Detailed guides to painful problems, treatments & more

All Archived Updates for:

The Complete Guide to Trigger Points & Myofascial Pain

This page lists all 195 updates for one book on, The Complete Guide to Trigger Points & Myofascial Pain. See also:

show only major updates

  1. Mar 25, 2022 — Science update — Added an interesting citation about the infectious roots of multiple sclerosis (Bjornevik).
  2. Dec 26, 2021 — Correction, neuropathy chapter — I excessively demonized gabepentin and pregabalin based on an oversimplification of their legal history and inadequate attention to the evidence on efficacy for neuropathy. In fact, these drugs are efficacious for some neuropathies.
  3. Dec 22, 2021 — Major upgrade, magnesium deficiency — Dramatically improved quantity and quality of information about magnesium deficiency and using it as a treatment for pain or cramping.
  4. Dec 22, 2021 — Upgrade, vitamin C deficiency — More and better information, especially a science-based revised of vitamin C dosing advice.
  5. Nov 8, 2021 — Science update, dry needling chapter — Almost an echo of last year’s science update on this topic: a second study of needling for neck pain, also quite good, and also quite negative.
  6. Oct 9, 2021 — Modernized — Dramatically improved the tone of the introduction to the “medical” section of the book with a healthy dose of skepticism. I’ve added what I hope is a persuasive warning about how easy and dangerous it is to start blaming things we don’t really understand.
  7. Oct 1, 2021 — Polishing — Long overdue proofreading of the entire book, correcting several dozen typos that have snuck into it over the years. This is by far the longest of my books, and so it had by far the most typos, and no doubt there are still a few — but it’s greatly improved. Also for this project, I updated all references made to my work as a massage therapist, a great many of which still read like I have appointments schedule next week, when in fact I haven’t seen massage therapy client in over a decade now.
  8. Sep 22, 2021 — Added anecdote — Added a solid anecdote from a physician reader about “appendicitis” cases treated with lidocaine injections in the abdominal muscles. Also added some extra medical information about pain in this area.
  9. Jun 5, 2021 — Improvements — More detail and polish, strain-counterstrain chapter
  10. Mar 11, 2021 — Upgrades — More and better information, mostly achieved in this case by consolidating information from other books in the PainSci library.
  11. Feb 6, 2021 — Upgrade, alternate explanations of trigger points — Today I dug much deeper into the idea that trigger points are a kind of “injury,” especially an overuse injury. I am quite pleased with this update — genuinely interesting stuff.
  12. Feb 6, 2021 — Improved, misdiagnosis chapter — I have added much clearer and more thorough information about the difference between a strain (clear mechanism involving structural damage) and a trigger point (unclear mechanism, no obvious structural component).
  13. Nov 8, 2020 — More info, about types of doctors and therapists — Added some context about trigger point therapy as a “modality” to introduce the section.
  14. Sep 30, 2020 — Science update — Added a citation to Smuck et al.
  15. Jun 25, 2020 — Minor update, quality control chapter — Added some thoughts on the theme of “What could possibly go wrong?” — inspired by a particularly bizarre example that is both disturbing and yet entirely too typical of the industry.
  16. Jun 8, 2020 — Science update, dry needling chapter — A small science update, but a significant one: the best quality study with negative results available to date.
  17. Mar 11, 2020 — Rewrite, other theories chapter — A substantial upgzrade. This chapter had become embarrassingly basic, falling behind my personal knowledge. It now has more summaries of competing hypotheses about the nature of trigger points, one particularly important new one, and a big and entertaining list of examples of bad ones. More improvements and refinements soon, but this is a good start.
  18. Jan 7, 2020 — New chapter, a case study about chronic hip pain decisively resolved by unusually intense massage —
  19. Nov 12, 2019 — Expanded, other causes of chronic widespread pain — Added two more sub-topics: psychological amplification and true psychosomatic pain.
  20. Nov 12, 2019 — Expanded, other causes of regional pain — Added three sub-topics: specific pain system dysfunction, spatial summation, and claudication.
  21. Sep 22, 2019 — Rewritten, “meltdown” cases — Completely rewritten to reflect the many things I have learned about severe chornic widespread pain over the last several years. Exploring the concept of chronic-acute pain is probably the most meaningful addition.
  22. Aug 13, 2019 — Science update — Added minor but very interesting new citation about the cause of chronic Lyme disease (see Jutras)
  23. Aug 13, 2019 — Major revisions underway — This medical factors part of the book is being revised. It was originally written by a physician collaborator, and I am now taking over, modernizing it until I’m happy to put my own name to it.
  24. Jul 30, 2019 — Edited, the unpredictability of TrP symptoms — Thoroughly edited, and added a disclaimer about “special pleading.”
  25. Jul 5, 2019 — Improved, introduction to basic trigger point therapy — Extensive editing and improvements throughout all the basic treatment sections. I added many key points and tips while staying within the scope of “basic” (a tricky balance), mining years of writing on this topic for a wide variety of refinements and carefully boiling them down to their essentials. Several ideas I consider obsolete were also removed. The Quick Reference Guide was also updated to match.
  26. Jun 19, 2019 — Upgraded — Added more detail about greater trochanteric pain syndrome, making the section a little more useful to many readers.
  27. May 28, 2019 — Revised, chapter about TrPs as a complication of injury — Significantly expanded and modernized (for the first time since it was originally written, I think).
  28. May 22, 2019 — Rewritten, morning symptoms chapter — Heavily revised to basically be an abdridged version of the article 6 Main Causes of Morning Back Pain, focusing on trigger points. This section had been aging poorly, full of unsubstantiated speculation and dubious premises. It’s on firmer footing now.
  29. May 10, 2019 — Editing — Some clarifications about the mechanism of “flushing” and whether uncomfortable massage intensity can be justified for that reason.
  30. May 10, 2019 — Edited, ischemic pressure technique — Clarified, modernized, and expanded a little bit, especially integrating new information about the effect of massage of tissue fluids and circulation.
  31. Apr 27, 2019 — Rewritten — Totally revised and tripled in length, this chapter is “like new.” I also moved it to the diagnosis section of the book to give it greater importance.
  32. Mar 25, 2019 — Edited, differential diagnosis — A thorough editing, especially to the information about frozen shoulder, part of an ongoing effort to upgrade differential diagnosis information in the book.
  33. Mar 23, 2019 — Edited, trigger point palpation — Thoroughly edited for clarity. Stronger focus on the many ways palpation can go wrong.
  34. Feb 22, 2019 — Revision, adhesions — A substantial editing of this topic for the first time in years, eliminating a fair bit of quaint naivete and credulity from the good ol’ days when I still didn’t know just how deep these waters run.
  35. Feb 14, 2019 — Science update, risk of hurting nerve — Extended the discussion of vulnerability to include “sensitization.”
  36. Feb 14, 2019 — Editing, overdiagnosis of nerve pain — This chapter now plays nicer with related sub-topics, and I’ve emphasized the differential diagnosis context a little more.
  37. Jan 4, 2019 — Addition, hypermobility section — Added excerpt from a comedic and interesting article about a patient with Ehlers–Danlos syndrome who’s shoulder was dislocated by a massage.
  38. Dec 4, 2018 — Additions — Added an informative and entertaining example.
  39. Nov 27, 2018 — Expanded, peripheral neuropathy hypothesis — Added substantially to the section with exploration of two examples of peripheral neuropathy that may be mistaken for trigger points (but only if you’re not very good at this stuff).
  40. Nov 2, 2018 — Editing, hypermobility section — Some minor clarifications and additions.
  41. Oct 12, 2018 — Editing, crepitus (noise) section — A light re-write, de-emphasizing the dubious link to trigger points.
  42. Sep 20, 2018 — Science update — Added a citation, a negative review.
  43. Sep 20, 2018 — Science update — More thorough citing on the topic of dry needling efficacy … and that is probably the last in a year-long series of updates to this section over 2018. This chapter has been well and truly rebooted.
  44. Aug 16, 2018 — Science update — Analysis of more putative “mechanisms of inaction” as presented in three more papers, one ancient, two new (Melzack, Chou, Cagnie).
  45. Jul 25, 2018 — New section — A new standard chapter for most tutorials summarizing several key concepts about placebo.
  46. Jul 19, 2018 — Science update, dry needling section — Added analysis of Couto, one of the more credible positive trials of dry needling available.
  47. Jun 9, 2018 — Revised — The Quick Reference Guide hadn’t been updated for a loooong time, and I finally got to it. It could still use more modernization and careful synchronization with book content, but it is greatly improved. (Fun fact: this update also eliminated some of the final traces of branding for the old domain name, three-and-a-half years after it was retired.)
  48. May 11, 2018 — Science update, dry needling section — A new sub-section about Llamas-Ramos et al, a study by dry needling proponents with surprisingly negative results (even if they didn’t see it that way). Plus a bunch of miscellaneous minor improvements.
  49. Apr 17, 2018 — Improvements, dry needling section — Significantly expanded discussion of the rationale for needling with an interesting example and a helpful image.
  50. Feb 20, 2018 — Improvements, dry needling section — Miscellaneous clarifications and elaborations, especially about schools of thought and mechanisms of effect. How does dry needling supposedly work? It’s hard for proponents to answer that question directly.
  51. Jan 31, 2018 — Miscellaneous improvements, nerve vulnerability section — Added much more information about endangerment sites, discussion of the potential relevance of neuritis, extensive clarifications and editing, and some footnotes.
  52. Jan 16, 2018 — Science update — Added a few new citations about the efficacy of needling. Made some improvements to the information on risks added last month.
  53. Dec 16, 2017 — Science update — Added more and better information about risks of dry needling.
  54. Nov 24, 2017 — New section, Hypermobility and Ehlers-Danlos syndrome —
  55. Nov 12, 2017 — Science update — Added a substantive footnote explaining the relationship between ulcers, stress, and H. pylori infection as one of the best examples of a “stress-sensitive condition.”
  56. Oct 31, 2017 — Full science review, massage efficacy section — Another huge update, though mostly “under the hood” — I have now completed a comprehensive informal review of all the available science, about 16 papers. The section now includes a large table of papers with links to all the summaries. Most readers are not going to want/need to click on all those links and read them all, but their availability is important.
  57. Oct 5, 2017 — Edited, strengthening as treatment section — Miscellaneous minor science updates; reduced confidence about the effect of trigger points on resistance training.
  58. Oct 5, 2017 — Rewritten, weakness section — Totally revised discussion of the effect of trigger points on strength; in particular, my old opinions are now clearly labelled as speculation, rather than presented as fact.
  59. Sep 25, 2017 — Science update, trigger point diagnostic reliability — A new citation, thorough discussion of Rathbone, and extensive related editing. The bottom line has been tweaked: I think the reliability evidence is encouragingly non-bad.
  60. Sep 12, 2017 — Science update. — Cited and discussed evidence that statin myalgia could be a nocebo—that is, not actually a real problem.
  61. Aug 30, 2017 — Major upgrade — Extensive new analysis of the scientific evidence of efficacy for massaging trigger points (mostly inconclusive). But I provide much more detail now, fully reviewing several noteworthy studies, and there’s more to come. The section has roughly quadrupled in length.
  62. Aug 10, 2017 — New section — An odd new section about trigger points in animals, with some interesting tangents and perspective.
  63. Jul 1, 2017 — Science update — Added brief discussion of an interesting theory about the effect of stretching on inflammation in connective tissue.
  64. Jun 8, 2017 — New section — A much more thorough discussion of vibrating massage tools.
  65. May 29, 2017 — Clarification, breathing section — Made it much clearer that changes in blood acidity with respiratory alkalosis are minor and transient. Miscellaneous minor edits.
  66. May 15, 2017 — Science update, trigger point therapy — Added citation to Webb et al, plus related edits.
  67. Feb 3, 2017 — Addition — Added a profound and very cool example of abnormal anatomy that confounds diagnosis of hard lumps in tissue.
  68. Jan 22, 2017 — Correction — Small but important correction about the value of opioids in severe cases that resemble fibromyalgia.
  69. Jan 22, 2017 — Minor improvements — Clarified several points and added a link to a new article dedicated to fibromyalgia.
  70. Jan 12, 2017 — Minor addition — Added a fun example of mistaken lump identity, and clarified warnings about how easily this can happen.
  71. Jan 9, 2017 — Minor maintenance — Some modernization, cleanup, and especially another “symptom checker” option.
  72. Jan 9, 2017 — Science update — Arcane but neat “bonus elaboration on the thalamic-convergence theory.”
  73. Jan 3, 2017 — General improvement — Purged some defunct resources, added a couple new ones, and made several corrections (broken links etc).
  74. Nov 21, 2016 — Science update — Added a few new citations about the prevalence of vitamin D deficiency and it’s correlation with chronic pain.
  75. Nov 15, 2016 — Rewrite — A new way of looking at how trigger points cause the sensation of “stiffness” and what happens when we try to stretch them out.
  76. Nov 15, 2016 — Modest revision — Reorganized presentation of the practical and theoretical challenges with stretching trigger points.
  77. Nov 15, 2016 — Major update — Almost all of the stretching sections have been edited, revised, and modernized.
  78. Nov 12, 2016 — Minor editing — Made the point of the section more clearly.
  79. Oct 20, 2016 — Edited — Thorough revision and modernization. Although I revised this section just five years ago, it needed it again!
  80. Sep 12, 2016 — Simplified — This section has been simplified, and now only covers key points about opioids and the relevance of opioids to MPS specifically. Detailed information about opioids has been moved to a separate article, Opioids for Chronic Aches & Pains.
  81. Sep 2, 2016 — Major rewrite — Thorough revision of the introduction to sarcomeres, inspired by the book Life’s Ratchet, about molecular machines.
  82. Aug 9, 2016 — Correction — Removed overconfident statements about the clinical significance of the effects of psychoactive drugs, plus related minor updates.
  83. Jul 6, 2016 — Safety update — Updated for consistency with new CDC guidelines. Thorough editing of the section.
  84. Jun 2, 2016 — Important new related reading — Although not an update to the book itself, I’ve published some important related articles about the scientific controversy over the explanation for trigger points: (1) a heavily referenced review of the evidence that a trigger point is a “tiny cramp”; (2) a summary of the academic controversy about trigger point science; (3) the story of my own doubts and how they’ve changed over the years (this is the “main” article on this theme; it was around before but has been revised heavily). All of this stuff is inside baseball, and not of interest to most readers, but it’s critical to my credibility as an author on this topic — it shows that I’ve really done my homework, and I’m not ignoring the concerns of skeptical experts — so for now I’ve made everything freely available to all site visitors instead of integrating them into the book. Nevertheless, the book has already been heavily influenced by this work, and will continue to be.
  85. May 23, 2016 — Minor update — Added a good new example of a trigger point “whisperer” myth.
  86. May 7, 2016 — Minor update — Finally added lacrosse ball recommendation.
  87. Mar 13, 2016 — Science update — More evidence about more serious side effects of statins, and controversy about prevalence.
  88. Feb 13, 2016 — Science update — Beefy tune-up for the “pillars” of trigger point science: several new and carefully written footnotes, linking to many painstakingly summarized papers for readers who really want to delve. It’s a bigger update than it looks like on the surface.
  89. Nov 18, 2015 — Edited — Yet more modernization and clarification.
  90. Nov 17, 2015 — Edited — Modernization and clarification.
  91. Nov 17, 2015 — Edited — Modernization and clarification.
  92. Nov 17, 2015 — Edited — Modernization and clarification.
  93. Nov 9, 2015 — Edited — Tuned for consistency with my current views.
  94. Nov 6, 2015 — Science update — Added a footnote about trigger points being associated with jaw pain.
  95. Oct 16, 2015 — Revised — Just modernizing and clarifying.
  96. Sep 15, 2015 — Science update — Some referencing about central sensitization, especially this “fun” fact: muscle pain may be especially good at causing CS.
  97. Sep 11, 2015 — New Section — Better late than never, I’ve added a summary of the expanded integrated hypothesis from Gerwin et al. (2004).
  98. Feb 28, 2015 — Science update — Added three good references and a diagram about how much “wiggle” room nerve roots have.
  99. Feb 22, 2015 — Science update — Two new science reviews considered and cited.
  100. Jan 4, 2015 — Rewritten — Completely revised for the 3rd edition of the Workbook: I no longer recommend it.
  101. Dec 30, 2014 — New citation — Added an important new reference to a scientific paper critical of conventional wisdom.
  102. Jul 8, 2014 — Minor update — New footnotes about the theory of acupuncture/trigger point overlap.
  103. Jul 7, 2014 — Science update — And, so sorry, it’s bad news.
  104. Mar 19, 2014 — Science update — Added evidence about the effect of massage on fibromyalgia.
  105. Jan 16, 2014 — Editing — General revision for quality. Added the cheek-bite analogy story for colour.
  106. Jan 16, 2014 — Editing — General revision for quality.
  107. Jan 5, 2014 — Minor update — Added a story about phantom limb pain.
  108. Dec 21, 2013 — Minor update — Minor but fascinating new item about the myth of anaesthetic paralysis and the dominance of the CNS over muscle tone — the kind of nifty item I just love to add to the book!
  109. Dec 13, 2013 — New section — An introduction to one of the most important theoretical challengers to the traditional explanation for trigger points.
  110. May 29, 2013 — Science update — Good news update: new study shows a clear reduction in nonspecific musculoskeletal pain after vitamin D supplementation.
  111. Mar 29, 2013 — Minor update — Upgraded risk and safety information about Voltaren Gel.
  112. Mar 1, 2013 — Minor update — Modernized and expanded a bit, a couple new references, and a generally much better explanation of what fibromyalgia is.
  113. Dec 14, 2012 — Science update — Some more evidence showing the role of smoking in chronic pain.
  114. Dec 7, 2012 — Science update — Added references showing connections between smoking and chronic pain.
  115. Dec 7, 2012 — Minor update — Added a funny sidebar about bad anatomy.
  116. Oct 25, 2012 — Minor update — A minor case study and some science to help establish that muscle can indeed be the source of pain.
  117. Oct 24, 2012 — New section —
  118. Oct 24, 2012 — Minor update — Added an item about “mobile” bumps that people often mistake for trigger points.
  119. Aug 27, 2012 — Edited — Now more accurate and clearer. Edits in preparation for audiobook version.
  120. Jul 23, 2012 — Major update — New evidence that massage can cause “rhabdomyolysis” makes it quite a lot easier to understand a lot of negative reactions to trigger point therapy. This is valuable perspective, and the section has been heavily revised to exploit it.
  121. Jun 9, 2012 — Minor update — This introduction now does a better (and more honest) job of mentioning some trigger point controversies, and links to an important companion article about them, for keener readers, Trigger Point Doubts.
  122. May 2, 2012 — Minor update — A minor but good: clearer, better language. Editing continues as I work on the audiobook version.
  123. Apr 25, 2012 — Minor update — More editing for clarity and thoroughness. This also happens to be one of the first edits I’m doing to prepare for audiobook production.
  124. Mar 28, 2012 — Science update — I revised the warning away from hydration, and included some fun new myth-busting evidence about hydration and cramping.
  125. Mar 8, 2012 — New section —
  126. Mar 8, 2012 — Minor update — Added an item about non-pain symptoms, like itching.
  127. Mar 7, 2012 — Minor update — Important new, skeptical footnote about the dangers of the powerful narcotic drugs.
  128. Jan 12, 2012 — Modest expansion (again). And the sassy new “muscle stabbing” section name. —
  129. Dec 21, 2011 — Science update — Added an interesting citation about the correlation (or lack thereof) between tissue hardness and sensitivity.
  130. Dec 14, 2011 — Trivial update — Added minor but odd note about “sensory annoyances” and hats. Yes, hats.
  131. Nov 11, 2011 — Products added — Three new product reviews, and some miscellaneous revision of the section.
  132. Oct 16, 2011 — Updated — Added new references to fascia science about the toughness and contractility of fascia, and some interpretation. This is also supported by a substantial new free article, Does Fascia Matter?.
  133. Aug 26, 2011 — New section —
  134. Aug 26, 2011 — Minor update — Added very basic information about magnesium.
  135. Aug 26, 2011 — New section —
  136. Jul 13, 2011 — New section — Some new thoughts about how stretching for trigger points might work — quite different from the mainstream theory — inspired some new stretching science.
  137. Jul 13, 2011 — Major rewrite — This might as well be a new section — not only did I re-write it, I gave it a completely new purpose. Previously the “bamboo cage” was a minor metaphor used to illustrate a possible mechanism for sensitization of muscle tissue. Now it is the basis of an extended and (I think) interesting exploration of how the concept of trigger points might actually be debunked. Pretty weighty stuff, but delivered with a major effort to make it interesting to any reader. Hope you enjoy it!
  138. Jul 12, 2011 — Minor update — Added an interesting observation about how Vitamin D supplementation might work.
  139. Jul 12, 2011 — Minor update — Miscellaneous editing and improvements, plus a couple new items.
  140. May 30, 2011 — Minor update — Added some basic information about the damage that “ugly pain” can actually do, inspired by a recent anecdote received from a reader.
  141. May 7, 2011 — Science update — The Vitamin D advice provided to readers has not changed, but the science supporting it has been dramatically beefed up — more science, new science, better summarized — to confirm that D supplementation is a safe and sensible option for patients. See also the separate article, Vitamin D for Pain.
  142. Apr 20, 2011 — Major update — Major improvements to the table of contents, and the display of information about updates like this one. Sections now have numbers for easier reference and bookmarking. The structure of the document has really been cleaned up in general, making it significantly easier for me to update the tutorial — which will translate into more good content for readers. Care for more detail? Really? Here’s the full announcement.
  143. Apr 10, 2011 — Minor update — Edited to distinguish more clearly between “dependence” and “addiction,” to reduce alarmism about addiction or contributing to the excessive stigma against opioids. (Thanks to reader Evelyn D. for pointing out the issue to me — a good example of how readers contribute to the improvement of this tutorial.)
  144. Mar 22, 2011 — Minor update — Updated the disclaimer (sidebar) about my “conflict of interest.” I no longer have it, since I am retired from my massage therapy practice.
  145. Feb 3, 2011 — Minor update — Added evidence showing that trigger point therapy improved ankle range of motion.
  146. Feb 3, 2011 — Minor update — Added a checklist item about muscle wasting.
  147. Dec 30, 2010 — Major update — Previously this section discussed ultrasound rather generally, without much discussion of the science; it is now beefed up with a thorough, fun discussion of the somewhat squishy evidence.
  148. Dec 30, 2010 — Minor update — Added an interesting footnote about the Google Book Ngram for “trigger points.”
  149. Dec 1, 2010 — Many minor repairs — A large batch of minor errors and glitches were corrected today, thanks to the sharp eyes of readers Effie and Doris.
  150. Nov 25, 2010 — Modest expansion —
  151. Oct 6, 2010 — New section — Not just for customers: this particular section is a short version of a new free article.
  152. Sep 23, 2010 — Major update — Numerous repairs and upgrades, some new charts, and a colorful anecdote about drinking blood (seriously). Thanks to several readers, and especially Elaine M., for their assistance with this.
  153. Sep 20, 2010 — Many new sections — An important new part of the book about nutritional and other biology and pathological factors that may be involved in MPS.
  154. Sep 15, 2010 — New section — Happy to add a whole small new section about evidence of the efficacy of trigger point therapy.
  155. Sep 15, 2010 — Minor update — I’ve done a bunch of work to continue integrating Dr. Taylor’s new chapter into the book: discussing perpetuating factors wherever they are relevant, and linking to the chapter. Thus there are many more spots in the book now where the importance and relevance of Dr. Taylor’s contribution is emphasized.
  156. Aug 6, 2010 — New cover — At last! E-book finally has a “cover.”
  157. Jul 20, 2010 — Corrected — Fixed some wrong science about hydrogen bonding and tissue adhesions. Hat tip to reader and chemist K.D. for the good catch.
  158. Jul 7, 2010 — Minor update — Updated the muscle relaxant section with a summary of a bizarre experiment with muscle relaxants that had quite surprising results.
  159. Jun 25, 2010 — Minor update — Added a nice anecdote from a doctor about a trigger point that was almost mistaken for a possible tumor.
  160. May 26, 2010 — New section — This is a major upgrade to the presentation of’s own Perfect Spots series of articles. They have always been here, but perhaps not presented in as useful a way as they could have been. I’ve also made many upgrades to the articles themselves over the last 2 months.
  161. May 26, 2010 — New section — Reviews and recommendations of other sources.
  162. May 25, 2010 — Major update — A weakness of this tutorial has finally been eliminated: reference material! Where are the trigger points? Although this is still not an encyclopedia of trigger points, and it never will be (by design), the book now helps readers find specific trigger point information in three new ways, in three new sections.
  163. May 17, 2010 — Many minor repairs — No specific update today, but a particularly large dose of editing love, with my thanks to reader Elaine M. for pointing out several errors that got me started. Elaine received some free product for her assistance, of course, and so can you if you send me any more than a few error reports.
  164. Apr 17, 2010 — Minor update — Improved description of physiatrists (a medical speciality).
  165. Apr 3, 2010 — New section — Finally, I’ve added a (free) appendix of online resources related to trigger point therapy. Better late than never.
  166. Feb 13, 2010 — Tiny update — Tiny-but-interesting: I added some pretty good evidence that a muscle relaxant was no better for injured neck muscles than ibuprofen.
  167. Jan 19, 2010 — New section —
  168. Jan 19, 2010 — Minor update — A little revision, slight expansion.
  169. Jan 12, 2010 — Major update — Section heavily revised, improved, and expanded.
  170. Jan 12, 2010 — Major update — Section heavily revised, improved, and expanded.
  171. Jan 7, 2010 — Minor update — A small but significant update on nutrition, based on Bischoff-Ferrari et al, which basically boils down to a recommendation to take vitamin D — it might help.
  172. Dec 31, 2009 — Minor update: just added a couple of references, Calandre et al and Fernández-de-Las-Peñas et al, to substantiate the relationship between migraines and trigger points.
  173. Dec 22, 2009 — A substantial new section makes the case for self-treatment: Fundamental limitations of trigger point therapy, and how to take advantage of them
  174. Nov 25, 2009 — Upgraded the quality of the writing in an important section, Trigger point diagnosis is not reliable … but it may not matter that much.
  175. Nov 17, 2009 — A little smorg of updates today: (1) A lovely new illustration by 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.”
  176. Oct 23, 2009 — 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.
  177. Oct 16, 2009 — 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.
  178. Sep 30, 2009 — 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.
  179. Sep 16, 2009 — Several minor updates and refinements, not in any particular section.
  180. Aug 15, 2009 — 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.
  181. Aug 13, 2009 — 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.
  182. Jul 24, 2009 — 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.
  183. Jul 16, 2009 — Physiatrists and rheumatologists added to Types of therapists and doctors and their relationship to trigger point therapy.
  184. Jun 12, 2009 — New section: “Quick-start trigger points” (access for customers only) describing the clinical characteristics and significance of extremely fast-activating and severe trigger points.
  185. May 18, 2009 — 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.
  186. Apr 1, 2009 — 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.
  187. Feb 15, 2009 — 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.
  188. Feb 9, 2009 — 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, “focusing on one trouble spot versus ‘a little bit of everything’ — which is the better strategy?”
  189. Feb 3, 2009 — 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 Gel Work for Pain?.
  190. Feb 2, 2009 — 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?.
  191. Jan 27, 2009 — 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.
  192. Dec 4, 2008 — 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 Muscle Pain as an Injury Complication: The story of how I finally “miraculously” recovered from the pain of a serious shoulder injury, long after the injury itself had healed. 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!
  193. Nov 17, 2008 — Added some information about some nice self-massage tools built by 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.”
  194. Sep 20, 2008 — 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.”
  195. Aug 18, 2008 — 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!