Published: November 2, 2008
I first became aware of the work of Dr. Janet Travell as a result of studying the effects of what are known as “myofascial trigger points.” Trigger points are small, often painful nodules in muscles. If you have them, you may call them “knots”.
Travell researched these knots extensively. She literally wrote the book on trigger points. Her two-volume exhaustive text about trigger points (co-authored by Dr. David Simons) pioneered a new treatment approach that has helped millions. She was well into her 80s when the first volume was released, and more than 90 years old when the second volume premiered.
It was because of her work with trigger points that Travell ended up in the White House. In 1955, then-Sen. John F. Kennedy was referred to Travell after failing to respond to two back surgeries. Kennedy had suffered from disabling back problems for years. His surgeon arranged for treatment with Travell. He found her approach so helpful that he continued to receive treatments from her weekly.
When Kennedy was elected President, he appointed Travell to the prestigious position of personal physician to the President. No female and very few civilians had ever occupied this position.
Although unknown to most of us during his term as President, Kennedy suffered excruciating pain and often had to walk with crutches when no cameras were around. He almost always wore a stiff corset beneath his clothes to maintain the appearance of erect posture that he could not maintain on his own. Close associates said he rarely complained. Travell’s weekly trigger point treatments helped control the pain.
Prior to Travell’s research, myofascial trigger points were unknown. She discovered that many patients with chronic pain are prone to have small, tender knots in their muscles that never completely go away. These knots are small, hypersensitive areas of contraction within the belly of the muscle itself. It is as if a portion of the muscle has been given the signal to contract and never signaled to relax. After a period of excessive contraction, the muscle fibers eventually “lock” into position. Trigger points are not only painful to pressure, but often refer pain to distant areas of the body. Trigger points can cause chronic headaches, neck, arm, leg and back pain, sciatica, fibromyalgia, TMJ and even menstrual pain.
Travell’s research led her to not only determine the anatomical nature of these trigger points, but to also create a map of the body that identified frequent sites of common trigger points and their likely referral patterns. Due to the nontraditional nature of her work at the time, it was largely ignored by the medical establishment. Her theories were adopted early by chiropractors and some physical therapists. Only decades later would she be heralded as a true medical pioneer by a growing number of pain specialists.
Travell developed several ways to treat these newly discovered trigger points, often involving stretching, manipulating, or injecting the involved muscles. One method was called “dry-needling.” Dry needling involves inserting a syringe needle into the trigger point itself with no medication in the needle. This treatment was surprisingly effective.
If you are already thinking that this treatment sounds similar to acupuncture, you are right. Travell actually pioneered the type of work that I do in my office every day. We treat trigger points in patients that are being seen for chronic pain. We have found the treatment very successful for a wide range of painful conditions.
Travell demonstrated that a muscle problem left uncorrected will cause joint dysfunction, and untreated joint dysfunction will cause painful muscle imbalance. Effective treatment requires both trigger point therapy and correction of joint dysfunction.
Travell also prescribed a treatment for President Kennedy that you may be more familiar with. She is the doctor that developed rocking chair exercises for his back pain. Over the years, he purchased at least fourteen identical rockers for his home, the White House, Air Force One and other places he stayed. He obviously found the rocking exercises to be beneficial.
Next week: Find out why a rocking chair might be helpful for you.
Dr. Mark Kestner