“Remember it’s a sin to kill a mockingbird.” That was the only time I ever heard Atticus say it was a sin to do something, and I asked Miss Maudie about it. “Your father’s right,” she said. “Mockingbirds don’t do one thing but make music for us to enjoy … but sing their hearts out for us. That’s why it is a sin to kill a mockingbird.”
The late Harper Lee struck an intense moral chord in the USA with her acclaimed novel – To Kill a Mockingbird (1960).
But does the innocent mockingbird have anything in common with the “myofascial trigger point (MTrP)”? Is it a sin to kill a MTrP?
There are physical therapists who firmly believe that MTrPs can cause considerable harm to people:
Myofascial TrPs are a preventable cause of musculoskeletal pain, they cause dysfunctions, such as blurry vision, erectile dysfunction, balance disturbance and dizziness, irritable bowel, diarrhea, vomiting, voice disturbances, and loss of fine motor control. They can cause colic in babies or contribute to falls in the elderly–and in the rest of us [Starlanyl & Sharkey, 2013].
Furthermore, in their eyes the potential havoc that MTrPs can wreak extends even to fibromyalgia (aka chronic widespread pain).
In their recent book Starlanyl and Sharkey (2013) make this promise to their readers:
“You will discover how TrPs can cause or maintain fibromyalgia and why the ability to control the TrPs directly affects the control of FM symptoms … the key to controlling trigger points is identifying and controlling perpetuating factors.”
Accordingly, Starlanyl and Sharkey (2013) see fit to issue a stern warning to those individuals who are unfortunate enough to harbour MTrPs:
If the perpetuating factors are not brought under control, satellite TrPs can develop in muscles that overwork trying to compensate for the TrP-weakened ones, or in muscles in the referral zone. Once primary TrPs develop satellite TrPs in other body areas, life, and treatment, becomes more complex. The satellites themselves can develop more satellites involving more of the body. Trigger points can cause body-wide pain.
On close examination, these perpetuating factors, of which the list is exceedingly lengthy, turn out to have only been figments of the fertile imagination of the original proponents of the MTrP theory [Travell & Simons, 1983].
The belief that MTrPs can be “controlled” has spawned a worldwide industry of therapists eager to kill (“deactivate”) them by various drastic methods, which include needling, compression, and manual release.
On her website Starlanyl (2014) advises therapists to proceed cautiously, as follows:
“Use the least invasive option for therapy, with the understanding that most treatment options may activate more TrPs and cause a temporary increase in pain. Toxins and waste materials trapped in the myofascia (sic) must be processed by the body and be eliminated, and that can only proceed so fast. It takes a while for the Gordian knot to unravel, and the process is not fun for the patient.”
Starlanyl (2014) describes: “… a cadre of patients with too many TrPs to count, in multiple levels in multiple muscles. They have chronic myofascial pain (CMP). The muscles may be so tight and swollen that you can’t see them move beneath the skin, and the pain levels escalate. These patients may have had multiple surgeries and procedures. There may have been multiple traumas. There may be a wide variety of perpetuating factors.”
When the preferred treatment fails to kill the MTrP(s), the blame then shifts from the therapist to the pain sufferer, who without any shadow of doubt must harbour one or more of these so-called perpetuating factors.
It may be a sin to kill a mocking-bird – but has any one ever seen a “dead” MTrP, let alone be able to identify and describe its true nature? No doubt there are some who would see it as sinful should therapists not try to “kill” as many MTrPs as possible in their attempts to alleviate human suffering. However the published research on outcomes for “treating trigger points” suggests that they are not easy to kill [Cohen & Quintner, 2008; Quintner et al., 2015].
Could this apparent resistance to destruction be explained by their very non-existence? Unless and until this is appreciated, the MTrP will continue to mock its followers.
Cohen ML, Quintner JL. The horse is dead: let myofascial pain syndrome rest in peace [letter]. Pain Medicine 2008; 9: 464-465.
Quintner J, Bove G, Cohen M. A critical evaluation of the “trigger point” phenomenon. Rheumatology 2015; 54: 392-399.
Starlanyl DJ, Sharkey J. Healing through trigger point therapy: a guide to fibromyalgia, myofascial pain and dysfunction. Berkeley, California: North Atlantic Books, 2013.
Starlanyl D. Fibromyalgia and trigger points for care providers, 2014. Available at: http://www.fmcmpd.org/physinfo.htm Accessed 13th May 2016.
Travell JG, Simons DG. Myofascial pain and dysfunction: the trigger point manual. Baltimore: Williams and Wilkins, 1983.