This is a listing of updates made to the trigger points tutorial prior to 2010. They are provided for historical interest only, and as a “paper trail” demonstrating how the documents have been maintained. All newer updates are listed in the tutorial itself. Note: most of the links to specific locations within the trigger points tutorial will not work, as they are from obsolete editions.
— A substantial new section makes the case for self-treatment: Fundamental limitations of trigger point therapy, and how to take advantage of them
— Upgraded the quality of the writing in an important section, Trigger point diagnosis is not reliable … but it may not matter that much.
— A little smorg of updates today: (1) A lovely new illustration by Shayne Letain for the introduction! Look for the man with toxic waste signs sticking into his back. And (2) a new case study section with a fascinating success story, demonstrating “a terribly important basic piece of wisdom to ‘get’ for anyone who is prone to muscle pain.” And (3) just a bit of updating of the tools sections with the idea of a “bucket of balls.”
— As promised last week, there are now four new advanced sections about the use of medications to treat trigger point pain. These are major new sections with a whole bunch of useful information for patients and pros.
Also, all discussion of Botox (especially the Botox section) was updated with new scientific evidence that it’s not as effective a therapy for trigger point pain as we all hoped.
— Two new sections: “Muscle knots are not inflammatory: the myth of the inflamed myofascial trigger point” and “Common medications that might make a difference (and might not).” More advanced medication information to follow soon: this is just a summary of the basics so far.
— A substantial new section today: Trigger point diagnosis is not reliable … but it may not matter that much. I wrote about this a while back on the front page and it will be there and free for a while longer, but I’ve also added more information here and included some references to other studies.
— Several minor updates and refinements, not in any particular section.
— It’s come to my attention that the trigger point treatment method of dry needling doesn’t have as much going for it as I used to think. I discuss the (lack of) evidence and problems in an overhaul of the section How about dry Needling and Intramuscular Stimulation (IMS) therapy? Since Dr. Chan Gunn is the doctor behind one of the most popular methods of dry needling (IMS), I also revised a section which was inspired by his ideas, “The bamboo cage” theory of muscle pain.
— Completely re-wrote the section How about myofascial release and fascial stretching? which is accompanied by a new (free) general review of the clinical importance of fascia.
— Rewrote the section How about chiropractic joint adjustment and popping? It’s been condensed into a more finely tuned summary, and links out to a much more detailed article on the topic.
— Physiatrists and rheumatologists added to Types of therapists and doctors and their relationship to trigger point therapy.
— New section: “Quick-start trigger points” (access for customers only) describing the clinical characteristics and significance of extremely fast-activating and severe trigger points.
— Added an important point to the section, “From the frying pan of injury pain to the fire of trigger point pain,” about injuries that are so severely complicated and overshadowed by trigger point pain that the victims literally don’t even know that there is a physical trauma at the heart of the problem.
— The visual design of the site was upgraded over the past several days. Although this is not an update to the content of this tutorial, it is nevertheless a significant upgrade for all of them — like publishing new editions of books with better typesetting and layout. The new design is even cleaner and reader-friendly; it now looks that good in most web browsers; and pages load as much as 50% faster. Many under-the-hood improvements will make it much easier for me to improve tutorial content. The tutorials are now well-oiled machines of digital publishing goodness, vastly superior to the low-production values of most eBooks. More information about the upgrade is published on the front page.
— Another new advanced tip section today: “Don’t be fooled by reverse referral.” This one’s a head trip. It’s so confusing, I left it out of earlier versions of the tutorial simply because I still didn’t know how to explain it. But I decided it was time to tackle it, and here you go — I think I more or less got the point across.
— This tutorial has always been strong in the “practical tips and tricks” department. Well, play to your strengths! Lately I’ve been in the mood to add even more tips, and here’s another one today, “Focussing on one trouble spot versus ‘a little bit of everything’ — which is the better strategy?”
— Added new information about Traumeel, a popular but questionable remedy that I often get asked about. See the section, “Reality checks: some self-treatments that don’t work at all (or not nearly as well as you would hope),” or the free article, Does Arnica Cream Work for Pain?.
— Improvements to the section, “How about acupuncture?” Some optimism about acupuncture was removed from the section, and an important new reference was added. Recent scientific evidence has continued to hammer away at acupuncture, and optimism about it can no longer be justified. You can read about the most recent acupuncture evidence in, Does Acupuncture Work for Pain?.
— New section! “Don’t get hung up on anatomy, and be persistent.” Sounds like a bit of a no-brainer, but there’s a couple ideas in there that patients often need to hear. It’s a nice addition in the “tip” category that really should have been there before.
— A new section, “From the frying pan of injury pain to the fire of trigger point pain,” helps readers understand the unholy relationship between injury and trigger points. For readers who have been injured, this is an important addition to the tutorial. Similar information is also available in the form of a story in the article Into the Fire: Trigger point pain as a major injury complication, and how I finally “miraculously” healed from a serious and stubborn shoulder injury by untying the muscle knots. There is some overlap between the new section here and the stand-alone article, but they both offer different information in different ways. If you are injured, read both!
— Added some information about some nice self-massage tools built by Allan Saltzman of YogaTools.com in the section, “Beyond the tennis ball: some of the best commercial massage tools,” as well as some self-massage tools and products I don’t like, in the (now independent and expanded) section “Commercial massage tools to avoid.”
— Added some information about the relationship between myofascial pain syndrome and disease that obviously affect the harmony of the musculoskeletal system, using Parkinson’s disease as an example. See the section “Are you a “triggery” person? The relationship between trigger points and other physiological disorders and diseases, especially fibromyalgia.”
— Corrections and minor improvements have been made by the hundreds since the publication of the last major upgrade, which was three weeks ago. The polishing never really ends!
— Massive upgrade published. This is by far the largest single update a PainScience.com tutorial has ever gone through. The trigger points tutorial has more than doubled the amount of information it offers, and is now book-length at around 80,000 words. Every single customer who ever purchased the tutorial received 2 weeks of free access to the upgraded tutorial. Here’s a summary of everything that’s changed:
October 2007 through May, 2008 — Fifteen substantive updates were published over eight months. All of them were made more or less made obsolete by and rolled into the major update of the whole tutorial, published July 28, 2008.