Janet Travell Stories
A collection of stories gathered by Devin Starlanyl
By Devin Starlanyl
Whenever friends and students of Janet Travell gather together, one of their prime joys is sharing Janet Travell stories. Here are some for the Archives.1
Janet Travell Stories
Excerpted from: Lowe JC. The master of myofascial therapy. ACA J Chiropr. 1993 Nov.
Over a three day period in early May, 1989, I attended the First International Symposium on Myofascial Pain and Fibromyalgia. The Symposium was boring at some points and fascinating at others. There was one event, however, that I had no trouble concentrating on. That event was Dr. Janet Travell examining and treating a young dentist who had been in pain for three years. His pain had driven him to close his practice the year before. For those not familiar with Dr. Travell, she is the premier clinician treating myofascial pain syndromes. She freed Senator John Kennedy from his back pain with myofascial therapy.
Dr. Travell was an unforgettable sight. She looked little more than 5 feet tall, with body contours that suggested her then eighty-eight years had taken their toll on her height. Her white hair was straight, and she wore blue tennis shoes over which she teetered as she moved. She seemed to fatigue easily while standing without support, so she braced herself against the treatment table as she moved around it. But whatever she may have lost to time physically was not reflected in her mental functions. During her one hour demonstration, she displayed an awe-inspiring knowledge of the human body, anatomy, biomechanics, kinesiology, biochemistry, nutrition, and more.
The dentist had been to many practitioners including chiropractors. She had him write out the history of his trauma and pain the night before the demonstration so she would have time to read it. He had written six pages. His history included numerous traumas, one of which was severe electric shock.
Dr. Travell's lecture the first day of the Symposium was titled "The Mystery of the History." In it, she emphasized the value of carefully eliciting a pertinant history from the patient. She gave a firsthand example of this in her demonstration with the dentist. What impressed me most was the way she went after perpetuating factors. I thought of a prized police dog sniffing out drugs. Nothing seemed to escape her. I suppose her reading his history had given her clues, but she also was observing him closely. After having him sit up straight, she pointed out that his right shoulder was lower than his left. She put a paperback book under his left ischium because she thought that the left hip was lower than the right. He said he could feel his muscles in his thoracic region adapting. She then had him flex laterally to the left to stretch the right quadratus muscle, while she sprayed the right lumbar region with Fluorimethane. He said it felt better.
She apparently noticed that his head and neck were consistently rotated slightly to the right as he attempted to look straight ahead. She took a piece of paper with a small hole in the middle and held it in front of his face. She held up a finger on the opposite side of the paper, and asked him to close his left eye and tell her if he could see her finger through the hole with his right eye. He could. She then told him to repeat the procedure by closing his right eye. When she asked if he could see her finger, he said no. She then pointed out that his right eye was dominant and that when he wanted to see with his left eye, he rotated his neck to the right to get the left eye in proper line. She indicated that this should be corrected to avoid chronic overloading of the muscles that rotate the neck to the right.
A doctor in the audience of about forty people asked Dr. Travell if she thought the dentist had short upper arms. She agreed that his arms were too short for the armrests of the chair he was sitting in. She took a couple of yellow sponges from a bag she had brought with her. They were the kind you might use to clean kitchen counters, and were still enclosed in their plastic wrapping. Dr. Travell put them under the dentist's elbows so that rather than using his trapezii to hold up his arms, he could rest his elbows on the sponges and relax the muscles. She encouraged the audience to recommend to their short-armed patients that they use foam rubber pads or plain old sponges to properly support their arms.
She had the dentist slump forward in his chair with his head toward the ground. This stretched his lower trapezii, which attach to the mid-to-lower thoracic vertebra and to the spine of the scapulae. She palpated the lateral border of the right lower trapezius. She found a trigger point and induced a twitch that indented his back along the lower trapezius on both sides of the trigger point for some distance. She sprayed the muscle, moving the stream of vapocoolant slowly and deliberately.
After she palpated his trapezius, the skin was distinctly red. She said this was a histamine reaction. She scraped a fingernail over the skin of his back drawing a red “X.” She backed away and said, "See, it stays there." And it did. She told him to take antihistamines for a couple of months and that should eliminate the problem. He said he had been diagnosed as having allergic rhinitis for about a year. He had also been treated with desensitization shots for a year because of allergies to house dust and a lot of other things. These hadn't worked.
She asked if he'd been bothered with cold sores and he said yes. She asked if he'd taken a lot of antibiotics. Again, yes. She said that the antibiotics had probably killed off too much of his normal intestinal protective flora. She said that the herpes simplex virus lives in the tissues of the G.I. tract and that the only way to drive them out is to restore the normal flora. She told him to take Lactinex tablets which contain the live cultures.
Then she told him to stick out his tongue, and after examining it, she said it looked normal. She explained that the tongue and the mucosa of the mouth are pieces of the G.I. tract, and when there is a malabsorption syndrome (which can induce nutritional deficiencies and then myofascial syndromes), there is a film on the lining of the G.I. tract and on the tongue.
She asked if he had had a blood vitamin test. He said he had. The only vitamin that was low was B12. He had taken it as a supplement but only through Centrum. She scoffed by pointing out that he needed about 3 grams per day to correct a B12 deficiency. She asked if he was anemic and he said no. She pointed out that he could still have a B12 deficiency. While it might not show up as anemia, as a folic acid deficiency would, it still might bring about subacute combined lateral sclerosis.
Someone in the audience asked, "When do you use injections?" She answered, "When the patient lacks motor coordination or for some other reason is unable to cooperate in properly stretching during the stretch and spray procedure." I took special note of this because I've heard some practitioners criticize Dr. Travell: they have the erroneous idea that she uses injections as her first line approach.
She dramatically loosened this dentist's myofascia so that he recovered normal ranges of motion. Before she began, for example, he couldn't get his chin closer than three fingerwidths from his sternum. After stretch and spray treatment, his chin touched his sternum.
She was just as effective in loosening the adductors of his thighs. Before starting, his left lower extremity would flex only about 45-50 degrees off the table. After only a couple of minutes of spraying and stretching the adductors, the extremity reached 90 degrees. Interestingly, after treating his left adductors, the right lower extremity also was flexible enough to reach 90 degrees. She said, "This is a crossover phenomenon. It usually happens when treating these muscles. Somebody has done a study and showed that when you treat trigger points in one set of hamstring muscles, the others also loosen."
Seeing Dr. Travell artfully free this man from chronic, debilitating pain was well worth flying to Minneapolis and being away from my office for three days. Her demonstration was as practical as practical can be. Much of the material presented by researchers at the Symposium was academic. I felt there was the implication that only through research will we come to understand myofascial pain well enough to effectively relieve it. I disagree with this. Behaviorists have long taught that the best way to learn to do something well is to model someone who has mastered the skill.
For relieving myofascial pain, there is no better model than Dr. Janet Travell, the master of myofascial therapy.
Addendum: When John Lowe gave me permission to use this excerpt in the second edition Fibromyalgia and Chronic Myofascial Pain: A Survival Manual, he also told me this story. After his article was printed, Janet Travell called him. One thing she said was, “But you made me sound so old.” John was concerned that he had in some way disappointed her. He wanted to honor her and her renowned observational and diagnostic skills. I told him that during a discussion concerning her Spray and Stretch tapes, she had told me, “I only wish I had done them earlier, before I looked so old.” John Lowe felt a little better after that, I think. Janet Travell remained young in spirit and in mind as long as she lived, and she lived to the fullest. She did indeed wear out and not rust out.
From Tasso Spanos, founder of the Academy for Myofascial Trigger Point Therapy, Pittsburgh PA.
The last time I saw Janet alive was billed as her last public presentation and because a chiropractor who was also a physical therapist was one of the promoters of the presentation. There were about 400 people who came, and about 100 physical therapists showed up. I had seen her presentation seven times before and I and rarely ever seen a physical therapist at those presentations. Many myotherapists, but rarely physical therapists. But at the last presentation finally about 100 physical therapists showed up, and they asked her this question: After three days with Travell, they asked her, “Youve been talking about stretching, stretching and stretching and WHEN do we do the work hardening or the strengthening exercise?” She said the patient has to be out of pain for two weeks AND have normal range of motion or close to normal range of motion for two weeks, in other words if they feel good and their arm moves pretty good on Monday, thats not the day. Then you ask them on Tuesday. Finally after 14 days, your can proceed with very, very light strengthening. Well, five minutes later a hand came up and they asked her the same question. Then a couple minutes later they asked her the same question. After answering this same question nine times, each time phrased differently, Travell stopped it all by saying “Ah, you know, I’m getting old, but I didn’t know I was getting deaf!” When she said that, they didn’t ask her the same question any more. One of my graduates turned to me and wondered why these people kept asking the same question. They’re asking the same question over and over again. Don’t they get it? I told her, It’s not that they don’t get it. They just dont like the answer! When the body is injured, you cannot subject it to a load. In this country, it is against the law to run an injured race horse. Yet that’s what too many physical therapists do. If you can’t lift your arm, you have to practice lifting your arm with weights and repetitions. If you can’t turn around, you have to turn around with weights and repetitions. That’s what Janet Travell was trying to tell these people. You can’t strengthen a muscle with a trigger point. Some of them got it. When I asked Janet to sign my copy of the Trigger Point Manual, and it was my third copy and held together with duct tape and very much used, she signed the book and told me, “Thank you for putting this book in this condition.”
Tasso Spanos
From Hal Blatman MD, myofascial specialist, Cincinnati, Ohio
It was back in 1990. I already had this myofascial pain practice and this country dentist from a little bit north of where I live calls me up and says Dr. Blatman, we share this patient. And shes got head and neck pain and numbness in her jaw and we ought to get together and talk about how we can work together and help her. Sometime within the next week or two I go up and visit with this guy and hes showing me stuff and telling me stuff and finds out Im no beginner with head and neck and TMJ stuff, Ive been doing it for6, 7 years. I find out hes got Janets book and his copy is autographed by her. And we have one of these conversations like, Shes still alive? Where can I find her? Cause Ive been saying for a while that somewhere it was my destiny to meet this woman but I wasnt really believing it was true. He tells me that theres a course by invitation only and he thinks he can get me in to it. And she happens to be teaching it.
Two months later, give or take, he and I get onto an airplane and go to Bethesda MD, and I spend 4 days with 30 people in a room with Janet Travell. And I kind of thought I knew what I was doing when I got there, and realized that I was still quite a beginner. And one of the things that impressed me most was that Janet would do examinations on patients coldthat shed never met before. So here we are in this room and this woman comes in from the back and walks up towards where Janet is sitting at this table. And Janet looks out at the class and she says, did you see that the left eye was dominant? Did you notice that the persons right handed? Did you notice that they walk with a limp to one side. Im looking, and I noticed the limp, but I didnt know anything about one eye being dominant and I didnt know half of the other stuff that she mentioned. I thought, Whoa, are we on the same planet here? What I realized was I couldnt do it yet. Whatever it was she did, it WAS possible to do what she did. It opened up my eyes to a new level of awareness. And that was my introduction to Janet Travell. The next time I went and spent a weekend with Janet Travell I was teaching next to her.
Hal Blatman, MD
From Robert Gerwin MD, neurologist, Bethesda MD, and organizer of Focus on Pain Travell Seminars
This Janet Travell story was told by a woman who was stationed overseas, and had been treated by Janet for about eight years before Janet stopped seeing patients. She wanted to come back to the states to be treated by me as a successor to Janet. Prior to seeing Janet, she had had about 15 years of unrelenting muscular pain. She told her story. Janet had actually given her two hours, and actually stretched it to three. Two hours just to hear the story, and then an hour to be looked at. And at the end of all this, the patient broke down and said, “I’m sorry to have taken your time because I know you can’t help me.” Janet put her hand on the patient’s hand and said, “I know what you have and I can help you.” And that was the beginning of healing. Being in the presence of someone who knew what she had and gave her the confidence. That is a side of Janet that we may not hear enough about.
Robert Gerwin, MD
From Lawrence A. Funt, DDS, teacher of myofascial medicine
Janet Travell’s father was not only a respected doctor, he was also an amateur magician. When Janet and her sister Virginia were young, their father would delight in providing magic shows as part of their birthday festivities. One of the tricks he performed was pulling a rabbit out of a hat into which he had previously put items that were definitely non-rabbit. Janet Travell reminisced on this once, and told me that the field of myofascial medicine was like that. What with nerve entrapments and referred pain and the like. What you put into it is not always what you get out.
Lawrence A. Funt, DDS
From Devin J. Starlanyl MD, writer and teacher of myofascial medicine
During the last few years she lectured, Janet Travell pounded on the importance of perpetuating factors. In every volume of the Trigger Point Manuals, the chapter on perpetuating factors is proclaimed as the most important in the book. I have always found that identifying and controlling perpetuating factors is the key to identifying and controlling symptoms in both fibromyalgia and chronic myofascial pain. I can never give a lecture without hearing Janet Travell’s voice in my head insisting, “You are going to get to the perpetuating factors, hummmn?” Our New Hampshire Mensa Regional Gathering at times comes at the same time as the Winter Olympics. I had just come back to our room when my husband told me that my favourite skater was about to perform. The Canadian champion spun and leaped and dashed over the ice. We sat and watched Elvis S. in silence. After the performance, my husband asked what I thought. He has short upper arms, I replied. I have been so thoroughly indoctrinated. I told this story to Janet Travell, and she laughed so hard she had tears in her eyes. But she was pleased.
Devin Starlanyl
Starlanyl DJ, Copeland ME. Fibromyalgia and chronic myofascial pain: a survival manual. 2nd ed. Oakland (CA): New Harbinger Publications; 2001.