnormal seesaw movement of the pelvis and shoulder-girdles results.

It is a matter of record that I prescribed a heel lift for John Kennedy for treatment of his back pain.

The net effect of a heel lift correction was expressed in a letter to President Kennedy from a Representative in the U.S. Congress whom the President had asked me to see professionally. The letter (quoted in my autobiography) read in part:

In case you - my audience today - have a question in your minds, I will tell you that according to the Congressman’s deductions, since President Kennedy’s left leg was a trifle shorter, the heel lift that I prescribed must have leaned him towards the right - but not beyond the center. (6) An appropriate heel lift can, if needed, straighten you up and improve the quality of your health.

It is difficult for me to understand why people tolerate that common environmental stress on the body caused by an ill-fitting, ill-designed chair. Everyone should realize the importance of sitting comfortably, which reduces skeletal muscle strain and fatigue. The new science of ergonomics is moving fast to provide adjustability of seats and their suitability for the task to be performed. Thanks to my part-time academic plan, I was able to devote some of my energy to industrial seating design - including airplanes, tractors, bicycles, work-station high stools for telephone operators and even toilet seats!

Sitting long in one position is disastrous to the muscles. Immobility reduces their circulation and leads to aching pain whereas isotonic movement (shortening and lengthening) increases blood flow which provides more oxygen and washes out the waste products of contraction. To insure movement, I have often prescribed an interval timer, set to go off in 20 or 30 minutes and placed across the room. When it rings, the preoccupied sedentary worker must then get up, walk across the room and reset it for its next cycle. The timer does not tell you the hour and minutes, and need not interrupt your train of thought.

For physical fitness and an alert mind, exercise is truly essential. But that statement needs qualification.

Like medicine, exercise must be of the right kind, in the right dose and at the right time. A weekend orgy of exercise, when you are out of condition, can be as disastrous for your muscles as no exercise. We must not accept pain as a normal side-effect of a physical fitness program.

When I moved to Washington in 1961, I was impressed by the high value which top government officials set on the quality of their health and by their insistence on getting regular exercise. President Kennedy swam, and President Johnson walked, almost every day.

It was not easy for the White House Physician, on 24-hour call, to do as well in that respect. It took some innovative planning. I brought a couple of jump ropes to my White House office. Behind closed doors, in my soundproof treatment room, my secretary, nurse and I took turns jumping them. We tied one end of the rope to the nose-and-throat examining chair and one of us twirled it while another jumped in and out.

Exercise should be fun. One evening at about 7:30, the Mansion was very quiet - it seemed to me like being inside the eye of a hurricane. President and Mrs. Kennedy were out and the children were upstairs, I thought.

I was tempted. I took a rope and skipped it down the long red-carpeted hall outside my office - past the surprised White House guard, past the line of statues on pedestals, the marble staircase and past the main entrance to the Mansion from the South Grounds. I had reached the far end of the hall and started back when Caroline and John, with their nurse, entered from the South Portico. I was caught and the children were enthralled with my act.

After that, Caroline would run up to me at a most embarrassing moment and say in her clear voice, “Dr. Travell, I want to see you skip rope down the hall again.”

Later, when Lynda and Luci Johnson, and their friend, Warrie Lynn Smith, came to live in the White House, I could not compete in rope-jumping.

Take care of your muscles and they will take care of you.

In the current craze for physical fitness, overload of the skeletal musculature happens too often. If 20 sit-ups are the right dose of that exercise, 100 sit-ups may cause long-lasting harm. Muscles are different from other tissues. When injured, the skin, bones and ligaments heal, but when a muscle is injured, it learns. It learns to protect that part of the body from movement and this splinting and guarding may continue for months, even for years. Muscle memory explains many of our chronic pain syndromes that are refractory to frequent forms of treatment, especially immobilization or overexercise. Overload occurs readily during fast repetitive movements and also during sustained, fixed (isometric) contraction.

Abuse of the muscles in housework, as it is usually performed to get it done as fast as possible, accounts for many such cases of chronic pain. Housework can be as strenuous as digging ditches. Most people can afford to take a little longer for it but they can not afford muscle injury. I will give you a few simple rules for efficient body mechanics that can preserve your muscle energy.

1) Vary your task each day. Do not iron for hours at a stretch or combine jobs which all involve stooping and bending. To achieve variety of movement, you will need to scramble your housework.

2) Cultivate a rhythm of movement. This discourages prolonged, fixed contraction that tires muscles and encourages pauses in which the relaxed muscles fill up with new blood and fresh fuel. Music helps.

3) Slow your working pace and avoid quick jerky movements. Muscle contraction is more efficient at the slower speed of shortening, just as your automobile uses less gasoline at 40 miles per hour than at 60 miles per hour.

4) Take short rests frequently. After an hour, or less, of housework, lie down to rest for a couple of minutes, if only on the floor. In the nearly horizontal position, your muscles are relieved of the constant anti-gravity stresses that cause reflex tension in the upright position.

5) Do not sit too long in one position. Sit in a rocker or in a chair with changing angles so that it, too, moves you.

6) Don’t try to lift a heavy piece of furniture by yourself. Do not carry excessively heavy grocery packages into the house from the supermarket. It would be better to divide the weight into more packages and to make more trips.

To maintain optimal health requires strict self discipline in all these activities of daily living. It requires attention also to total body nutrition and the avoidance of known health hazards such as cigarette smoke. I believe that the woman physician of today is basically concerned, and rightly so, about her optimal health and that she tends to seek medical care earlier in the course of a health problem than does her male counterpart.

Myofascial Pain Syndromes

My clinical research for many years has dealt mainly with the performance of the skeletal muscles under stress, usually unrelated to disease. It is the old “wear and tear” syndrome. The skeletal musculature is the largest organ in the body, with some 500 muscles, and it accounts for nearly half the body weight. Without our muscles we can not eat, speak, walk, jog or carry on any of life’s functions. The muscles are also the most neglected system of the body.

* * *

Dr. Travell ended her talk by saying that she wanted “to show the women physicians of today, and the men who are here also, a few lantern slides related to myofascial pain syndromes. The muscle that I have chosen,” she said, “is the quadratus lumborum which in my experience is the most commonly overlooked cause of low back pain.”

Notes

(1) OFFICE HOURS: DAY AND NIGHT, The Autobiography of Janet Travell, M.D. by Janet Travell, M.D., NAL/World Publishing Company, New York and Cleveland, 1968, p. ix.

(2) OFFICE HOURS: DAY AND NIGHT, p. 183.

(3) Journal of the American Osteopathic Association, 77:308 - 312.

(4) OFFICE HOURS: DAY AND NIGHT, pp. 21 & 22.

(5) Westchester Medical Bulletin, The Westchester County Medical Association, Purchase, NY, Vol. 17, pp. 22 & 39, Nov. 1949 and OFFICE HOURS DAY AND NIGHT, pp. 246 & 247.

(6) OFFICE HOURS DAY AND NIGHT, pp. 409 & 410.

Janet Travell’s youngest daughter, Virginia P. Street, passed away on December 18, 2025, at age 90. Ms. Street, a fine artist, author, and Co-founder of The Janet Travell Foundation, published over 150 articles about Dr. Travell, from April 2014-June 2022. Ms. Street published a biography, “Janet Travell, M.D., White House Physician and Trigger Point Pioneer, in 2015. Ms. Street and her sister, Janet Powell Pinci donated Dr. Travell’s papers to The Gelman Library at George Washington University. As Co-founder of The Janet Travell Foundation and Ms. Street’s daughter, I wish to thank my mother Virginia Powell Street for her many contributions over the years as an author, archivist, historian, and walking encyclopedia of all things Dr. Travell. Ms. Street left behind an historical archive of correspondence, articles, memorabilia and other interesting materials that will become part of the foundation’s research materials. Ms. Street cared deeply about her mother’s legacy, and dedicated many years of her life writing the articles and biography, and overseeing the preservation of Dr. Travell’s papers. To my dearest Mom, thank you!

Hi Travellians,

Happy October! This autumn brings two outstanding opportunities for clinicians, therapists, and wellness professionals dedicated to advancing the science and practice of myofascial care. From the shores of Hawaiʻi to the high desert of New Mexico, leading experts will share cutting-edge research, hands-on protocols, and collaborative strategies for treating pain and dysfunction. Whether your focus is clinical practice, manual therapy, or interdisciplinary learning, these gatherings promise inspiration, skill-building, and community.

🌺 Upcoming Event: Hawaiʻi Myofascial Symposium

From October 23–25, 2025, leading voices in the field of myofascial pain and dysfunction will gather in Kailua-Kona for the inaugural Hawaiʻi Myofascial Symposium, hosted at the Outrigger Keauhou Beach Resort & Spa.

Presented by the MYO Foundation, this landmark event will unite health practitioners across disciplines—physicians, physical therapists, massage therapists, acupuncturists, chiropractors, nurse practitioners, dentists, and students—for three days of education, hands-on training, and interdisciplinary collaboration.

Highlights

• Focus Topics: Myofascial pain syndrome, central sensitization, and innovative interdisciplinary treatment strategies.

• Featured Experts:

  • Dr. Jay Shah (keynote speaker)

  • Dr. John Srbely

  • Dr. Hal J. Blatman

  • Dr. Jacob Teitelbaum

  • Sharon Sauer

  • Dr. Frederick Kennedy

  • Ruthie Moss, L.Ac.

  • Dr. Jenny Hobson

  • Carolyn Silan, PT

Why It Matters

Speakers will share the latest research and practical protocols for treating both chronic and acute myofascial pain, including:

• Hands-on manual therapy

• Stretch rehab training

• Needling techniques and trigger point injections

• Approaches to correcting perpetuating factors

As symposium organizer Sharon Sauer notes:

“In some cases, drugs and surgery don’t completely address the underlying causes of pain and dysfunction. By correcting perpetuating factors and applying hands-on treatments, we can help thousands find real relief.”

Dr. Jay Shah adds:

“The emerging science in myofascial pain is incredibly exciting, offering new avenues for diagnosis, treatment, and understanding.”

Registration

Early bird registration is available through September 30, 2025.
👉 Learn more at hawaiimyofascialsymposium.com

🩺 Upcoming Training: UNM Myofascial Institute – TMI25

The University of New Mexico Myofascial Institute will host its annual TMI25 training series in Albuquerque this fall, offering advanced, hands-on instruction in Trigger Point Injections (TPI) and Manual Release Techniques (MRT).

📍 Location: UNM Continuing Education, Albuquerque, NM
📅 Dates:

• Trigger Point Injections (TPI): November 20–21, 2025

• Manual Release Techniques (MRT): November 22–23, 2025

Who Should Attend

This program is designed for health care professionals working with myofascial pain syndrome, including:

• Physicians, Nurse Practitioners, and Physician Assistants

• Chiropractors, Physical Therapists, and Occupational Therapists

• Acupuncturists, Massage Therapists, and Myofascial Therapists

• Doctors of Oriental Medicine

Note: The TPI course is intended for clinicians with injection privileges.

Program Focus

• Trigger Point Injections (TPI):
  Participants will learn to identify subtle myofascial syndromes, perform basic and advanced trigger point injections, and integrate safety protocols.

• Manual Release Techniques (MRT):
  Emphasis on identifying perpetuating factors, applying advanced release techniques, and integrating fascial dysfunction concepts into patient care.

Workshops include palpation practice, dry needling demos, stretching protocols, low back/hip/pelvic assessments, and kinetic chain treatment strategies.

Faculty

Instruction will be led by experienced clinicians from the UNM School of Medicine, including:

• Dr. Benson Daltz, MD (Professor Emeritus)

• Dr. Brian Shelley, MD (Professor)

• Dr. Arthur “Spike” Lynch, MD (Assistant Professor)

• Dr. Michael Domino, DOM, PA-C (Lecturer III)

• Dr. Lucy Whyte Ferguson, DC (Volunteer Faculty, Neurosurgery)

• Dr. Andrea Whyte Griffin, DC (Chiropractor, Taos, NM)

Accreditation

• Physicians may claim AMA PRA Category 1 Credits™:

  • 14.0 credits for Trigger Point Injections

  • 15.75 credits for Manual Release Techniques

• Additional CE approvals pending from NM licensing boards for chiropractic, massage therapy, and physical therapy.

Registration

• Early Bird Deadline: November 6, 2025

• Includes course materials, breakfast, lunch, and refreshment breaks.
  👉 More info & registration: bit.ly/2025TMI

  ---

Looking for The Trigger Point Manuals in digital format? Here are links to the PDF versions in Google Drive, see below.

2nd_Ed_Vol_1_Upper_Body.pdf

https://drive.google.com/file/d/129rIn54IqRj87Z2ymSqxmsv-D_n2skiY/view?usp=sharing

1st_Ed_Vol_2_Lower_Body.pdf

https://drive.google.com/file/d/1s5dZtBzXq_EmGjiWNveusdNiZBQz2n1B/view?usp=sharing

Visit our Vimeo Channel to stream our video series, “Myofascial Pain Syndromes: The Travell Trigger Point Tapes. Janet Travell, M.D., shares her knowledge of myofascial trigger point therapy, from head to toe.

Click here to go to our Vimeo Channel: https://vimeo.com/ondemand/481264/

Update on projects in progress

• Nancy Shaw’s August workshop for myofascial trigger point therapists was a huge success, with many thanks to Gebauer for providing Spray and Stretch vapocoolant for Nancy’s workshop series!

• Next month, Sharon Sauer will be heading up the Travell Study Group for her recent graduates and students of myofascial trigger point therapy.

• Sharon Sauer and Nancy Shaw will be teaching our “beta test” of The Janet Travell Foundation’s first online course, with her recent graduates volunteering to be our “guinea pigs” for the course! The course will be available to all trigger point therapists in the months ahead.

• The original 1982 First Edition Volume 1 of the Travell & Simons Trigger Point Manual, Upper Extremities, digitized and available in PDF format.

• A redesigned, custom website featuring the self-hosted Omeka S platform, with Janet Travell’s published papers, articles, unpublished research and lecture notes, in a searchable format.

• A series of articles and preview chapters of a new book, “Myofascial Trigger Point Therapy, What’s next?: The Travell Protocol” by Nancy Shaw.

• A new trigger points wall chart, which will be available as a PDF download and print format.

• A blog featuring guest posts by the top experts in myofascial trigger point therapy.

Visit our website at JanetTravell.org

Follow us on Facebook

Much love,

Janet Street

Hi Travellians,

As summer races by at lightning speed, it’s challenging to carve out time to enjoy each glorious day, especially here in New England where the thought of winter is looming, even now. As I sit for too long in my chair, my grandmother’s gentle reminder, a favorite ancient proverb, is more true than ever:

Here at the Janet Travell Foundation home office, we’re making steady progress on our “big” projects. And for this month’s newsletter, I decided to tackle the topic of fascia vs. myofascial pain, from the perspective of a non-professional (I’m not a trigger point therapist — I just grew up with one). As an outlier, I find some of the terminology and definitions to be confusing and inconsistent. The bigger picture: I see many errors regarding Travell & Simons’ shared legacy in the eyes of AI-assisted research. And AI’s knowledge base is quickly becoming synonymous with truth or fact. For this reason, the task ahead is crystal clear: Digitize and publish Janet Travell’s entire collection of research, bringing it all online so it will be included in the AI-driven knowledge base — for today’s practitioners and for the future.

So, where does fascia fit in with Travell and Simons’ approach to the diagnosis and treatment of myofascial pain? The following article takes a look at this question. Comments, questions, thoughts, discussion — always welcome.

Featured article

Upcoming projects in progress

• A new trigger points wall chart, which will be available as a PDF download and print format.

• An online self-guided study of the Travell & Simons Trigger Point Manuals.

• The original 1982 First Edition Volume 1 of the Travell & Simons Trigger Point Manual, Upper Extremities, digitized and available in PDF format.

• A redesigned, custom website with Janet Travell’s published papers, articles, unpublished research and lecture notes, in a searchable format.

• A series of articles and preview chapters of a new book, “Myofascial Trigger Point Therapy, What’s next?: The Travell Protocol” by Nancy Shaw.

• A blog featuring guest posts by the top experts in myofascial trigger point therapy.

  ---

Looking for The Trigger Point Manuals in digital format? Here are links to the PDF versions in Google Drive, see below.

2nd_Ed_Vol_1_Upper_Body.pdf

https://drive.google.com/file/d/129rIn54IqRj87Z2ymSqxmsv-D_n2skiY/view?usp=sharing

1st_Ed_Vol_2_Lower_Body.pdf

https://drive.google.com/file/d/1s5dZtBzXq_EmGjiWNveusdNiZBQz2n1B/view?usp=sharing

Visit our Vimeo Channel to stream our video series, “Myofascial Pain Syndromes: The Travell Trigger Point Tapes. Janet Travell, M.D., shares her knowledge of myofascial trigger point therapy, from head to toe.

Click here to go to our Vimeo Channel: https://vimeo.com/ondemand/481264/

Visit our website at JanetTravell.org

Follow us on Facebook

Much love,

Janet Street

So this is the thing with doctor Travell's work. She was a genius in putting the pieces of the puzzle together. She was so attentive and so inquisitive, looking with her mind and her eyes and her being to see what was causing the problems that people were having. It was fascinating. And one of the greatest gifts she gave me was a teaching of observation.

She could look across the table at someone's eyes, one being higher or lower than the other, and then compare that to the position of the arms next to the body or not next to the body, or one hip higher than the other, one shoulder higher than the other. She could notice even sitting. So she could tell you already a number of things that were balancing out of balance. So the body wasn't imbalanced, but it were those things, the why of the pain, and that's what she went after.

There was a lady in the airport sitting there. I went to get her something to drink and came back, and this lady she had never met was sitting next to her waiting for the plane. And she had her barefoot in the in doctor Trevall's lap so she could explain to her the Dudley Morton's, the long second metatarsal bone that put her on a straight line base of support. And then she looked at her shoes, and she said, the shoes don't bend, so you must hike with your hip. You must lift your hip to walk. And the lady said, “Oh, my, is that why I've had so much hip pain?” And doctor Travell just giggled. “Yes.” So she made that correction.

She never missed an opportunity to help someone be better. But she was always just observant, not because she had to be or intended to be. If you look enough and train yourself enough, it's just like a muscle learning to function correctly. If you really work with observation skills and look for different things, it becomes automatic. I have friends that didn't like to go walking around with me for a while because I kept saying, “Hey, look at that one. They're really crooked. Can you see that?” What happened was they got observant, and every once in a while, they'd poke me and say, “Hey, Nancy. Look at that one. She's really crooked. She needs a heel lift.” So, Doctor. Travell, in being passionate about it, became such an expert. And that expertise became available in the books.

She didn't try and integrate it into regular medicine, traditional medicine, structural medicine, which she was a part of when she was doing cardiology work because they they were two different things. It was like a neurologist integrating orthopedic medicine into his neurology. That didn't make any sense any more than her muscle field of muscle medicine didn't mesh with structural medicine. So she was looking to find a development, how to present it in a way that people could get passionate at the finding of a whole new field of medicine.

And you know what? It's been difficult for a lot of people because you have to practice it just like muscles have to practice to get a new function correctly rather than being all contracted up. So if you take the the path you really want or wanted that started, whether you were in physical therapy or, lymphatic, chiropractic, acupuncture, or and take those massage, any of those fields. It's not just a matter of tweaking them with some things about trigger points and how they affect the body. It's an integration that actually meshes things so that you you find the power to change pain, not manage it, but to change pain, eliminate pain so that people literally can be pain free. And I say this humbly.

In the forty some years that I've had practice, I've not used other kinds of treatments other than very strictly Travell's work because I got so enmeshed with it when I was with her for those thirteen years. I saw how powerful it was and how easy it was if you're just observant and follow the path that she gave in her protocol. And remember her protocol, she said seventy some percent is a perpetuating factor. Why people have muscles not working well? That's what we have to find out.

That's the pieces to the puzzle. And she would say that to eliminate any one of these seven steps of the protocol in treating myofascial pain dysfunction would lead to treatment failure. If you're making a loaf of bread and you put everything in but you forget to put the yeast in, they're not gonna have the best bread. Or if you're making a sandwich and you don't put much in, maybe a little bit of lettuce and a piece of meat, but I don't have any bread in the house. There goes a sandwich.

It's a whole different kind of mayo you've got. Medicine for doctor Travell was discovery. It wasn't treating. It was discovery. She discovered in every person.

Every person was different, and she got to discover with each and every person what it was that was interfering with normal muscle body function, and she joyed. She literally joyed in teaching them things that they could do very simply if they were just aware of them. No one ever taught them those kind of things. How you sleep, how you walk, what kind of shoes do you wear, what kind of movements do you do, what kind of exercise do you do, what kind of chairs do you get, what do you eat, how do you relax, so many things that make up who you are, not everybody else. You can't do a double blind study.

You can't have 10 people. And she would say, oh my. 10 people. How do you do a study to prove that your particular approach to the pain is from what you do if you do 10 different things on them. Because 10 different backaches are not the same backache on every person.

What makes up their backache is different than everybody else's. Someone might be lifting small kids all day. Someone else might be up on a ladder putting a roof on. Someone else might be driving an 18 wheeler. Someone else might be a gardener.

All of those people can have the same pain complaint, but totally different reasons for it. That's what she delighted in. She delighted in discovering what it was. And when you do it long enough and passionately enough, that becomes your world of treatment without needing to add literally anything else. And because I've done it that way for forty years with ninety seven percent success rate, I'm excited to be able to present her work and be involved with the foundation's work of teaching her work from day one from scratch.

Start with the basics. And that might be nothing more than bringing pictures so that you can see how they sit, how they stand, how they walk, how they move, how they sit down, how they reach. It's fun. And I hope you can get as much fun and enjoyment and satisfaction out of her work as she did.

God bless you, doctor Travell.

About Nancy Shaw

https://www.paintreatmentdirectory.com/united-states/springfield/provider/nancy-shaw-mtpt

Thesis:
While the diagnostic and treatment approaches to fascia are generating excitement in the manual therapy world, there is a risk that this "fascial turn" distracts from the rigor and specificity of the Travell & Simons protocol for the diagnosis and treatment of myofascial trigger points. A careful reading of the literature reveals distinct conceptual frameworks and clinical implications for each, highlighting the value—and risk—of conflating fascia-focused strategies with Travell & Simons’ myofascial trigger point therapy.

To add further confusion, the term "myofascial release" is used to describe fascia treatment by fascia practitioners, while Travell & Simons’ terms Trigger Point Release or Trigger Point Pressure Release (Travell & Simons 1999) refer to their manual trigger point therapies.

The interchangeable—and sometimes contradictory—use of terms like “myofascial release” and “trigger point therapy” by different practitioners and schools of thought is a major source of confusion in both clinical practice and patient education. Here’s how these terminologies are complicating the landscape around fascia and myofascial pain treatment:

1. Historical vs. Modern Usage of Terms

• Travell & Simons' Definitions:

  • Trigger Point Pressure Release, Trigger Point Release, or simply Release: Originally used by Travell & Simons to describe manual therapy techniques specifically targeting pain caused by myofascial trigger points. Their myofascial release was synonymous with hands-on trigger point inactivation within muscle tissue.

  • Trigger Point Therapy: Precisely defined as the identification and treatment of hyperirritable points in skeletal muscle that produce referred pain patterns—a highly structured clinical protocol.

• Contemporary Fascia Practitioners:

  • Myofascial Release: Now commonly refers to a variety of gentle, sustained manual techniques aimed at stretching or “releasing” restrictions in fascia (the connective tissue), not necessarily focused on muscular trigger points. This approach is based on the concept of treating fascial adhesions and restoring tissue glide, often with broader, more global techniques.

  • Trigger Point Therapy: Sometimes appropriated to mean the application of pressure to “tender spots” perceived within the fascia, not strictly the well-defined muscular trigger points mapped by Travell & Simons.

2. Implications of Terminology Overlap

• Diagnostic Confusion:
  When “myofascial release” is used to mean both targeted trigger point inactivation and global connective tissue mobilization, it blurs diagnostic clarity. Patients with classic myofascial pain may be treated with fascial techniques that do not address the muscular sources of their symptoms (and vice versa).

• Clinical Protocol Blurring:
  Therapists may conflate muscular and fascial pain, applying interventions indiscriminately—such as using light myofascial release for a clinical scenario that actually requires specific trigger point inactivation via Travell & Simons’ protocol.

• Patient Education Issues:
  Patients searching for relief may not understand what kind of treatment they are receiving or what to expect in terms of results. “Myofascial release” could mean anything from deep, targeted manual therapy to gentle fascial stretching, depending on the therapist's training or method.

3. Consequences for Research and Outcomes

• Inconsistent Study Results:
  The lack of standardized definitions makes it difficult to interpret research outcomes or to meta-analyze studies. A “myofascial release” technique in one study might be fundamentally different from another; “trigger point therapy” might target muscle in one context, fascia in another.

• Professional Identity and Scope:
  Different professions (e.g., physical therapists, massage therapists, osteopaths) claim authority over these terms, leading to further inconsistency in both training and application.

The confusion stems from ambiguity and shifting definitions: What was once a muscle-focused, protocol-driven intervention is now used by some practitioners to describe varied, and sometimes unrelated, fascial techniques. This inconsistently applied terminology obscures the distinction between treatments for muscular trigger points and interventions aimed at the connective tissue, leading to confusion in diagnosis, treatment, research, and patient expectations.

Clarity in terminology—and fidelity to original definitions—is critical for effective diagnosis, research, and patient care. Practitioners should specify which tissues, mechanisms, and protocols they are applying and educate patients accordingly to avoid this ongoing confusion.

1. Conceptual Frameworks

Fascia

• Definition & Role: Fascia is now regarded as a richly vascularized and innervated connective tissue system, sensitive to mechanical, chemical, and neuroimmune signals. It's implicated in pain, proprioception, thermoregulation, and even autonomic regulation.

• Pathology: Fascial dysfunction is recognized in terms of fibrosis, altered vascularity, and aberrant innervation, often linked to systemic disorders like complex regional pain syndrome (CRPS).

Myofascial Pain

• Definition & Role: Myofascial pain, according to Travell & Simons, is a localized or regional pain condition arising from specific hyperirritable spots (“trigger points”) within taut bands of skeletal muscle. These trigger points produce predictable referred pain, motor, and autonomic phenomena.

• Pathology: Myofascial pain is explicitly muscular in origin. The emphasis is on motor dysfunction and characteristic pain referral patterns mapped extensively in their protocols.

2. Diagnosis: Key Differences

Fascial Disorders

• Diagnostic Tools:

  • Imaging (US, MRI) to reveal fascial thickening, adhesions, or altered echogenicity.

  • Palpation is becoming more sophisticated with elastography to assess fascial stiffness.

• Criteria: Focus is on changes in the mechanical, vascular, and sensory properties of fascia, sometimes with systemic or widespread symptoms.

Myofascial Pain (Travell & Simons Protocol)

• Diagnostic Tools:

  • Detailed patient history, pain mapping, and physical exam identifying taut bands and trigger points.

  • Confirmation via referred pain reproduction, local twitch response, and range-of-motion testing.

• Criteria: Diagnosis depends on physical findings (taut bands, referred pain patterns) and exclusion of other causes. Imaging is ancillary, not primary.

3. Treatment Approaches: Contrasts

Fascia-Focused Interventions

• Methods: Gentle, sustained manual pressure (myofascial release), fascial stretching, instrument-assisted techniques, and approaches designed to affect global fascial tension.

• Goals: Restore tissue glide, reduce adhesions and stiffness, influence autonomic tone, improve vascularity, and address systemic patterns of dysfunction—not just local symptoms.

Myofascial Trigger Point Therapy (Travell & Simons)

• Methods: Stretch-and-Spray, ischemic compression (Trigger Point Pressure Release), dry needling and trigger point injection — on identified trigger points, are the main treatment techniques as taught by Travell & Simons. Always guided by precise mapping and differential diagnosis.

• Goals: Identify and eliminate perpetuating factors, inactivate trigger points, restore normal muscle length and function, and eliminate referred pain. Treatment is systematic and protocol-driven.

• Rehabilitation: Post-treatment includes stretch-and-spray, corrective exercises, and patient education for self-care, all underpinned by detailed anatomical and functional assessment.

4. Argument: Risks of Conflating the Two

• Trend: Many therapists have shifted toward fascia-oriented treatments, sometimes at the expense of the precision and clinical reasoning outlined by Travell & Simons.

• Concern: Treating “fascial restrictions” or global tension patterns may have value in chronic, diffuse pain syndromes. However, for treatment of myofascial trigger points, loss of focus on taut bands and trigger points risks missing both diagnosis and effective intervention.

• Evidence Gap: While fascial research is illuminating and expanding understanding of connective tissue biology, high-quality evidence supporting fascia-specific techniques as replacements for myofascial trigger point protocols is limited.

5. Conclusion

The advance of fascial research and corresponding therapies is a welcome expansion of the musculoskeletal medicine toolkit. However, clinicians must resist abandoning the time-tested, evidence-based protocol laid out by Travell & Simons, which is built on rigorous diagnosis and direct treatment of myofascial trigger points.
Incorporating insights from fascial studies may enrich holistic care, but it should not replace the discipline and clinical acumen required to treat myofascial trigger points effectively.

Key Sources

• Myofascial Pain Reference: Travell JG, Simons DG. General Overview. In: Myofascial Pain Syndromes: The Trigger Point Manual, 2nd ed. Vol 1. LWW; 1999:43.1

• Fascia Literature: "An Emerging Perspective on the Role of Fascia in Complex Regional Pain Syndrome" [PMC11942918].2

Recommended Reading

• Recent systematic reviews on diagnosis and treatment of MPS.

• Contemporary reviews and consensus statements on fascial disorders and their implications for therapy.

Bottom line:
Fascia is not a surrogate for the muscle-focused approach of Travell & Simons. Each paradigm brings unique insights—but conflating or substituting one for the other may dilute the clinical efficacy honed by decades of myofascial pain research and practice.

A brief review of Travell & Simons on fascia as a source of non-myofascial TrPs

Travell & Simons refer to fascia as non-myofascial TrPs, along with ligaments and joint capsules.

Non-myofascial Trigger Points

Fascial and Ligamentous Trigger Points

In addition to occurring in the fascia and tendons of muscles, TrPs also may be found in joint capsules and ligaments.

Kellgren demonstrated experimentally that fascial epimysium of the gluteus medius muscle referred pain several centimeters distally when injected with 0.1 ml of 6% saline solution, and that a tender spot in the tendon of the tibialis anterior, similarly injected, referred pain to the medial aspect of the ankle and instep.

Travell reported that an acute sprain of the ankle was accompanied by the development of four TrPs in the joint capsule, each of which referred pain to the ankle and foot. Myofascial TrPs resulting from acute sprains of the knee, ankle, wrist and metacarpopha- langeal joint of the thumb have been reported to cause referred pain, which was at first elicited and then permanently relieved by injection of each TrP with physiologic saline. Leriche identified ligamentous TrPs following fracture or sprain; the TrPs responded completely to 5 or 6 injections of a local anesthetic. Gorrell reviewed the anatomy of the ankle ligaments and described a technique for the identification and injection of ligamentous TrPs at this joint.

Kraus briefly reviewed the literature on ligamentous TrPs and noted that they are easily localized for injection, which often gives immediate pain relief and a postinjection soreness lasting up to 10 days. Hackett illustrated patterns of pain referred from the iliolumbar, sacroiliac, sacrospinal, and sacrotuberous ligaments; he recommended injection of a sclerosing agent, which was not widely accepted because his technique caused too many complications. Dittrich found TrPs in the aponeurosis of the latissimus dorsi muscle where it joins the lumbodorsal fascia; the TrPs referred pain to the shoulder region. Two authors, de Valera and Raftery reported trigger areas in three pelvic ligaments, the sacroiliac, sacrospinous and sacrotuberous, which, when strained, become tender to palpation, refer pain, and respond to injection with a local anesthetic. (Travell and Simons 1993, p. 19-20).

A brief summary of “myofascial” vs. “fascial” pain

The terms "myofascial" and "fascial" are related but distinct. "Fascial" refers to the fascia, a connective tissue network throughout the body that surrounds muscles, bones, and organs, providing support and allowing for movement. "Myofascial," on the other hand, specifically refers to the fascia that is connected to or interacts with muscle tissue. Myofascial release therapy focuses on releasing tension and restrictions within this interconnected system of muscle and fascia.

Here's a more detailed breakdown:

Fascia:

• A broad term for the connective tissue network that provides structural support and allows for movement throughout the body.

• It's a continuous, three-dimensional web that surrounds and connects everything from muscles and bones to organs and nerves.

• It can be superficial (close to the skin) or deep, surrounding individual muscles and muscle fibers.

• In a healthy state, fascia is flexible and allows for smooth movement.

• Dysfunctional fascia can become tight, restricted, and contribute to pain and limited mobility.

Myofascial:

• Myofascial refers to the relationship between muscles (myo) and the connective tissue that surrounds them, called fascia.

  • Myo: Derived from the Greek word "mys," meaning muscle.

  • Fascia: A thin, fibrous layer of connective tissue that covers and supports muscles, tendons, and bones.

  Together, myofascia forms a complex network that plays a crucial role in movement, posture, and pain perception.

Key Differences:

• Fascia is a broader term encompassing all connective tissue, while myofascial refers specifically to the fascia connected to or surrounding muscle.

• Myofascial trigger point therapy focuses on the interconnectedness of muscle and fascia, while broader fascial work may address restrictions in other areas like organs or bones.

In essence, myofascial is a specific type of fascia that is closely linked to muscle tissue, and myofascial release is a therapeutic approach focused on addressing restrictions within this interconnected system.

Trigger points are often associated with muscles, and are technically referred to as myofascial trigger points. However, the fascia itself can also be a source of pain and tenderness, even when not directly connected to a muscle knot.

Here's why:

• Fascia's Role: Fascia is a network of connective tissue that surrounds and supports muscles, organs, and other structures throughout the body. It's designed to be flexible and allow for smooth movement.

• Fascial Restriction: When fascia becomes tight, thickened, or damaged (due to trauma, inflammation, overuse, or even inactivity), it can restrict the movement of underlying tissues and lead to pain.

• Painful Knots: This fascial restriction can cause painful knots or nodules to develop within the fascial layers themselves, not just within the muscle belly. These can be thought of as localized areas of tension and stiffness within the fascia.

While research on the precise mechanisms behind trigger points, including those in the fascia, is still ongoing, it's increasingly recognized that fascial health plays a crucial role in overall musculoskeletal well-being. Treatments like massage, physical therapy, and stretching can help address fascial restrictions and the associated pain.

What is the difference between the diagnosis and treatment protocol for fascia vs. myofascial pain?

Fascial pain and myofascial pain are closely related but distinct conditions, both involving the body's connective tissues

1. Fascia and fascial pain

• Fascia is a network of connective tissue surrounding and supporting muscles, nerves, organs, and bones.

• Fascial pain arises when the fascia itself becomes restricted, tight, or inflamed due to injury, overuse, poor posture, or other factors.

• Key characteristics:

  • Pain localized to a specific area of the fascia.

  • Pain that may improve with movement and respond well to heat therapy.

  • Can potentially worsen over time if not addressed, leading to trigger points in surrounding muscles.

2. Myofascial pain

• Myofascial pain involves pain originating in the muscles and the surrounding fascia.

• Key characteristics:

  • Localized or referred pain originating from trigger points (sensitive knots or bumps in the muscle).

  • Trigger points can cause referred pain in seemingly unrelated areas.

  • Pain upon palpation (touch) of trigger points.

  • May be accompanied by muscle stiffness, reduced range of motion, fatigue, and other symptoms.

3. Diagnosis

• Fascial Pain: Diagnosis relies primarily on a detailed patient history and physical examination, where the practitioner assesses for fascial restrictions and tightness.

• MPS: Diagnosis involves identifying trigger points through palpation, observing referred pain patterns, and assessing for a local twitch response upon stimulation of the trigger point. Other diagnostic tools like electromyography and ultrasound can help visualize trigger points and rule out other conditions.

4. Treatment protocol

• Common Goal: Both conditions often benefit from treatments aimed at reducing tension, restoring mobility, and addressing underlying causes.

• Treatment Options:

  • Manual Therapy: Trigger Point Pressure Release or Trigger Point Release (ischemic compression), stretch-and-spray, massage, and other hands-on techniques are crucial for addressing fascial and muscular restrictions.

  • Trigger Point Injections (TPI): Injections of local anesthetics, saline, or other substances directly into trigger points to alleviate pain and muscle spasms.

  • Dry Needling: Insertion of a thin needle into the trigger point without injecting any substance to inactivate the trigger point.

  • Physical Therapy: Stretching, strengthening exercises, posture correction, and modalities like heat, cold, ultrasound, and electrical stimulation.

  • Medications: Over-the-counter pain relievers, muscle relaxants, antidepressants, and other prescription medications as needed.

  • Lifestyle Modifications: Exercise, stress management, ergonomic adjustments, and adequate sleep.

Key takeaway: While both fascial and myofascial pain are rooted in connective tissue dysfunction, myofascial trigger point therapy involves the specific presence of trigger points that can lead to referred pain. Therefore, treatment protocols for myofascial trigger points often focus on inactivating these trigger points in addition to addressing broader fascial restrictions and underlying causes.

Glossary (Travell & Simons 1999)

Editor's note: The term "fascia" is not listed in the glossary.

Fibrositis: An outmoded term with multiple meanings. Many authors in the past used it to identify what were myofascial trigger points. Other authors have used the term very differently (see Chapter 2). We avoid using the term because of its ambiguity.

Ischemic Compression: Now revised and identified as Trigger Point Pressure Release.

Myofascitis (Myositis Fibrosa): Induration of a muscle through an interstitial growth of fibrous tissue. Sometimes used erroneously in the past as synonymous with myofascial trigger points.

Myalgia: Pain in a muscle or muscles. The term is used in two ways to signify: (1) diffusely aching muscles due to systemic disease, such as a virus infection, and (2) the spot tenderness of a muscle or muscles as in myofascial trigger points. The reader must distinguish which use an author has in mind.

Pressure Release: See Trigger Point Pressure Release.

Release (of muscle tightness): Any procedure that reduces the resting muscle tension (or muscle stiffness).

Myofascial Pain Dysfunction Syndrome: A controversial, largely outmoded term that has been considered to mean a syndrome largely of muscular origin, a complex psychophysiological phenomenon, or a syndrome primarily due to disturbed occlusal mechanics.

Myofascial Pain Syndrome (Myofascial Syndrome): 1. (as used in this book) The sensory, motor, and autonomic symptoms caused by myofascial trigger points. The specific muscle or muscle group that causes the symptoms should be identified. A regional pain syndrome of any soft tissue origin. To avoid confusion, we recommend that when anyone uses the term myofascial pain syndrome, that person should specify which meaning applies— file general or specific definition.

Trigger Area: Sometimes used in this volume as synonymous with an attachment trigger point.

Trigger Point (Trigger Zone, Trigger Spot, Trigger Area): See Myofascial Trigger Point.

Trigger Point Pressure Release: Application of slowly increasing, nonpainful pressure over a trigger point until a barrier of tissue resistance is encountered. Contact is then maintained until the tissue barrier releases, and pressure is increased to reach a new barrier to eliminate the trigger point tension and tenderness. In this edition, Trigger Point Pressure Release replaces the term Ischemic Compression that was used in the first edition. Other versions (some of which are painful) are identified elsewhere as Acupressure, Myotherapy, Shiatzu, and as ʺThumbʺ Therapy.

Trigger Point Release: Release of muscle tension by inactivating the trigger points that are causing the taut bands which are responsible for the increased tension. Many methods of release are described in Section 12 of Chapter 3.

Further reading

Simons DG, Travell JG. Myofascial origins of low back pain. 1. Principles of diagnosis and treatment. Postgrad Med. 1983 Feb;73(2):66, 68-70, 73 passim. doi: 10.1080/00325481.1983.11697756. PMID: 6218489.

Steen JP, Jaiswal KS, Kumbhare D. Myofascial Pain Syndrome: An Update on Clinical Characteristics, Etiopathogenesis, Diagnosis, and Treatment. Muscle Nerve. 2025 May;71(5):889-910. doi: 10.1002/mus.28377. Epub 2025 Mar 20. PMID: 40110636; PMCID: PMC11998975.

Chad E. Cook, Brian Degenhardt, Sasha Aspinall, Casper Nim, Shaista Malik, and Damian Keter. Journal of Orthopaedic & Sports Physical Therapy 2025 55:4, 231-234.

Slater AM, Barclay SJ, Granfar RMS, Pratt RL. Fascia as a regulatory system in health and disease. Front Neurol. 2024 Aug 7;15:1458385. doi: 10.3389/fneur.2024.1458385. PMID: 39188704; PMCID: PMC11346343.

Rehnke RD. Clinical Implications of the Fascial System: A Commentary on One Surgeon's Journey. Life (Basel). 2024 Jan 5;14(1):89. doi: 10.3390/life14010089. PMID: 38255704; PMCID: PMC10817567.

Effectiveness of Myofascial Trigger Point Manual Therapy Combined With a Self-Stretching Protocol for the Management of Plantar Heel Pain: A Randomized Controlled Trial.

Rômulo Renan-Ordine, Francisco Alburquerque-SendÍn, Daiana Priscila Rodrigues De Souza, Joshua A. Cleland, and César Fernández-de-las-PeÑasJournal of Orthopaedic & Sports Physical Therapy 2011 41:2, 43-50.

Cao QW, Peng BG, Wang L, Huang YQ, Jia DL, Jiang H, Lv Y, Liu XG, Liu RG, Li Y, Song T, Shen W, Yu LZ, Zheng YJ, Liu YQ, Huang D. Expert consensus on the diagnosis and treatment of myofascial pain syndrome. World J Clin Cases. 2021 Mar 26;9(9):2077-2089. doi: 10.12998/wjcc.v9.i9.2077. PMID: 33850927; PMCID: PMC8017503.

Stecco A, Stern R, Fantoni I, De Caro R, Stecco C. Fascial Disorders: Implications for Treatment. PM R. 2016 Feb;8(2):161-8. doi: 10.1016/j.pmrj.2015.06.006. Epub 2015 Jun 14. PMID: 26079868.

References

July 10-12, 2025

Hawaii Myofascial Symposium

October 23-25, 2025

For more details about the symposium (speakers, itinerary, registration, volunteering, and venue) visit https://hawaiimyofascialsymposium.com/

Who Should Attend:

The Hawaii Myofascial Symposium is ideal for a diverse range of healthcare and wellness professionals seeking to expand their expertise in myofascial pain assessment and treatment including:

• Acupuncturists

• Chiropractors

• Dentists and Dental Assistants

• Massage Therapists

• Myofascial Trigger Point Therapists

• Nurse Practitioners and Physician Assistants

• Occupational Therapists

• Physical Therapists and Assistants

• Physicians especially in primary care, pain management and rehabilitation

• Sports Medicine Professionals

• **Students pursuing a course of study in any of these professions.

Hi Travellians,

While the Gelman Library is closed for the summer, we’re switching gears and focusing on various projects, including applying for grants to digitize The Janet G. Travell Papers in the fall. Here’s an overview of several exciting projects we’re working on this summer!

Upcoming projects in progress

• A new trigger points wall chart, which will be available as a PDF download and print format.

• An online self-guided study of the Travell & Simons Trigger Point Manuals.

• The original 1982 First Edition Volume 1 of the Travell & Simons Trigger Point Manual, Upper Extremities, digitized and available in PDF format.

• A redesigned, custom website with Janet Travell’s published papers, articles, unpublished research and lecture notes, in a searchable format.

• A series of articles and preview chapters of a new book, “Myofascial Trigger Point Therapy, What’s next?: The Travell Protocol” by Nancy Shaw.

• A blog featuring guest posts by the top experts in myofascial trigger point therapy.

Thanks to Ben Daitz, M.D., I’m pleased to present this video of Janet Travell’s 90th birthday celebration and interview, which aired on ABC Television in December 1991. In this brief interview, Travell doesn’t miss a chance to share some trigger point therapy insights.

Note: There’s an error in the video: Robert Gerwin, M.D. is a neurologist, not a dermatologist! Robert Gerwin, MD, FAAN is a co-founder of Myopain Seminars. He is a Board Certified Neurologist and a Fellow of the American Academy of Neurology. He is also a Diplomate of the American Board of Pain Medicine and a member of the American Academy of Pain Medicine. Dr. Gerwin graduated from the University of Chicago School of Medicine. He had a two-year special fellowship at NIH in neurology and immunology. He has been in private practice in the Washington DC area, and has been working in the area of Myofascial Pain and Fibromyalgia for many years. Dr. Janet G. Travell was his mentor while she lived in Washington DC. https://www.myopainseminars.com/team/robert-gerwin/

Featured article

“Janet G. Travell, MD on Myofascial Pain,” written by Larry W. White, DDS, MSD, and published in the Journal of Clinical Orthodontics, July 1989

This article presents an in-depth interview with Dr. Janet Travell in 1989. The discussion centers on her groundbreaking work with trigger points, (specific areas of muscle tenderness that cause pain to spread to other body parts), a concept previously misunderstood in medicine. Dr. Travell explains her diagnostic methods, including the critical role of physical examination and patient-reported pain maps, contrasting them with traditional reliance on X-rays or nerve tests. She also touches upon treatment approaches like procaine injections and spray-and-stretch techniques, while highlighting the importance of addressing perpetuating factors like poor posture, nutritional deficiencies, and even certain dental issues for lasting relief. The interview concludes with insights into her personal journey and influences, showcasing her dedication to patient care and the often-overlooked muscular origins of widespread pain.

Read the entire interview on the Journal of Clinical Orthodontics website:

https://www.jco-online.com/archive/1989/07/468-jco-interviews-janet-g-travell-md-on-myofascial-pain/

Are you looking for The Trigger Point Manuals in digital format? Here are links to the PDF versions in Google Drive, see below.

2nd_Ed_Vol_1_Upper_Body.pdf

https://drive.google.com/file/d/129rIn54IqRj87Z2ymSqxmsv-D_n2skiY/view?usp=sharing

1st_Ed_Vol_2_Lower_Body.pdf

https://drive.google.com/file/d/1s5dZtBzXq_EmGjiWNveusdNiZBQz2n1B/view?usp=sharing

Visit our Vimeo Channel to stream our video series, “Myofascial Pain Syndromes: The Travell Trigger Point Tapes. Janet Travell, M.D., shares her knowledge of myofascial trigger point therapy, from head to toe.

Click here to go to our Vimeo Channel: https://vimeo.com/ondemand/481264/

Visit our website at JanetTravell.org

Follow us on Facebook

In peace,

Janet Street

Hi Travellians,

I hope everyone is doing well on this rainy Friday afternoon! And Happy Mother’s Day on Sunday! Here’s a brief update on what’s happening at The Janet Travell Foundation. We have several new folders of documents from The Gelman Library. These two are especially interesting: Travell and Simons give a lecture on the Quadratus Lumborum Muscle, 1980; and “Ethyl Chloride Spray for Relief of Spasm and Pain.” The links take you to our website, JanetTravell.org.

Travell and Simons give a lecture on the Quadratus Lumborum Muscle, 1980

https://www.janettravell.org/janet-travell-archives/quadratus-lumborum-lecture-1980

“Ethyl Chloride Spray for Relief of Spasm and Pain”

https://www.janettravell.org/janet-travell-archives/ethyl-chloride-spray-lecture-1951

Tired of lugging around “the red bibles”? The Trigger Point Manuals, Upper Half of Body and Lower Half of Body, are now available in digital format on our website.

Click here to view and download “Upper Half of Body” https://www.janettravell.org/trigger-point-manuals/upper-half-of-body

Click here to view and download “Lower Half of Body” https://www.janettravell.org/trigger-point-manuals/lower-half-of-body

Download our poster, “Janet Travell, M.D., White House Physician and Trigger Point Pioneer.” Based on JGT’s autobiography and Gelman Library documents, we’ve created a timeline of JGT’s personal milestones and career highlights. Everything from 1901 through 1968 is easily found in “Office Hours: Day and Night.” Then, from 1968 until 1997, JGT continued teaching, lecturing, publishing articles, co-authoring the trigger point manuals, and managing her clinical practice for nearly thirty more years. Consider this poster a work-in-progress though, and please let us know if you see any errors or ommissions!

Visit our Vimeo Channel to stream our video series, “Myofascial Pain Syndromes: The Travell Trigger Point Tapes. Janet Travell, M.D., shares her knowledge of myofascial trigger point therapy, from head to toe.

Click here to go to our Vimeo Channel: https://vimeo.com/ondemand/481264/

Lastly, Nancy Shaw has sent us a treasure trove of VHS and cassette tapes of JGT’s lectures and interviews, which will be published here once the tapes have been digitized.

Much love to you all,

Janet Street

Course Information

Advance registration is now open for The University of New Mexico School of Medicine’s 2025 Myofascial Institute program. Workshops will be taught over 4 days; November 20-23, 2025.

Who Should Attend

Acupuncturists | Chiropractors | Doctors of Oriental Medicine | Massage Therapists | Myofascial Therapists | Nurse Practitioners | Occupational Therapists | Physical Therapists | Physician Assistants | Physicians

The courses are designed for those who can perform TPI/have the injection privilege and to train clinicians to be able to independently practice advanced TPI or manual therapy. These courses are intended for acupuncturists, chiropractors, doctors of oriental medicine, massage therapists, myofascial therapists, nurse practitioners, occupational therapists, physical therapists and physicians.

These courses are specifically designed for individuals who have not previously taken them.

Nov. 20-21: The UNM Myofascial Institute - Trigger Point Injections

Myofascial Diagnosis and Needling

Course Objectives for TPI

At the conclusion of the training, the participant should be able to:
• Identify common myofascial pain syndromes in the clinical setting.
• Perform basic and advanced trigger point injection (TPI) in patients with myofascial pain syndrome.
• Enumerate techniques to maximize patient safety related to performing TPI.

Nov. 22-23: The UNM Myofascial Institute - Manual Techniques

Manual Diagnosis and Treatment

Course Objectives for Manual Release Techniques

At the conclusion of the training, the participant should be able to:
• Identify common and subtle myofascial syndromes in the clinical setting.
• Perform basic and advanced release techniques for patients with myofascial pain syndrome.
• Identify factors that are likely to perpetuate myofascial trigger points and discuss mitigation.

Visit The UNM 2025 Conference Calendar for registration information and to request a brochure

https://hsc.unm.edu/medicine/education/cpl/learn/cme-conferences-index.html

March 31, 2025 | Issue #5

Hello, Trigger Point Community!

March updates: We launched a podcast! Selected readings will be available in audio format. These podcast episodes will also be integrated into the foundation’s learning center.

IN THIS ISSUE:

Welcome to the Deep Dive podcast, covering all things Travell and trigger points.

Dr. Lucy Whyte Ferguson, DC, shares her tribute to Dr. Janet Travell.

Announcing the annual UNM myofascial trigger point therapy conference offering advanced hands on training in myofascial diagnosis, trigger point injections and manual release techniques

Announcing The Travell Trigger Point Masterclass with Nancy Lee Shaw, MTPT

Nancy will be teaching an in-person myofascial trigger point therapy workshop in May/June (TBA) at her clinic in Springfield, Virginia. In this hands-on workshop, Nancy will be teaching The Travell Trigger Point Protocol and demonstrating these principles in a clinical setting. There are a few spots left. Send us a message or contact Nancy directly if you’re interested in attending the workshop.

Special thanks to Jan Dommerholt, PT, DPT, for including The Janet Travell Foundation and The Travell Trigger Point Tapes video series in this month’s Myopain Seminars newsletter!

Myofascial Pain Syndromes: The Travell Trigger Point Tapes - 6 Part Video Series

Ever wonder where the whole trigger point thing started? Step into the clinic where it happened. We've unearthed rare footage of Dr. Janet Travell, the OG of myofascial pain, captured in her element. Think 90s vibes, VHS nostalgia, and pure, unfiltered knowledge. Now, this historical goldmine is online, thanks to the Janet Travell Foundation. It's not just a video series; it's a front-row seat to the origins of a revolution. If you're serious about myofascial pain, this is your mandatory history lesson.

The Travell Trigger Point Point Tapes are now on Vimeo On Demand. The six video series can be rented or purchased, individually or as the complete set.

To learn more (literally) visit our Vimeo Showcase:

Vimeo

Watch video clips from The Travell Trigger Point Tapes on YouTube

Visit The Janet G. Travell Papers collection at The Gelman Library.

Find us on our Website and Facebook, and subscribe to our free newsletter here:

Subscribe now

First published in the Dynamic Chiropractic™ Newsletter, November 1997

Editor's note: In the Sept. 22 issue of DC, our rehabilitation columnist, Craig Liebenson, DC, dedicated his column to Janet Travell, MD, who died Aug. 1, 1997 at the age of 95.

Dr. Lucy Furguson wanted to add some personal comments about Dr. Travell, and her impact on the chiropractic profession.

I would like to share some of what Dr. Janet Travell meant to me and my development as a chiropractor, and also to share the ways in which I have been able to see her influence as a friend of chiropractic.

While she was known as President John Kennedy's doctor, her true passion was the development of an understanding of diagnosis and treatment of muscle-related pain. While she did research in the prescribed manner, she was also known to offer impromptu treatment sessions whenever she noticed someone in pain and had a few minutes to spare. This someone might have been a party or dinner companion, or might have been a cabbie driving her to the airport. One of the causes of amusement of those who knew her well was how often, and in how many circumstances, people would take off their shirts to let her examine and treat their trigger points.

I first met Dr. Travell in 1983 when I was invited to attend a seminar at which she was presenting. I had seen her first book, Myofascial Pain and Dysfunction: The Trigger Point Manual, written with coauthor David G. Simons, MD, but I had no idea of the manual skills and procedures involved in trigger point identification and release. I also had only the most rudimentary understanding of myofascial pain, its diagnosis and treatment, although I was convinced of the importance of muscle balance from my time spent working with DCs John Thie and Leroy Perry.

I sat spellbound as Dr. Travell used her deft hands and her incredibly strong fingers to identify and treat painful conditions and restore normal patterns of mobility. Often it appeared that she had three or four hands. She had a holistic approach, identifying body imbalances which were perpetuating myofascial dysfunction, even attending to breathing patterns which were overloading the scalene muscles in a runner with chronic neck problems. She stressed the importance of identifying even marginal vitamin and mineral insufficiencies to allow the body to be better able to heal from chronic painful conditions.

In private discussions with her, she was very encouraging. It was clear that she enjoyed teaching chiropractors because we already have such strong palpation skills and such a sophisticated understanding of body mechanics and function. Also, she clearly viewed manual therapies as the heart of successful treatment of trigger points and myofascial dysfunction. I proceeded to take what I had learned back to my practice and develop my skills at diagnosis and treatment and a fuller hands-on understanding of the relationship between muscle and joint function.

I realized that Dr. Travell's teachings were having a profound influence on my practice. I found that I could make sense out of a much broader range of pain problems in patients under my care. I even became better able to quickly identify the pain problems which were not of musculoskeletal origin, such as liver cancer, because the accompanying muscle and joint problems did not respond to treatment as expected. I found that latent (not painful) trigger points and associated shortened muscles had a powerful influence on postural patterns, affecting the success of my attempts to reorganize joint function and eliminate subluxations.

I could tell if patients were properly performing their stretches and exercises, and could adapt and refine their home regimen to carry them through an orderly rehabilitation sequence.

As I proceeded to take more advanced courses, I was gratified that every presenter, no matter what the background, recognized the importance of addressing both joint and muscle function to deal with chronic pain. Dr. Travell and others clearly stated that any time there is a long-standing joint problem, there will almost invariably be myofascial dysfunction; every time there is long-standing myofascial dysfunction there will almost invariably be joint dysfunction. For this reason, those attending these programs were encouraged to work as teams, even from their separate private practices and coordinate the care of patients with difficult to treat chronic pain problems.

As I was practicing in the Washington, DC, area, Dr. Travell encouraged the development of a referral network which included me, a neurologist, an anesthesiologist, a physiatrist, a physical therapist, a dentist, a myotherapist, among others. We shared our most difficult patients, which was a marvelous learning experience. None of these practitioners pulled rank. We all collaborated on an equal footing to help our patients.

Two years ago I was helping to teach a seminar in Bethesda, Maryland. The course director was Robert Gerwin, MD, an eminent neurologist from Johns Hopkins, who also has a private practice. A segment of the course dealing with quadratus lumborum had just been presented; one of those attending asked whether this wasn't a much better way to deal with lower back pain than forceful manipulations of the spine.

I was sitting in the back and I cringed at what had just been said. But I was pleasantly surprised when Dr. Gerwin responded, "Well, let's let our chiropractic expert respond to that question." He called me to the front and I proceeded to explain that release of the quadratus lumborum addresses only the muscular component of back pain, and that most often there is a painful joint component: joint dysfunction or subluxation. I demonstrated the positions involved in muscular release, and the different positions involved in joint manipulation or adjustment, the specificity of the maneuvers for each. I stated that adjustments can be performed in a gentle and specific manner; that performing the muscular release first makes it possible to perform the adjustment procedures with less impulse in the thrust.

Dr. Travell was smiling and nodding in the audience and I know that it was her influence which generated the relationships which made it possible for me to correct the false impressions of these practitioners regarding chiropractic.

Later that year, Robert Gerwin joined me and Ben Daitz, MD, in presenting the first interdisciplinary myofascial pain seminar sponsored by a medical school. The University of New Mexico Office of Continuing Medical Education sponsored the course, and Ben and me were course directors. I was delighted, and watched a number of jaws in the audience drop, when Bob Gerwin stated that medicaldoctors will never understand low back and pelvic pain unless they develop some understanding of the function and dysfunction of the sacroiliac joint. We will be presenting this course again at the end of this October, and I know that it would never have been possible without the knowledge and teaching of Dr. Travell, but more importantly her direct encouragement of interdisciplinary relationships in teaching and in treatment of patients.

A little over a year ago, Janet Travell asked for a copy of my CV. I was dismayed when she returned it with lots of corrections and suggestions. She has always been a meticulous person, and somewhat of a perfectionist. I learned about this side of her when I showed her the artwork which was to accompany my article, "Frozen Shoulder and Shoulder Dysfunction," which appeared in Chiropractic Technique a couple of years ago. Very quickly she had identified six or seven errors in the artwork which obviously needed to be corrected. This time, I reworked my CV and only later found out that she had nominated me for an award. Last fall, I became the first chiropractor to receive the "Janet G. Travell Soft Tissue Pain Management Award" from the American Academy of Pain Management.

So I sense a great loss with the passing of this great healer, writer, and teacher. I will remember her as an individual motivated by a burning desire to help those with pain. Everything in her professional career was derived from this basic desire. She had a view of the future where there would be no barriers to interprofessional cooperation in the treatment of patients in pain; she proceeded to take a direct hand in bringing this view into reality. Her legacy will live on, not only in the lives of those she directly influenced, but in the directions which she charted for health care in treating chronic pain patients. Patients, the chiropractic profession, and health care in general are better for her guiding light.

Lucy Whyte Furguson, DC El Prado, New Mexico

©2025 Dynamic Chiropractic™ All Rights Reserved NOVEMBER 1997

About the author

Lucy Whyte Ferguson, a chiropractor deeply connected to Taos, New Mexico, and passionate about alleviating pain by releasing physical constrictions. Her early life, influenced by her anthropologist father, fostered an appreciation for diverse cultures and prepared her for extensive travel and work with various populations. Ferguson's career path shifted after a back injury led her to chiropractic and the study of myofascial pain under prominent figures. This journey culminated in her becoming a respected expert, authoring a significant book on myofascial pain treatment, and now sharing her knowledge through teaching initiatives to expand access to effective pain management.

Recently published: Myofascial Therapy for Adolescent Idiopathic Scoliosis: A Clinical Study

This research article investigates the potential of myofascial and articular treatment, alongside standard care, to improve outcomes for adolescents with idiopathic scoliosis (AIS). The study compared a control group receiving standard treatment to an active treatment group that also received specialized manual therapy and exercises targeting muscle imbalances and fascial restrictions. While the study was limited by a small sample size due to the pandemic, it observed significant curvature reductions in a notable portion of the active treatment group and documented clinical observations suggesting a strong link between fascial constriction, pelvic imbalance, ligamentous laxity, and AIS. The authors propose that addressing these myofascial and articular factors could be crucial in managing AIS progression and potentially reducing the need for surgery.

Myofascial and Articular Treatment of Adolescent Idiopathic Scoliosis (AIS)

https://crimsonpublishers.com/oproj/pdf/OPROJ.000756.pdf

Deep Dive Podcast; March 27, 2025

Myofascial and Articular Treatment of Adolescent Idiopathic Scoliosis (AIS)

Sources

https://dynamicchiropractic.com/article/38606-janet-travell-md-what-she-meant-to-me

https://chironeurointl.org/member-directory-search/lucy-whyte-ferguson/

https://womenoftaos.org/women/profiles-caregivers?/item/198/Lucy-Whyte-Ferguson-Chiropractor

Trigger point pain originates from myofascial trigger points (TrPs), which are hyperirritable spots within a taut band of skeletal muscle or in the muscle's fascia. These spots are painful on compression and can give rise to characteristic referred pain, tenderness, and autonomic phenomena. Myofascial trigger points are distinct from cutaneous, ligamentous, periosteal, and nonmuscular fascial trigger points.

A key characteristic of trigger point pain is that it is referred, meaning the pain arises in the trigger point but is felt at a distance, often entirely remote from its source. The pattern of referred pain is reproducibly related to its site of origin. For example:

• Trigger points in the quadratus lumborum muscle can refer pain to the sacroiliac (SI) joint, lower buttock, and sometimes even to the front of the thigh.

• TrPs in the gluteus minimus muscle can refer pain over the lower lateral buttock, down the lateral aspect of the thigh, knee, and leg to the ankle, mimicking sciatica.

• Failure to recognize that the painful area is usually the pain reference zone, not the location of the TrP, can lead to misdiagnosis.

The sources distinguish between active and latent myofascial trigger points.

• An active myofascial trigger point is symptomatic with respect to pain; it causes a pattern of referred pain at rest and/or on motion that is specific for that muscle. It is also tender, prevents full lengthening of the muscle, weakens the muscle, usually refers pain on direct compression, mediates a local twitch response, causes tenderness in the pain reference zone, and often produces specific referred autonomic phenomena.

• A latent myofascial trigger point is not explicitly defined in this excerpt but is mentioned as something to be distinguished from an active one. It can be inferred that latent TrPs are not currently causing pain but have the potential to become active. Shortening activation can turn latent myofascial trigger points active due to unaccustomed sudden shortening of the muscle during stretch therapy of its antagonist, leading to increased tension and referred pain.

Trigger point pain is a central component of myofascial pain syndrome, which is characterized by pain, tenderness, and autonomic phenomena referred from active myofascial trigger points, along with associated dysfunction. This syndrome is often a significant component of somatic dysfunction.

The experience of trigger point pain can vary. It can be described as a deep ache, though TrPs in the sartorius muscle might be described as sharp or tingling. The intensity can range from a mild discomfort to intolerably persistent and excruciatingly severe, as can be the case with pain referred from gluteus minimus TrPs. Palpation of an active TrP often elicits a jump sign, which is a general involuntary pain response of the patient. It can also evoke a local twitch response of the taut muscle fibers.

Trigger points in different muscles of the lower extremities cause specific patterns of referred pain. For example:

• Iliopsoas muscle TrPs refer pain in a vertical pattern along the lumbar spine, down to the sacroiliac region, and into the groin and upper anteromedial thigh.

• Gluteus maximus muscle TrPs refer pain locally in the buttock region and sometimes to the sacroiliac joint and upper posterior thigh.

• Tensor fasciae latae muscle TrPs refer pain and tenderness to the anterolateral thigh over the greater trochanter and down toward the knee.

• Hamstring muscles TrPs refer pain to the gluteal fold and the back of the knee, sometimes extending into the calf and posterior thigh.

• Tibialis anterior muscle TrPs refer pain and tenderness primarily to the anteromedial aspect of the ankle and over the dorsal and medial surfaces of the great toe.

• Soleus muscle TrPs commonly refer pain and tenderness to the heel.

Understanding the concept of referred pain and being familiar with muscle anatomy and trigger point characteristics are crucial for health professionals to become proficient in identifying and treating myofascial pain. Effective management often involves inactivating the trigger points through techniques like ischemic compression, injection, and stretch, along with addressing any mechanical or systemic perpetuating factors.

February 28, 2025 | Issue #4

Greetings from the frozen North!

Speaking of cold, I’ve been re-reading Office Hours: Day and Night, Janet Travell’s autobiography published in 1968, and came across this interesting excerpt on cold therapy:

February has been a busy month for The Janet Travell Foundation!

Here are some highlights

We’re excited to announce our first workshop, The Travell Trigger Point Masterclass! Nancy Shaw, MTPT, will be hosting an in-person workshop in May/June at her clinic in Springfield, Virginia. Space is limited. Details coming soon.

Send us a message if you would like to be on the waiting list for the workshop:

The Travell Trigger Point Point Tapes are now on Vimeo On Demand. The six video series can be rented or purchased, individually or as the complete set.

To learn more (literally) visit our Vimeo Showcase:

Vimeo

We launched our YouTube channel and added some video clips of The Travell Trigger Point Tapes

This video clip features the venerable Robert Gerwin, M.D., and the one-of-a-kind Janet Travell, M.D., recorded in 1990. Myofascial Pain Syndromes: The Travell Trigger Point Tapes. Video 1: Introduction to Myofascial Pain Therapy.

Watch more video clips on YouTube

New documents from the Gelman Library

Thanks to the Gelman Library team for scanning several folders of documents for our digital archives. Each folder contains multiple pages. To view these research materials, visit our website and click on Archives.

https://www.janettravell.org/janet-travell-archives/box-20-folder-1

https://www.janettravell.org/janet-travell-archives/box-20-folder-15

More coming soon!

Visit The Janet G. Travell Papers collection at The Gelman Library.

Find us on our Website and Facebook, and subscribe to our free newsletter here:

Subscribe now

Hello friends,

Happy 2025! Wishing everyone a safe, healthy and prosperous new year. We have been quite busy this month. I’m excited to be working with the amazing staff at The Gelman Library on reproducing some of the most interesting materials from The Janet G. Travell Papers, and we’ll be sharing our finds in this newsletter.

In this issue, Nancy Shaw has written the first in a series of articles entitled, “Myofascial Trigger Point Therapy, What’s Missing?: The Travell Protocol.” This article outlines a book that Janet Travell and Nancy Shaw were working on in 1997. Over the years, Nancy has been using The Travell Protocol in her practice, and currently is working on the book that Travell envisioned; a companion guide to the trigger point manuals.

Don’t miss Devin Starlanyl’s article, “Janet Travell Stories,” with insightful and endearing retellings by Janet Travell’s esteemed colleagues.

One big project that I’m working on is to publish the out-of-print trigger point manuals on the foundation website and here on Substack, for educational purposes. These texts will be searchable and provide an invaluable research tool for myofascial trigger point practitioners.

Our incredible team of Travell enthusiasts is growing, and we are working on submitting Travell’s published papers and unpublished research to online medical research libraries worldwide. We also have a team of artists working on creating an online library of trigger point illustrations for our subscribers to use for educational purposes, such as teaching and creating self-care handouts for patients.

For those of you who are new to The Travell Trigger-Point Tapes, this video series filmed by Dr. Ben Daitz in 1990 features Janet Travell teaching about myofascial trigger point therapy, and is packed full of wisdom and insight.

I’ll be posting more articles during the week as they are finished.

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Subscribe now

New this week:

Hello Travellians,

Today is December 17th and the birthday of Janet Travell, born in 1901. That’s one hundred and twenty three years ago!

What’s new this week:

https://jtravell.substack.com/p/digitizing-janet-travells-research

There’s alot of exciting developments happening behind the scenes, so stay tuned and we’ll be sharing more in the upcoming newsetters!

Warm regards to all,

Janet Travell Street and Virginia Powell Street

Email: thejanettravellfoundation@gmail.com