Travell & Simons' Myofascial Pain and Dysfunction: The Trigger Point Manual, Volume 1: Upper Half of Body, ed 2.

Travell & Simons' Myofascial Pain and Dysfunction: The Trigger Point Manual, Volume 1: Upper Half of Body, ed 2

Simons D, Travell J, Simons L. Baltimore, MD 21201-2436, Williams & Wilkins, 1999, hardcover, 1,038 pp, illus, ISBN: 0-683-08363-5, $99.

The second edition of Travell and Simons' text, Myofascial Pain and Dysfunction: The Trigger Point Manual, is a tool that all practitioners who treat patients with musculoskeletal pain will want to have in their clinic. As the authors state, the text presents a basis for understanding the causes of myofascial trigger point pain, methods of eliminating the source of the pain, and ways of preventing its recurrence. In achieving this objective, the authors identify a comprehensive working knowledge of anatomy, physiology, kinesiology, palpation, and symptom recognition as a necessary prerequisite for the effective treatment of musculoskeletal pain associated with myofascial trigger points. This comprehensive manual is a valuable resource in learning and understanding the nature of myofascial trigger points as well as identifying their role in musculoskeletal pain complaints.

The text is divided into 5 sections. The first section contains 4 chapters and provides extensive introductory information on the nature and clinical aspects of myofascial pain. There are noteworthy changes in chapters 2 and 3 of this section. Chapter 2 presents updated information and expands on the role of myofascial trigger points in areas such as overuse and occupational overload of muscles. Chapter 3, "Apropos of All Muscles," serves as a general introduction to the corresponding chapters for every muscle. It provides information that is applicable to all regions of the body and is critical in the application of the principles in this text. When using the manual, readers can easily refer back to this essential information as necessary. Changes in the diagnostic and treatment sections of chapter 3 reflect a new level of understanding of the nature of myofascial trigger points. The authors further emphasize the importance of the muscular dysfunctions associated with trigger points, and they expand on the physical treatments to address those dysfunctions. Chapter 4, "Perpetuating Factors," discusses the identification and significance of factors that activate as well as exacerbate myofascial trigger points, the interaction between related trigger points, and the relevance of these factors to the progression of treatment. Mechanical stresses; nutritional, metabolic, and endocrine inadequacies; psychological factors; and chronic stresses are also discussed in this chapter.

Subsequent sections of the book are organized by region of the body: the head and neck; the upper back, shoulder, and arm; the forearm and hand; and the torso. Each section begins with an overview, including a pain guide to involved muscles, which is a concise reference document designed to assist the clinician in determining which muscles to treat.

The overview chapter of each section is followed by chapters on examination and treatment of specific muscles, including differential diagnosis, screening and examination, and identification of referred pain patterns. Each chapter is then subdivided by the following headings: referred pain, anatomy, function, symptoms, activation and perpetuation of trigger points, patient examination, trigger point examination, entrapment, differential diagnosis, trigger point release, trigger point injection, and corrective actions. The consistent organization of each chapter allows for the efficient and effective use of the text. Diagrams depicting anatomy, muscle fiber orientation, referred pain patterns, localization of trigger points, palpation, patient positioning, special tests, and treatment effectively supplement the text.

The differential diagnosis portion of each chapter has been enhanced with up-to-date information on the relationship between myofascial trigger points and common musculoskeletal disorders (eg, carpal tunnel syndrome, thoracic outlet, rotator cuff tendinitis, scapulo-humeral imbalances). The relevance of myofascial trigger points relative to each disorder is discussed. In addition, this portion guides the clinician through conditions that present a similar but confusing clinical picture.

The treatment portions of each chapter have been rewritten and enhanced to include trigger point release techniques in addition to spray-and-stretch, trigger point injection, and corrective actions. The coverage of corrective actions is comprehensive throughout the manual, and several chapters include stretching, posture, activity modification, and home exercise suggestions. Information in this portion is extremely practical and functional in nature.

The addition of a chapter devoted to the respiratory muscles, chapter 45, "The Intercostal Muscles and the Diaphragm," is valuable. It includes a concise discussion of the anatomy of the muscles of respiration as well as an in-depth discussion of function related to respiratory mechanics and posture.

This text presents a significant volume of information in an orderly, consistent manner. The utilization of contributing authors in this edition does not interfere with its organization and the consistent presentation of the material. All information presented is extensively referenced, providing the clinician with a comprehensive bibliography with which to expand his or her knowledge base. The second edition provides all of the information in the first edition, with enhancements reflecting current research as well as extensive clinical experience in the diagnosis and treatment of myofascial trigger points.

Christine A McNamara, PT
Cornell University
Ithaca, NY

Ms McNamara is a staff physical therapist and coordinator of the clinical education and aquatic physical therapy programs at Cornell Physical Therapy.