The Manual of Trigger Point and Myofascial Therapy.

Kostopoulos D, Rizopoulos K. Thorofare, NJ 08086, Slack Inc, 2001, paperback, 259 pp, illus, ISBN: 1-55642-542-2, $45.

This book is intended to serve as both a teaching textbook for students and a reference book for clinicians who are dealing with myofascial pathology. It is divided into 2 sections. Part A, "Theory," covers the theory, current research, and trends regarding myofascial trigger point syndrome. Myofascial trigger points are probably best known to physical therapists from the classic texts by Travell and Simons (Myofascial Pain and Dysfunction: The Trigger Point Manual, Vols. 1 and 2). The authors of this manual have chosen to use the same definition: a hyperirritable spot in skeletal muscle that is associated with a hypersensitive palpable nodule in a taut band. The authors have provided evidence from current literature to substantiate the existence of trigger points, as well as research studies on the efficacy of treatment. Review questions are given at the end of each chapter.

Part B, "Muscle Regions," covers the regions of the body. Information about each muscle is presented using a 2-page format with text and illustrations. The information on the muscle is organized into the following sections: muscle attachments, location of trigger points, referred pain patterns, myofascial stretching exercises, positive stretch signs, biomechanics of injury, and clinical notes.

The authors of this manual hope to further contribute to the field of myofascial trigger point syndrome by emphasizing the mechanism of injury; considering the syndrome in relation to the neuromuscular system; and introducing the positive stretch sign, a pain indicator that allows the clinician to identify the appropriate amount of stretch during treatment. Evidence is provided that the use of certain modalities may be effective in treatment of trigger points. For example, a quick check on the Physiotherapy Evidence Database (PEDro) showed ranking of 6-7/10 for recent studies on the effects of helium-neon laser on trigger points. However, research is needed on the specific stretching treatments advocated by the authors to determine their efficacy.

The strength of this text is the 2-page format that concisely illustrates and explains the information about a specific muscle. This format allows for quick identification of the trigger point. This concise packaging, however, is also the weakness of the text, particularly if you want more information. I put this book on the shelf next to my copies of Travell and Simons' trigger point manuals. Although I could use Kostopoulos and Rizopoulos' manual as a quick and easy reference, I always end up looking for more information in Travell and Simons. I therefore recommend this text as an adjunct to the classic texts, but not as a replacement.

Maggie Fillmore, PT, OCS
Kaiser Permanente
Oakland, Calif

Ms Fillmore is a clinical specialist at Kaiser Permanente, providing outpatient orthopedic and pediatric care. She is also on the clinical faculty of the Kaiser Residency Program in Advanced Orthopedic Manual Therapy.