Does trigger point treatment work?

[webslave]

In my opinion your clinic is a scam

I have no connection to the Wise-Anderson clinic. I have never been there, and never met David Wise. We have spoken on the phone a handful of times.

I said I was sceptical of trigger point treatment.

As a complete layman, your opinion is worth very little.

You go on to say

It is increasingly accepted in Medicine

So you agree with my statement that it is not mainstream medicine. If its increasingly accepted that means it is not generally accepted. I could say homeoptahy is increasingly accepted but there is weak evidence for that as well. 'Increasingly accepted' is a very subjective statement.

Homoeopathy is not featured on the Mayo Clinic website, nor is it endorsed by senior medical specialists, as MTrP treatment now routinely is. Nor are there hundreds of positive scientific papers on homoeopathy, as there are for myofascial pain syndromes and trigger points. So you make a very weak argument, as usual.

Did you read the articles I posted? They are questioning the definition of trigger points. They are arguing that trigger points may actually be inflamed peripheral nerve endings. No one is denying that there are are points in the body that often cause refered pain.

It hardly matters what a trigger point is, just that it's treatable. The diagram below is based on an electron microscope view of a trigger point. Those "bundles" can be visualized, so it has to be more than just inflamed nerve endings. Of course, underlying the bundles are nerves. That's how those bundles arise.

Your argument about doctors not learning about trigger points is to my mind a weak one. As I have said trigger points are touted as being the cause of so many ailments , in your opinion they are responsible for causing nearly all forms of pelvic pain. It would not take much for doctors to learn about this and help so many of their patients. The fact is they don't as the evidence is not conclusive. The articles you have provided do not conclusively prove trigger point theory. I have learnt that in the UK trigger point treatment is not included in any physical therapy degree. Why is that? Trigger point treatment has been around for 35 years , there has been enough time for this to be accepted into degree courses.

Trigger point therapy is available from literally thousands of physiotherapists in the UK, and is routinely taught, eg http://www.norrisassociates.co.uk/courses/trigger.html

A search for "trigger point" physiotherapy site:.uk brings up over 6,400 hits. Whether or not the UK teaches it is neither here nor there, because most physiotherapists in the UK offer it.

Here's a 2007 paper from the UK that endorses MTrP therapy.
http://ukpmc.ac.uk/articlerender.cgi?artid=1258458

Trigger points are very new. 35yrs is nothing in medical circles. Doctors are extremely conservative. I have medical textbooks, published recently, that lack all sorts of modern discoveries and research. An example is CFS, which was, until recently, viewed as nonsense by the majority of doctors. Now it's mainstream medicine. Go figure. It took many years for the medical profession to accept that most gastric ulcers are caused by bacteria. If you set as your benchmark a wide acceptance by the conservative medical profession, you'll wait another 20 years. Most people have found that physical therapists know things, and can do things, that doctors do not know, and cannot do. Why is that? Even though these things can make enormous differences to our comfort and ease great pain, doctors are not able to do them and do not know about them. It's like that with MTrPs at this stage.

The neurosurgeons and doctors I have discussed trigger points with are well aware of trigger point treatment. However they do not believe in it as they feel there is not strong enough evidence for it.

Yet there is plenty of research by highly qualified medical people that says it does work. Who are you going to believe: your local doc, or the researchers (and patients who are being cured with it)?

I am not saying categorically trigger point treatment does not work. I belive patients should try it. I don't think theres any need to pay for expensive clinics in hotels in order to recive it but I definitly think they should try it. To conclude I am just saying I am very sceptical of trigger point treatment.

[shakes head] You are a confused, sad person, Charles. I feel sorry for you. Wise's clinic is specialised, equipped with the best therapists with the most extensive experience in the world at treating this disorder. Wise is an ex-sufferer, an expert in the mental side of the condition. Is a few thousand dollars really so much for this Rolls Royce treatment? The risky PNE operation touted here costs many times that. Get a grip!

[Charlie]

Firstly can I say its very difficult to have a sensible debate when the person you are conversing with states

As a complete layman, your opinion is worth very little.

Are you implying that your opinion is more valid than my own.

You also resort to insults when you state

You are a confused, sad person, Charles. I feel sorry for you.

I don't like to resort to insults. I appreciate that my next comment might offend you but are you really a man in his fifties because I am more used to hearing these type of comments from teenagers.

But anyway lets deal with your points. You state

Trigger points are very new. 35yrs is nothing in medical circles. Doctors are extremely conservative. I have medical textbooks, published recently, that lack all sorts of modern discoveries and research. An example is CFS, which was, until recently, viewed as nonsense by the majority of doctors. Now it's mainstream medicine. Go figure. It took many years for the medical profession to accept that most gastric ulcers are caused by bacteria. If you set as your benchmark a wide acceptance by the conservative medical profession, you'll wait another 20 years.

This is a favorite argument of quackery. You will find many quacks defend themselves when asked why their ideas are not generally accepted by stating their ideas are new and that it takes ages to convince the medical establishment. If you look at the history of science it does not work like this. If you can provide reliable, solid evidence for your idea then science will adopt it. By your reasoning it takes 55 years for a new medical idea to become widely accepted. How do you explain penicillin then? Penicillin was discovered in 1928 and by 1945 during the second world war thousands of soldiers lives were being saved by it. Bear in mind that this was a time when there was no T.V and far more importantly no internet to publicise new ideas.

Trigger point treatment is not complex. To help my argument you have thankfully provided a UK link for physical therapists to learn trigger point treatment in a single day. So it's possible to learn this in a single day yet its still not standard accepted medicine. I would also point out that the course you linked to is a post graduate course. Trigger point treatment is not taught on any undergraduate physical therapy course in the UK.

It hardly matters what a trigger point is, just that it's treatable.

Of course it matters, if you do not know what you a treating how do you know the treatment is correct? Could it be that a tight , tough area of muscle is merely a symptom of an inflamed periperal nerve or even an entrapped nerve? I don't know and it seems neither does anyone else. It seems reasonable to be sceptical then.

You say

patients who are being cured with it)?

That would disagree with David Wises argument who is keen to stress that his protocol is not a cure. He says you need to keep practising the protocol which would suggest that you are treating a symptom not the cause of the pain.

I would also point out that the UK government will now pay for PNE surgery in France if you appeal. There are plans to introduce it to the UK. It is also now being performed in Australia. Of course you know its already being performed here and in addition Egypt, France and Belguim. I am not telling anyone to have surgery but I think they should consider it as a treatment option.

I have repeatedly said that I think people should try physical therapy and trigger point treatment. Virtually everyone on this forum does. I have never said categorically that trigger point treatment does not work.

What I have also repeatedly stressed is that in my opinon there is no need to go to the Wise clinic. I think it is a waste of money. Going to the Wise clinic is like buying a car and then crossing the street to find out you could have got it for a fifth of the price.

You state that it is ''specialized''. What is specialised about it? What does the Wise clinic provide that you cannot get at a cheaper price elsewhere? Before I hear 'Tim Sawyer is one of the best trigger point therapists in the world I would point out you have no evidence for that. In my opinion there is far superior phsycial therapy availble elsewhere which is a fraction of the cost of the Wise clinic.

If it really is Rolls Royce treatment then judging from where the clinics held its a Rolls Royce whose owner cannot afford a garage. How do you come to your conclusions about the Wise clinic if as you admit you have never even been there. I can at least speak from a position of experience having attended the clinic you on the other hand can not.

Anyway hopefully you can refrain from insults. I'll leave you with a qoute

He who angers you , conquers you

[webslave]

As a complete layman, your opinion is worth very little.

Are you implying that your opionion is more valid than my own.

Yes, I am. To quote you on another forum:

I have zero medical training, which probably makes anything I say here comical, but...

What more needs to be said?

I don't like to resort to insults.

Then please stop doing it.

Trigger points are very new. 35yrs is nothing in medical circles. Doctors are extremely conservative. I have medical textbooks, published recently, that lack all sorts of modern discoveries and research. An example is CFS, which was, until recently, viewed as nonsense by the majority of doctors. Now it's mainstream medicine. Go figure. It took many years for the medical profession to accept that most gastric ulcers are caused by bacteria. If you set as your benchmark a wide acceptance by the conservative medical profession, you'll wait another 20 years.

This a favorite argument of quackery. You will find many quacks defend themselves when asked why their ideas are not generally accepted by stating their ideas are new and that it takes ages to convince the medical establishment. If you look at the history of science it does not work like this. If you can provide reliable, solid evidence for your idea then science will adopt it. By your reasoning it takes 55 years for a new medical idea to become widely accepted. How do you explain penicillin then? Penicillin was discovered in 1928 and by 1945 during the second world war thousands of soldiers lives were being saved by it. Bear in mind that this was a time when there was no T.V and far more importantly no internet to publicise new ideas.

Look, you don't like trigger point therapy, you feel it should be accepted by the entire medical profession before you can believe in it. We get it. Move on. Don't fester over it and create videos attacking people who are using it to help patients.

What I have also repeatedly stressed is that in my opinon there is no need to go to the Wise clinic. I think it is a waste of money. Going to the Wise clinic is like buying a car and then crossing the street to find out you could have got it for a fifth of the price.

You are entitled to that opinion. But do not then post videos implying dishonesty, stupidity, duplicity and conniving to defraud on the part of people like me and David Wise. That is another matter altogether.

I'd like to disengage now, Charles. I've had my say and I think you have expressed your feelings repetitively.

[webslave]

This is an interesting article on trigger point treatment. Don't shoot the messenger here I am not saying trigger point treatment does not work. You will find it an interesting read though. The main argument of the article is that trigger point treatment does not work. In fact if you can't be bothered to plough through it the article has a brief synopsis at the start.

If you are in a hurry and want to save yourself the trouble of reading the rest of this article on trigger point therapy, you can save yourself some time if you just read and agree with the following:

Pain does not cure pain.
Trigger point theory is wrong.
Stop hurting your patients.
Stop hurting your hands.
Stop losing patients because of poor results and unnecessary pain.
Make more money by helping your patients and not hurting and losing them.

http://www.massagetoday.com/mpacms/mt/a ... p?id=13337

I think physical therpy for pelvic pain can help. However I have to say that I am extremely sceptical about trigger point treatment. I certainly feel that the press and hold technique on trigger points is quackery. That technique has never been proven to work.

Can't leave this thread without pointing out that not only does the linked site above contain numerous articles endorsing the existence and treatment of trigger points, but it also carries an article directly debunking the article Charles has chosen to present here, calling it "grossly inaccurate and [containing] unsupported assertions". Not surprising really, given that gross inaccuracy and unsupported statements are Charles' stock-in-trade.

Anyway, be sure to read the debunking:
http://www.massagetoday.com/mpacms/mt/a ... p?id=13364

[Charlie]

I would not describe the article as a debunking. It is an argument against the previous one.

I have never once stated that trigger points do no exist only that the evidence for trigger point treatment is weak. Only yesterday you admitted that no one can actually define a trigger point , at least not a definition on which everyone agrees with. My argument still stands , why do so many doctors refuse to accept trigger point theory? Why is it not mainstream medicine?

You are fond of saying PNE is fringe medicine. Yet trigger point treatment is exactly the same. At least with pudendal nerve entrapment a surgeon can visibly see scar tissue on a nerve. Or are you going to tell us that neurosurgeons can not recognise scar tissue on a nerve now?

Your argument that it takes medicine 55 years to accept new ideas does not hold up, not when you look at history. I notice that you compleltly ignored my argument about penicillin.

All I am saying is that trigger points are not a definite science and are very controversial. Patients should realise that when they pay money for trigger point treatment. There are some excellent therapists to see and I certainly do not think there is any need to pay thousands for a single week of trigger point treatment as I did at the Wise clinic.

I think your own website only presents one side of the argument. You are guilty of cherry picking research.

I thought the last line of the article you posted pretty much summed up the debate over trigger points.

Thinking we have it figured out ends the learning game. We do not have all the answers - none of us do

.

Also I am not this Charles (aka Northern spy) guy you keep saying I am.

[webslave]

All I am saying is that trigger points are not a definite science and are very controversial.

If they are "very controversial", then you should have no problem pointing us to published studies that challenge their existence. I wait with bated breath (no studies before 2000 please).

Thinking we have it figured out ends the learning game. We do not have all the answers - none of us do

There are few areas of medicine that are not still undergoing study. Medicine is not like Law, it's a science. Scientists never stop looking for more detail and greater knowledge.

[Charlie]

If they are "very controversial", then you should have no problem pointing us to published studies that challenge their existence. I wait with bated breath (no studies before 2000 please).

This is when it's clear to me that you have absoloutly no understanding of how science works. No wonder you flunked medical school.

In science you cannot prove a negative. The onus is on the person to prove a positive statement. For instance 'trigger point treatment is effective for pelvic pain' Or for example ' fairies live at the bottom of gardens'. If the person cannot prove their statement we assume in science that it is not true or at least not conclusive.

You cannot point me to a study that can prove that trigger point treatment is effective for pelvic pain. There is not one that exist. Before you point me to David Wises studies they are not worth the paper they are written on. They are not controlled. I can point you to uncontrolled studies which show homeopathy is effective but I think you would agree that there is little evidence for homeopathy.

This is the reason why the majority of doctors do not believe in trigger point theory and it is not taught as part of a doctors standard training.

Asking me to find a study that can prove trigger points do not exist or that trigger point treatment is not effective is like asking me to point to a study that can prove that God does not exist.

Or will it take another ''55 years'' for us all to accept God ?

Do I think people should try trigger point treatment? Yeah its worth a shot. There is no reason to go to your clinic though. There is no need to pay thousands for standard trigger point treatment. There are excellent therpists you can see who do not charge those sorts of prices.

I've also edited this to point out to people that you are using the avater of a serial Killer suspect, Arthur Leigh Allen. A biazare choice. For more regarding this. viewtopic.php?f=2&t=6140

[KrisG]

Hi guys ,

I would say ..if it works for you ..it's good enough . isn't it ?

No really ..Of course for every treatment there are people that are helped (or think they are ) by it .
Even the " do-nothing-and-drink-a-beer-treatment" will have some people in the world that are saying they are cured by it . And I do believe even that they are sincere .

What I'm trying to say and I second what Charlie says here is that even if you have some people stating it works , that is not the same as scientific evidence .
But of course this does not prove the opposite either ..because indeed you cannot ..ever !
Even for the more invasive things where you can prove that here is a relation between the intervention and how you feel the outcomes are not conclusive ..

but

If a treatment is at a normal price
doesn't do anything wrong or at least nothing you aren't warned for .

you can try it , if it is the next thing on the list .
Why ?

I know of people having a stimulator placed and find out afterwards that they are cured with PT.
So they find what helps in the end but the order is a bit wrong isn't it ??

I have consulted enough doctors and I can say here that you will get PT if you go to a physical therapist , you will get trigger therapy if you go at Wise's , you will get surgery with a PNE surgeon , and you will get a stimulator with the famous neurologists for that trick .
Why ?
If you say you have tried the rest , even with a negative EMG , doctors will operate on you if you insist . It's how they earn their money and it has a chance in their book that it helps you.
They believe in that otherwise they wouldn't do the intervention ..

So in essence it is not the doctor that makes the diagnose but the patient just by choosing the doc . At least that is what I think about it .
So what to do ?
I would say go down the list from the less invasive to the most and try your luck ..it's in my view the only way ..
Because in the end ..the only thing we know for sure is that we all have pain in the pelvis .
But given the possible causes for it , it's only normal that allot of us will have allot of different outcomes , even for the same treatment ...that's also only logic ..

Good luck to you in finding your own..

Kris

[Charlie]

Another article below questioning the validity of trigger points. The science for trigger point does seem to be weak. As this article states

Until both consensus and reliability of diagnostic criteria for identifying MTPs are achieved and implemented in research studies, data on the validity, prevalence, aetiology and treatment of MTPs should be interpreted with prudence.

There do seem to be many therapists that use trigger point therapy but popularity of an opinion does not prove validity. It is certainly not mainstream medicine.

http://www.lukerickardsosteopath.net/di ... lications/

I have qouted the main points of the article below.

Despite the widespread acceptance of MTPs as an important clinical entity the diagnosis of MTPs is a source of continuing controversy. There are no accepted biochemical, electromyographic or diagnostic imaging criteria recognised as a definitive diagnostic gold standard.2 Furthermore, there is currently no reliable list of physical diagnostic criteria for MTPs.1 The detection of MTPs is solely dependent on manual palpation and patient feedback. These circumstances have raised concerns regarding the non-substantive manner in which MTPs are identified.

The authors concluded that the current evidence supporting the reliability of diagnostic palpation for MTPs is weak and further high quality studies are required.

The clinical uncertainties surrounding MTP diagnosis present challenges to the interpretation of all research on MTPs. In the absence of an accurate diagnosis, the results of any epidemiological, pathophysiologic or clinical investigation will be misleading

Having assumed that identification of each of the MTP characteristics is reliable, the researchers state that a clinically relevant MTP was present if three out four listed criteria were met. However, using this methodology it is possible that the diagnostic process would identify presentations other than MTPs, such as non-specific muscle pain, pain of peripheral nerve trunk origin, underlying joint sensitivity, secondary hyperalgesia, or even normal intramuscular physiology. It also explains their report of active MTPs in up to one third of the pain-free controls, which should be considered impossible considering that active MTPs are symptomatic by definition.

Until both consensus and reliability of diagnostic criteria for identifying MTPs are achieved and implemented in research studies, data on the validity, prevalence, aetiology and treatment of MTPs should be interpreted with prudence.

[KrisG]

HI Charlie ,

Sorry for the late reply ...sometimes you have to get out for a while ...

It looks like you are following the matter on the foot
Indeed ...I also come to the conclusion that if triggerpoint works ...it wasn't PNE in the first place.
But of course nerve damage gives muscletension , which gives pain and for that you could have help if you relax or something of that kind .

How are you these days ?

Kris