History of Myotherapy
Brief Historical Review of Myotherapy
Myofascial pain syndrome (MPS) is defined as the 'sensory, motor and autonomic symptoms caused by myofascial trigger points (MTrPs)' and is a now a recognised diagnosis amongst pain physicians (Harden et al, 2000). Dr Janet Travell (1901-1997) is generally credited with bringing MTrPs to the attention of healthcare workers in the 1940s, though MTrPs have been 'rediscovered' many times as far back as the 16th century (Ruhmann, 1940). According to Dommerholt and colleagues (2011), in the late 1930s Travell was compelled to switch her focus from cardiology to musculoskeletal pain after learning that many muscles and spinal ligaments when injected with hypertonic saline (known to induce pain experimentally), elicited repeatable referred pain patterns. This eventuated in publishing a paper in 1952 on the myofascial genesis of pain with detailed referred pain patterns for 32 muscles, prompting further research on the topic from Europe, Australia and the USA on the existence of MTrPs, their symptoms and treatment.
In 1966, Travell founded the North American Academy of Manipulative Medicine with Dr John Mennell. Travell promoted integrating myofascial treatments with treatments for dysfunctional joints, but was of the belief that manipulating muscles and joints was the domain of physicians and therefore did not admit physical therapists to the Academy (Paris, 2000). In the early 1960s, Dr David Simons , who was working in the US airforce and was famous for piloting a balloon to the edge of outer-space in 1957, met Janet Travell. They collaborated and in 1983 produced the Trigger Point Manuals, a two volume comprehensive review of more than 140 muscles' symptoms and referred pain patterns based on the clinical observations of Travell. A second edition of volume one was published in 1999 and both volumes have now been translated into many languages and are the primary texts for anybody studying myofascial pain.
As more clinicians began looking to the muscles as a source of patients pain, a non-profit multidisciplinary society called the International Myopain Society (IMS) was formed, initially in the USA and then incorporating European clinicians and more recently clinicians and researchers from the southern hemisphere. The IMS publishes a quarterly scientific peer-reviewed journal called the Journal of Musculoskeletal Pain and presents an international conference called Myopain where the latest research in myofascial pain and fibromyalgia (a condition where muscle pain is a strong feature) is presented and discussed.
In the last 15 years or so, the number of colleges and universities in Australia training therapists to treat patients suffering myofascial pain has grown exponentially. The same can be said for the research being published on the pathology and treatment of these conditions in the international peer-reviewed literature. Though in the scheme of the research of medical conditions, there is still more work to be done in the area of MPS. However, with thanks to the many talented clinicians and researchers who worked tirelessly through the 20th century (there are far too many to mention in this brief review) we now have a good knowledge base of how MTrPs develop and have a very good understanding on which to base the treatment and management of patients with MTrPs and MPS.