The Chronic Pain Center offers treatment following Dr. Janet Travell’s protocol to those suffering from myofascial trigger point and dysfunction.


Patients are seen for a consultation by Frank Gresham to evaluate their problem and to devise a treatment plan. Patient progress is monitored and adjusted as needed to ensure the patient is moving toward pain-free movement within a reasonable time frame. Reports are sent to referring physicians to enhance team communications.

Frequently Asked Questions

1) What is myofascial trigger point pain?

2) Why do muscles tighten and cause chronic pain?

3) What are common perpetuating factors?

4)What conditions can you help?

5)How does myofascial treatment differ from physical therapy, chiropractic care, acupuncture, and massage?

6)Where can I learn more?

1) What is myofascial pain?

Myo means muscle. Fascia is the thin, translucent film that wraps around muscle tissue. Fascia is the extensive, gauze-like network that gives shape to the body and supports its musculature.

Trigger points are tender spots that can develop anywhere in a muscle following chronic overload. They can also be caused by poor posture or trauma, such as a broken bone, surgery, sports injury, whiplash, or from repetitive motion.

Often, where the pain is felt is not where it originates. The muscular system often refers pain to other parts of the body, making it difficult for those not familiar with Trigger Point Myoth-erapy to determine the pain’s source. For example, common trigger points in the major neck muscle can irritate nerves causing tingling in the arm and numb fingers.

Trigger points may be active or latent. Active trigger points cause muscular pain and will refer pain and tenderness to another area of the body when pressure is applied. Latent trigger point have all the characteristics of active points but exhibit pain only on compression. Latent trigger points are believed to be one of the causes of stiff joints and restricted range of motion in old age.

Trigger points may be associated with myofascial pain syndromes. Trigger points are very common. Some might refer to trigger points as muscle knots.

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2. Why do muscles tighten and cause chronic pain?

Muscles contract whenever we use them. Unfortunately, they do not always relax back to a neutral resting position. We all know there are areas where our bodies are tight, where we carry stress. We change the way we sit, stand, and move to accommodate that tightness. These changes are called perpetuating factors.

The body tries to handle the tightness as best it can. That tension in the muscles, accumulates over days, months, and years. Just like drops of water eventually filling a bucket, the tension in the muscle is more than the body can handle and a trigger point is established. That trigger point, an irritable spot in the muscle causes it to stay contracted and results in a medically documented pain pattern. Often where the pain is felt is not where it originates.

The goal is to reverse the involved tightness and pain by eliminating the perpetuating factors, then through stretching, return the muscles to their full functioning length. This allows the muscles to return to full use as they learn to function correctly. This leaves you free to enjoy work and activities without tightness or pain.

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3. What are common perpetuating factors?



Different leg lengths
Pronation – flat feet
small hemi-pelvis


Sleep positions
Sitting positions (watching television, reading, at the computer, driving, etc.)
Head forward/round shoulders
Standing positions


Finding comfortable positions
Difficult getting to sleep
Difficult staying asleep


Low vitamin/mineral levels
Inadequate eating habits/food choices


Improper office chair, desk height, and phone


Stress – good and bad

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4.What Conditions you can help!

Tendinitis Bursitis
Fibromyalgia Whiplash Low back pain
Rotator cuff TMJ
Carpal tunnel Failed back surgery Accidents
Vertigo Headaches
Syndromes Plantar fasciitis
Elbow Knee, ankle, foot pain Tennis Hip pain/sciatica

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5. How does myofascial treatment differ from physical therapy, chiropractic care, acupuncture, and massage?

Myofascial Trigger Point Therapy

Alternative treatment therapys


Pain source

Pain site

Range of motion testing

Strength testing

Muscular differential diagnosis

Traditional diagnosis

Perpetuating factors

Precipitating factors


Myofascial origin


Pain elimination

Pain management

Total trigger point treatment

Pain site treatment

Total person treatment

Pain site treatment



Hand-on treatment

Mechanical treatment






No pain range of motion

Pain for gain

Muscle retraining

Muscle conditioning

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6. Where can I learn more?

American Institute for Myofascial Studies
National Association of Myofascial Trigger Point therapists
American Academy of Pain Management

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15100 Washington Street • Suite 102 • Haymarket, Va 20169

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