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.

What is myofascial trigger point 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.

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.

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

What conditions can you help?

If you would like to contact Frank about any of the conditions listed within this section please click the link next to the condition type to send him a message.

•  Accidents  →  Send a note to Frank

•  Bursitis  →  Send a note to Frank

•  Carpal tunnel  →  Send a note to Frank

•  Elbow    Send a note to Frank

•  Failed back surgery  →  Send a note to Frank

•  Fibromyalgia  →  Send a note to Frank

•  Headaches  →  Send a note to Frank

•  Hip pain  →  Send a note to Frank

•  Sciatica    Send a note to Frank

•  Knee pain    Send a note to Frank

•  Ankle pain  →  Send a note to Frank

•  Foot pain    Send a note to Frank

•  Low back pain  →  Send a note to Frank

•  Plantar fasciitis  →  Send a note to Frank

•  Rotator cuff  →  Send a note to Frank

•  Syndromes  →  Send a note to Frank

•  TMJ  →  Send a note to Frank

•  Tendinitis  →  Send a note to Frank

•  Tennis  →  Send a note to Frank

•  Vertigo  →  Send a note to Frank

•  Whiplash  →  Send a note to Frank

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

Where can I learn more?

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