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Major new content about the trigger point controversy, and my official (fence) position

Paul Ingraham ARCHIVEDMicroblog posts are archived and rarely updated. In contrast, most long-form articles on are updated regularly over the years (see updates page).

Working as a massage therapist from 2000-2010, I tried to cure clients’ “trigger points” (aching, sensitive patches of tissue). I wrote a book and many articles about them, all without an inkling that there was any controversy on this topic. I did this even as I was building a strong reputation as a debunker and a writing career based on critical thinking about treatments for pain. And then I discovered that some experts — even some of my own mentors and allies in other debunking battles — had believed for years that trigger point therapy was totally bogus.


The controversy about trigger points has heated up and polarized over the last few years, while I quietly crammed. I studied the conflicting opinions and science, and placed uncertainty disclaimers all over they may not be what they seem and the science is half-baked and diagnosis is unreliable, and so on. I didn’t pick sides. It’s all “just” a technical argument anyway, a kerfuffle between experts about the explanation for a painful problem. Most patients and professionals are oblivious to the whole mess. I sat on the fence.

Today I’m making my fence-sitting official: I’ve built a little platform up there, because I think it’s a reasonable place to be, and I expect to be camped here for quite a while. I built my perch on the science, such as it is. I’ve written a heavily referenced new article about the central issue: are trigger points explained by something wrong with muscle? I wrote it with the help of Dr. Brian James, formerly a massage therapist and now a physician — and a superb and fair-minded critical thinker with a talent for getting to the heart of the matter. I’m grateful for his assistance.

My personal impression is that Dr. James isn’t really on anyone’s side either: he just wants to understand why people have these painful spots. That’s why I wanted to work with him on this.

And, with that foundation finally laid, I can do this

The highlights of my current thinking about trigger points and their controversial explanation

These points can also now be found near the beginning of my revised and updated “Trigger Point Doubts” article, along with the full story of how my thinking about trigger points and myofascial pain syndrome has evolved over the years. “Once upon a time, I learned about trigger points from my first massage therapy mentor … .”

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