The Complete Guide to Trigger Points & Myofascial Pain An extremely detailed guide to the unfinished science of muscle pain, with reviews of every theory and treatment option

Trigger points (TrPs) or muscle “knots” are sore spots in soft tissue that cause deep aching. Too many of them is often called myofascial pain syndrome (MPS), a chronic pain disorder. TrPs are usually described as micro-cramps, but the science is half-baked and their nature is controversial. Regardless, these sore spots are as common as pimples, often alarmingly fierce, and they seem to grow like weeds around injuries. They may be a major factor in back and neck pain, as a cause, a complication, or a bit of both. Trigger point therapy is mostly rubbing and pressing on trigger points, which can feel amazingly relieving. Dry needling is a popular (but dubious) method of stabbing trigger points into submission with acupuncture needles. TrP treatment is not rocket science1 — it’s much too experimental to be so exact! But most people can learn to get at some relief safely and cheaply. There are many possible causes of unexplained aches and pains, but trigger points are an interesting piece of the puzzle for many people, and offer some potential for relief. This is a huge tutorial for both patients and professionals, regularly updated and for more than a decade now. It’s a plainly written guide to all the science (such as it is), the myths and controversies, and the treatment options. There’s a lot of overlap with chronic pain in general, and fibromyalgia, so I get into those topics quite a bit too.

Does your body feel like a toxic waste dump? It may be more true than you realized! Some data shows that a knot may be “polluted” with waste metabolites. If so, it’s no wonder they hurt … & hurt weird. it’s more like being poisoned than being injured. Back pain may be the best known symptom of the common muscle knot, but they can cause a startling wide array of other aches & pains.

Trigger point therapy is not a miracle cure for chronic pain Trigger point therapy isn’t “too good to be true” — it’s probably just ordinary good. It’s definitely not miraculous.2 It’s experimental and often fails. “Dry needling,” the trendiest type, recently bombed a good quality scientific test.3 Good therapy is hard to find (or even define), because many (if not most) practitioners are amateurish4 and some treatment methods are way out in left field and potentially harmful, to your wallet if nothing else. They are often barking up the wrong tree, treating so-called trigger points when there’s actually another problem. Attention physicians & therapists: This massive tutorial is written for both patients and professionals. It includes analysis of recent research that you won’t find in other texts, crafted for any skill level. Footnotes add a optional layer of advanced detail that you can take or leave. Trigger points are more clinically important than most health professionals realize, and body pain seems to be a growing problem.5 It’s a rewarding topic for doctors and therapists, a clear path to helping some people you probably couldn’t help before. Even if you already know about myofascial pain syndrome, you will get new ideas here. There are no “trigger point whisperers.” Trigger points are not little switches that can be flicked off (“released”) by anyone who has sufficiently advanced technique — they are a mysterious, cantankerous, complex phenomenon. Any therapist who is highly confident about their ability to banish your sore spots should probably be fired. The good news Good trigger point therapy is hard to find but under-rated.6 It can be a safe self-treatment with the potential to help with many common pain problems that don’t respond well — or at all — to anything else.7 Done with care and humility, it’s worth dabbling in. For beginners with average body pain — a typical case of unexplained nagging hip pain or low back pain or neck pain — the advice given here may well seem almost miraculously useful. I get a lot of email from readers thanking me for pointing out simple treatment options for such irritating problems. Some are gobsmacked by the discovery that their chronic pain could have been treated so easily all along. For veterans who have already tried — and failed — to treat severe trigger points, this document is especially made for you. You should learn more before giving up. This could give you a fighting chance of at least taking the edge off your pain, and maybe that is a bit of a miracle. GO TO TOP • CONTENTS • NOTES

About footnotes. There are 433 footnotes in this document. Click to make them pop up without losing your place. There are two types: more interesting extra content,1 and boring reference stuff.2 Try one!

What exactly are muscle knots? A trigger point is basically just a spot that is too sensitive to pressure, mainly in muscle tissue.89 Almost everyone gets these spots, like pimples, but some people get worse and more of them, and no one really knows what they are. They have had many names over the decades,10 but myofascial trigger point ( TrP ) is the trendiest and most widely accepted label in the last 20 years. For much longer, TrPs have also been informally called muscle “knots.” Obviously it’s not a clove hitch or a bowline: there are no actual knots in there, but it does feel like that. And sometimes there’s some muscle hardness or lumpiness at the site, maybe embedded in a taut band of muscle — but these abnormal textures are hard to detect reliably, and even professionals routinely mistake normal anatomy for trigger points (or other abnormalities). Please don’t assume every spot/bump in your body is a trigger point. 😜 A few TrPs can get vicious for a while, causing far more discomfort than most people believe is possible. Its bark is much louder than its bite — these episodes will pass like a headache — but the bark can be painfully loud. It can also be a weird bark — trigger points can generate some odd and troubling sensations, and the source may not be obvious. What makes a trigger point sore? Although their true nature is uncertain, the usual story is that a trigger point is a small patch of tightly contracted muscle, a micro-cramp of a tiny patch of muscle tissue (as opposed to a whole-muscle spasm like a “charlie horse”11). And the story goes on: that small patch of muscle chokes off its own blood supply, which irritates it even more, a vicious cycle dubbed a “metabolic crisis.” This swampy metabolic situation is why I sometimes think of it as sick muscle syndrome. But that could be wrong. A couple major competing ideas are that it’s a more purely sensory disturbance, or the pain of slightly irritated peripheral nerves, a type of peripheral neuropathy. Trigger points aren’t just sensitive to pressure; they are also involve aching and stiffness that spreads out around the TrP, even when you aren’t poking it. The TrP may be in the center of the aching, like the yolk of an egg, or the aching may spread surprisingly far away (via the mechanism of referred pain, another major sub-topic for later). It’s this aching that really puts the “syndrome” in myofascial pain syndrome… Growing a crop of trigger points A few minor trigger points here and there is a common annoyance, but a bunch of bad ones is myofascial pain syndrome ( MPS ), and it can be disabling. TrPs are to MPS as pimples are to a serious acne problem. The more severe trigger points, the more extensive and severe the associated aching and stiffness. There are many other possible causes of unexplained pain, but trigger points are an interesting piece of the puzzle for many people, and knowing about them offers some potential for relief. This is a fairly detailed summary, but we’re really still just getting started here. GO TO TOP • CONTENTS • NOTES

Why muscle pain matters During a minor cyst removal from my chest many years ago, a potent stab of hot pain made me jump under the knife. “Very sorry,” the surgeon said. “I slipped and poked your pectoralis major with my scalpel, and only the superficial tissue is anaesthetized. Don’t worry, it won’t happen again.” And it didn’t. But I had learned a useful lesson: muscle tissue is sensitive stuff!12 Muscle pain matters. Aches and pains are an extremely common medical complaint,13 and trigger points seem to be a factor in many of them.1415 They are involved in headaches (including migraines),1617 neck pain and low back pain, and (much) more. What makes trigger points clinically important — and fascinating — is their triple threat. They can: cause pain problems, complicate pain problems, and mimic other pain problems. Muscle just hurts sometimes. Trigger points can cause pain directly. Trigger points are a “natural” part of muscle tissue.18 Just as almost everyone gets some pimples, sooner or later almost everyone gets muscle knots — and then you have some pain with no other explanation or issue. It’s complicated. Trigger points complicate injuries and other painful problems. They show up like party crashers: whatever’s wrong, you can count on them to make it worse, and in many cases they actually begin to overshadow the original problem. “It felt like a toothache.” Trigger points mimic other problems. Many trigger points feel like something else. It is easy for an unsuspecting health professional to mistake trigger point pain for practically anything but a trigger point. For instance, muscle pain is probably more common than repetitive strain injuries (RSIs), because many so-called RSIs may actually be muscle pain.19 A perfect example: shin splints.20 The daily clinical experience of thousands of massage therapists, physical therapists, and physicians strongly indicates that most of our common aches and pains — and many other puzzling physical complaints — are actually caused by trigger points, or small contraction knots, in the muscles of the body. ~ The trigger point therapy workbook, by Clair Davies, p. 2 GO TO TOP • CONTENTS • NOTES

The shabby state of trigger point science Trigger point science is as disappointing as an empty Christmas stocking.21 Trigger points are under-explained and over-hyped. They aren’t a flaky diagnosis,22 but they’re not exactly on a solid scientific foundation either. Some critics have harshly criticized conventional wisdom about them.23 None of that is a deal-breaker, though: muscle pain is still an important topic, “trigger points” is a useful work-in-progress label for whatever is actually going on, and everyone agrees that something painful is going on. So all the more reason to have a rational tour guide to take you through a murky subject. What’s useful in the theory of trigger points? Who disagrees and why? What’s half-baked and obsolete? What are the major pitfalls? I critically analyze the topic from all sides.24 Sometimes half-baked ideas turn out okay if you just keep them in the oven. Trigger point science may be a bit of a hot mess, but it also isn’t over: the controversy about trigger points is a legitimate, interesting controversy. And meanwhile, as far as I know, I am actually the only author out there who is both promoting and criticizing trigger point therapy. GO TO TOP • CONTENTS • NOTES

Why are trigger points so neglected by medicine? Family doctors aren’t really equipped for troubleshooting chronic pain.

Cartoon by Loren Fishman, HumoresqueCartoons.com Trigger points are medically neglected because medicine has always had many much bigger fish to fry, and musculoskeletal medicine has only just recently started to get any real attention.25 Chronic pain with no obvious cause is a relatively unstudied epidemic and not many doctors know what to do with it and don’t even try. If trigger points are a muscle tissue dysfunction or pathology — which is plausible but far from proven — that’s another reason they have fallen through the medical cracks: “Muscle is an orphan organ. No medical speciality claims it.”26 Muscle tissue is the largest organ in the body, complex and vulnerable to dysfunction, and full of known-unknowns.27 Although it is the “primary target of the wear and tear of daily activities,” nevertheless “it is the bones, joints, bursae and nerves on which physicians usually concentrate their attention.”28 Family doctors are particularly uninformed about the causes of musculoskeletal aches and pains29 — it simply isn’t on their radar. They are busy with a lot of other things, many of them quite dire. And the topic is just trickier than it seems to be, so it’s not really surprising that doctors aren’t exactly muscle pain treatment Jedi. What about medical specialists? They may be the best option for serious cases. Doctors in pain clinics often know about trigger points, but they usually limit their methods to injection therapies — a bazooka to kill a mouse? — and anything less than a severe chronic pain problem won’t qualify you for admittance to a pain clinic in the first place. This option is only available to patients for whom trigger points are a truly horrid primary problem, or a major complication. Medical specialists may know quite a bit about muscle pain, but still aren’t all helpful to the average patient for practical reasons. An appallingly high percentage of doctors and other practitioners are still pretty much out of the loop regarding trigger points. ~ The trigger point therapy workbook, by Clair Davies, p. 2 Physical therapists and chiropractors are often preoccupied to a fault with joint function, biomechanics,30 and exercise therapy. These approaches have their place, but they are often emphasized at the expense of understanding muscle pain as a sensory disorder which can easily afflict people with apparently perfect bodies, posture and fitness. A lot of patient time gets wasted trying to “straighten” patients, when all along just a little pressure on a key muscle knot might have provided relief. Massage therapists have a lot of hands-on experience of muscle tissue, but know surprisingly little about myofascial pain syndrome. Their training standards vary wildly. Even in my three years of training as an RMT (the longest such program in the world31), I learned only the basics — barely more than this introduction! Like physical therapists and chiropractors, massage therapists are often almost absurdly preoccupied with symmetry and structure. The right hands can give you a lot of relief, but it’s hard to find — or be — the right hands. No professionals of any kind are commonly skilled in the treatment of trigger points. Muscle tissue simply has not gotten the clinical attention it deserves, and so misdiagnosis and wrong treatment is like death and taxes — inevitable! And that is why this tutorial exists: to help you “save yourself,” and to educate professionals. Those clinicians who have become skilled at diagnosing and managing myofascial trigger points frequently see patients who were referred to them by other practitioners as a last resort. These patients commonly arrive with a long list of diagnostic procedures, none of which satisfactorily explained the cause of, or relieved, the patient’s pain. ~ Myofascial Pain and Dysfunction, by Janet Travell, David Simons, and Lois Simons, p. 36 GO TO TOP • CONTENTS • NOTES

Does your trigger point therapist have the big red books? The Big Red Books Even atheists should be familiar with the Bible & every professional should have a copy of these books, despite their flaws. In addition to many scientific papers, this tutorial is based on medical textbooks like the massive two-volume set, “the big red books” — Myofascial Pain and Dysfunction 32 — and “the blue book,” Muscle Pain 33 These are not easy reading.34 They don’t contain all the answers — indeed, they contain some nonsense — but anyone who claims to treat muscle pain should still have the big red books in their office. They are too historically important not to be familiar with. If you don’t see dog-eared copies of these books, ask about them — it’s a fair, polite clue about a therapist’s competence. Muscle Pain (the blue one) is just as important. I highly recommend it to any professional who works with muscle (or should). It’s more recent, and it covers a much wider range of soft tissue pain issues, putting trigger points in context. GO TO TOP • CONTENTS • NOTES

A brief note about the relationship between myofascial pain syndrome and fibromyalgia Fibromyalgia ( FM ) is the disease of “hurting all over.” Fatigue, sleep disturbance, and “fibro fog” (mental confusion) are classic symptoms too. Fibromyalgia is a syndrome, not a disease, which means that it is unexplained by definition.35 It is just the label we give to undiagnosed chronic widespread pain. So “no one has FM until it is diagnosed.”36 MPS is just one of many possible explanations for the pain of fibromyalgia, and/or it might be a distinct meaningful diagnosis on its own. It would be nice if such a clear distinction were established someday. FM and MPS are both imperfect, imprecise labels for closely related sets of unexplained symptoms, which makes them harder to tell apart than mischievous twins who deliberately impersonate each other. They may be two sides of the same painful coin, or overlapping parts on a spectrum of sensory malfunction, or different stages of the same process. Some cases are effectively impossible to tell apart. There may be no real difference between FM and severe MPS. Add to that the fact that both conditions are controversial to the point where some people deny they even exist, and it’s understandable that they get confused. Note that the “tender points” of fibromyalgia are not the same thing as trigger points.37 Whatever the causes or labels, therapeutic approaches for MPS seems to be helpful for some FM patients as well,38 although pure FM cases seem to be mostly immune to massage.39 But this book is still useful for many FM patients, insofar as it overlaps with our main topic. GO TO TOP • CONTENTS • NOTES

Trigger points may explain many severe and strange aches and pains I once suffered from a brutal “toothache” that was completely relieved by a massage therapist the day before an emergency appointment with the dentist: a particularly vivid experience, and one of the reasons I first got keen in this topic. Pain is a trickster; it is often not always what it seems to be. Trigger points are a common alternative explanation. Got a bizarre pain that just flared up one day? Sure, it might be something scary or rare. But in many cases it’s probably just a trigger point — about as serious as banging your funny bone. But it can feel worrisome. This is where trigger points really get interesting. In addition to minor aches and pains, muscle pain often causes unusual symptoms in strange locations. For instance, many people diagnosed with carpal tunnel syndrome are actually experiencing pain caused by an armpit muscle (subscapularis).40 Seriously. I’m not making that up. This odd phenomenon of pain spreading from a trigger point to another location is called “referred pain.” Here are some other examples of interesting referred pain leading to misdiagnosis:41 Sciatica (shooting pain in the buttocks and legs) is often caused by pain in the piriformis or other gluteal muscles, and not by irritation of the sciatic nerve. Many other trigger points are mistaken for “some kind of nerve problem.” (And, to be fair, some kinds of nerve problems can be mistaken for trigger points! More on this to come.)

Chronic jaw pain, toothaches, earaches, sinusitis, ringing in the ears (tinnitus), and dizziness may be symptoms of trigger points in the muscles around the jaw, face, head and neck.4243

A sore throat or a lump in the throat is often caused or aggravated by trigger points anywhere around the throat.44

“Appendicitis pain” often turns out, sometimes after surgery, to be caused by a trigger point in the abdominal muscles. Wow.

Severe MPS is often mistaken for fibromyalgia (and other causes of pain hypersensitivity).

Example of referred pain The phenomenon of referred pain is one of the main reasons that trigger points can cause pain in unexpected places. This image shows a classic example. Many people have a sore spot in the upper gluteus maximus, but pain in this location often spreads either up into the low back and/or down into the rest of the gluteals & hamstrings. This pattern causes it to be widely misinterpreted as back pain and/or sciatica, when in fact it’s just a sore spot in the butt. I narrowly escaped a breast biopsy because of trigger points in the pectoralis major. I’d had bad chest pain for a month. I was on the table, permit signed, draped. The doctor wasn’t sure: she said she wanted another mammogram. I left confused, relieved … but still hurting. Then I lucked out: my regular internist was puzzled, but thought it might be “soft tissue.” That made me go to a physical therapist. The physical therapist pulled out the big red books on trigger points, and we read together. Treatment was a complete success. A month-old severe pain that I had been treating with ice packs in my bra and pain-killers — gone! Janice Kregor, competitive swimmer, retired pediatrician and medical school instructor Another client once spent three days in hospital for severe abdominal pain that doctors couldn’t diagnose — her pain was mostly relieved by massaging a trigger point in her psoas major muscle.45 But most symptoms caused by myofascial pain syndrome are simply the familiar aches and pains of humanity — millions of sore backs, shoulders and necks. Some of which can become quite serious. Is this like you? Muscle knot pain can be savage. Over the years I have met many people who were in so much pain from muscle dysfunction that they could hardly think straight. Is muscle pain “trivial”? Not if you have it! GO TO TOP • CONTENTS • NOTES

Two typical tales of trigger point treatment The link between trigger points and mild-to-moderate body pain can be so straightforward that “therapy” is so easy it barely deserves to be called therapy. One of the nice things about working with trigger points is that sometimes they do make me seem like a miracle worker, because they are such a clinical “slam dunk” for garden variety persistent pain. For instance, Lois McConnell of Vancouver came to see me complaining that she’d had moderate, chronic back pain for several years. She’d received some common misdiagnoses, particularly sacroiliac joint dysfunction.46 But she had a prominent gluteus maximus trigger point47 that, when stimulated, felt exactly like her symptoms — a deep ache in the region of the low back and upper gluteals. Her pain was permanently relieved in three appointments. She was quite pleased, I can tell you! Just wanted to give you a quick update … my back has been absolutely fine. Unbelievable … or perhaps not, considering what I’ve learned from you! A big thank you for all your help. ~Lois McConnell, retired airline executive, suffered chronic low back and hip pain for a few years Or consider Jan Campbell. Jan developed a hip pain sometime in early 2004 during a period of intense exercising. The pain quickly grew to the point of interfering with walking, and was medically diagnosed as a bursitis, piriformis strain, or arthritis. “Ain’t nobody got time for that.” I did not think any of these were likely, and treated a trigger point in her piriformis muscle once on June 12, 2004. Her symptom was 100% relieved for about eight months, before it slowly began to reassert itself (as trigger points often do, despite our best efforts — more about that to come). One trigger point therapy treatment completely relieved a nasty stubborn hip pain that I'd had for five months! ~Jan Campbell, retired French language teacher, Palm Springs, recovered easily from several months of hip pain Every decent trigger point therapist has a pack of treatment successes like this. (Not that therapists are great judges of their own efficacy,48 but where there is this much smoke…) Although most such cases involve relatively minor symptoms, this is not to say that they were minor problems. In almost every such case, the pain was relatively mild but extremely frustrating and persistent for many years, then relieved easily by a handful of treatments — an incredible thing, when you think about it. So much unnecessary suffering! But of course trigger points don't always yield so easily… GO TO TOP • CONTENTS • NOTES

The myth of the trigger point whisperer Can a good enough massage therapist remove all trigger points in a session? Is there such a thing as a “trigger point whisperer”? I got this question by email, and it exposes a common theme: the optimistic/desperate quest for the mystique of the magic super therapist who can fix anything in two or three sessions. Or even less.49 The idea is exasperating to all the honest, humble professionals who know better. And, if you know the basics about pain and muscle knots, it’s obviously foolish. The skill of a therapist is actually only one relatively minor factor among many that affect the success of massage therapy for trigger points — or any therapy, for any pain problem. Trigger points are not little switches that can be flicked off (“released”) by anyone who has sufficiently advanced technique — they are a mysterious, cantankerous, complex phenomenon. Even the best therapists can be defeated by a no-win situation and factors beyond their control.50 And nearly any therapist can luck out and get great results with the occasional patient when all the planets are aligned: sometimes trigger points respond well to virtually any intervention. For comparison, can a good enough dog trainer train any dog in a hour? Even Cesar “Dog Whisperer” Millan says he can’t if the dog is traumatized, sick, and/or injured, and requires hours of smart, gradual conditioning. It depends on the situation. It depends, it depends, it depends. This is a major theme in this document, and it is why I am dedicated to teaching concepts and principles, not treatment recipes and formulae — and that’s why it’s an important thing to cover in the introduction. GO TO TOP • CONTENTS • NOTES

Part 2 Diagnosis How can you tell if trigger points are the cause of your problem? Trigger points have many strange “features” and behaviours, and can easily be confused with many other common undiagnosed causes of pain in general51 and muscle pain in particular. There are several common kinds of muscle pain, or pains that can seem like it: arthritis, medication side effects, exercises soreness, muscle tears, and the profound body aching caused by an infection like COVID-19.52 The only hope of telling these things apart is a good working knowledge. Thanks to their medical obscurity and the half-baked science, trigger points are often the last thing to be considered. There are some clues you can look for that will help you to feel more confident that, yes, this kind of muscle pain is the problem instead of something else, maybe something scarier. Whether you knew it or not, you were probably already familiar with trigger points even if you’d never heard of them before laying eyes on this page. Almost everyone more or less knows what it feels like to have a muscle knot, so almost everyone has a head start in self-diagnosing trigger points. If you’ve ever been inexplicably stiff — and really, who hasn’t? If you’ve ever wrenched your neck around trying to stretch and squirm your way free of discomfort. If you’ve begged a boyfriend to dig into that nagging sore spot in your back. If you had experiences like those, then you already know something about what trigger points feel like: pain and stiffness that feels like it’s in your muscles, sensitive patches of soft tissue in locations where there’s no obvious reason for it. But, Padawan learner, there may be many things you do not yet know about how trigger points behave and feel…

END OF FREE INTRODUCTION Purchase full access to this tutorial for USD$1995. Continue reading this page immediately after purchase. See a complete table of contents below. Most content on PainScience.com is free.? Out of work because of COVID-19? I’m offering a 50% rebate to anyone un- or under-employed because of this pesky plague.details ~ Paul Ingraham, Publisher

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Collect them all. Get a “e-boxed” set of all PainScience.com tutorials, ideal for pros … or patients with a lot of problems. MORE “The clarity of your writing is very impressive, and you bring a great attitude to it.” ~ Brittney Taylor “One trigger point therapy treatment completely relieved a nasty stubborn hip pain that I'd had for five months!” ~ Jan Campbell, retired French language teacher, Palm Springs, recovered easily from several months of hip pain “Thanks to your website, I pretty much got rid of my back problems almost overnight. It’s also fun and thought provoking to read!” ~ Amsterdam Jeroen Strompf, MFA, Screenwriting, Chapman University You can also keep reading more without buying. Here are some other free samples from the book, and other closely related articles on PainScience.com: EXCERPT Muscle Pain as an Injury Complication

Muscle Pain as an Injury Complication EXCERPT Micro Muscles and the Dance of the Sarcomeres

Micro Muscles and the Dance of the Sarcomeres EXCERPT Toxic Muscle Knots

Toxic Muscle Knots EXCERPT The Pressure Question in Massage Therapy

The Pressure Question in Massage Therapy Basic Self-Massage Tips for Myofascial Trigger Points

Trigger Point Doubts

The Trigger Point Identity Crisis

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call 778-968-0930 for purchase help More frequently asked questions about the subject matter of the book Q. Does your tutorial include diagrams showing common trigger points? A. Not really, but in a way: thirteen classic trigger points are explored in separate (free) articles, the “Perfect Spots” for massage (check out #1), which are associated with many common pain problems. But charts tend to put the focus on the wrong thing, and people need principles way more than they need diagrams. In any case, there are lots of good free/cheap charts out there. Please don’t buy this book and then ask for a refund because it doesn’t have charts: it’s like asking for a refund for your zoo admission because you didn’t see any cats, dogs, or squirrels! Q. Does the tutorial include information on [insert your pain problem]? A. Probably not! Many specific pain problems are mentioned briefly, but the book doesn’t go into detail about any of them. You don’t really need the link to every common pain problem spelled out. Trigger points cause and complicate all injuries in fairly predictable ways — that’s why they are clinically intriguing! Q. Why not The Trigger Point Therapy Workbook ? A. Clair and Amber Davies’ popular book is written well. It’s illustrated nicely, and offers detailed muscle-by-muscle reference material — things this tutorial deliberately lacks. The Workbook promises too much & neglects relevant science. (This is a very short version of my full review.) I used to wonder why I even bothered to create this tutorial! Why not just recommend the Workbook ? Because this tutorial has grown to offer a lot that the Workbook doesn’t. Delving into the nature of the beast — the science — is the strength of this tutorial. But the Workbook has fallen behind the times on that score. The current edition still promises too much and neglects important new knowledge. Trigger point therapy has been challenged by many scientific insights and new ways of understanding pain, but the Workbook doesn’t acknowledge any of that. This topic is too important for such neglect. This tutorials offers a more realistic and balanced view of trigger point therapy, meets the challenge of difficult cases head on, and hard-nosed reviews of every possible treatment option. All for $20. Which is quite a bit less than even a single appointment with someone who claims to do trigger point therapy. BUY NOW $ 19 95 USD

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