Myofascial Trigger Point Therapy, What's Missing?: The Travell Protocol
Dr. Janet G. Travell's Seven-Step Myofascial Trigger Point Treatment Protocol
By Nancy L. Shaw, MTPT
Dr. Janet G. Travell had long emphasized the need for adherence to an entire treatment regime to ensure success. Utilizing the Travell & Simons Myofascial Pain Syndrome: The Trigger Point Manual, Volumes 1 & 2 only for the identification of specific trigger points and myofascial treatment aimed at their deactivation interprets her work as a treatment modality, not as a treatment protocol. She lectured for many years on the necessity of following the “entire treatment program,” but the protocol in its totality has not been specifically presented in the literature.
Professionals in many fields have embraced the myofascial factor in chronic pain. The diversity of professionals includes physicians, physical therapists, chiropractors, trigger point myotherapists, massage therapists, dentists, psychologists, and others who diagnose and treat chronic pain, indicating the widespread nature of myofascial pain and dysfunction. This diversity has also created complications in treating myofascial pain patients. Each discipline has drawn upon its specialty in evaluation and treatment, adapting basic primary information from Travell & Simons, Vol. 1 & 2. Unfortunately, many have not understood the complexity and comprehensiveness necessary to ensure treatment success.
Travell, the clinician, developed the treatment protocol that set the standard for the treatment of myofascial pain and dysfunction, or myofascial pain syndrome. The protocol is listed below and will be the focus of the following work. This protocol has stood the test of time and has an outstanding success rate if performed in its entirety, without shortcuts or alterations. However, the multiplicity of the current terminology continues to add confusion and needs to be clarified if differential diagnosis and, thus, treatment are to be correctly directed. A listing of important expansions of the protocol and definitions that pertain to the material will be forthcoming.
The following is Travell’s Seven-Step Myofascial Trigger Point Treatment Protocol that she put forth, both in our personal communications and in every presentation and teaching situations in which she was involved.
Finally, the utilization of trigger point therapy as a treatment protocol, not as a modality, leads to ultimate success.
7 Step Protocol
Medical diagnosis
Patient history
Pain documentation
Range of motion
Perpetuating factors
Trigger point therapy
Specific muscle stretch retraining
TO ELIMINATE ANY ONE OF THE STEPS IN TREATING MYOFASCIAL PAIN AND DYSFUNCTION CAN LEAD TO TREATMENT FAILURE!
Dr. Janet G. Travell
To add unnecessary steps to the protocol interferes with the determined progression necessary to achieve treatment success!
About the author
Nancy L. Shaw, MTPT
Author of Simple Changes to End Chronic Pain, Nancy Shaw is a myofascial trigger point therapist and the founder of the Myofascial Pain Treatment Center, where she’s offered simple changes to help anyone end their chronic pain since 1981.