published 10/14/06, updated 7/06/08

Clair Davies’ <cite>Trigger Point Therapy Workbook</cite>

Clair Davies’ book is good … but it promises too much, and its final chapters are disappointing.

Review of The Trigger Point Therapy Workbook: Your Self-Treatment Guide for Pain Relief, a book by Clair Davies and Amber Davies

An important but flawed attempt to spread the word about trigger points

by Paul Ingraham, Vancouver, Canada MORE
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Credentials and qualifications

I am a writer and retired Registered Massage Therapist (unusually well-trained for a massage therapist, a 3000-hour program). I’m almost done with a Bachelor of Health Sciences degree. I am a peer reviewer for The Natural Standard, and a copyeditor for Science-Based Medicine. My most important qualification is more than a decade of workaholic post-graduate study, clinical experience, and constant conversations with readers from around the world, including many experts who have provided countless suggestions and criticisms.

For more information, see: Who Am I to Say? More information about my qualifications, credentials and professional experiences for my readers and customers.

Clair Davies and Amber Davies. The Trigger Point Therapy Workbook: Your Self-Treatment Guide for Pain Relief. New Harbinger Publications, 2004.

I recommend my own extremely detailed trigger point tutorial as a superior alternative and excellent companion to Mr. Davies’ book. As you will read here, Davies’ book has many qualities, but tends to promise too much, and fails to help many people with more serious trigger point pain.

(Note: Clair is a man. Although his daughter, Amber, earned co-author status with significant contributions, it is really Mr. Davies’ book, and I refer to him as though he were the sole author.)

A trigger point is a “knot” in your muscle. Muscle knots generally cause a surprising amount of trouble, including a wide array of both minor and serious and aches and pains, many of which often imitate the symptoms of more serious conditions (i.e. heart attack, appendicitis) and are responsible for fooling doctors and frightening patients.1

In fact, even though several medical experts have spent their careers studying trigger points, their clinical importance is underestimated by most health care professionals.

So, Clair Davies has made an effort to take the information directly to the people. He also hopes to take it to thousands of under-trained massage therapists,2 who are in an ideal position to help people with trigger point therapy but are often unaware of their own potential.

A strong start

The book starts out well, with a clear and reasonable tone that made me feel like cheering — finally, a popular but credible guide to trigger points and myofascial pain syndrome!

What a worthy project! It is essentially a translation, a user-friendly version of a classic but technical muscle pain text by Dr. Janet Travell and Dr. David Simons.3 And so it offers hope to countless people suffering needlessly from pain that their doctors have failed to diagnose.

I thought I was going have to write this book myself. Indeed, I was planning to. But Mr. Davies beat me to it!

The book starts out well, with a clear and reasonable tone that made me feel like cheering.

Signs of trouble

Unfortunately, the book doesn’t live up to its potential. Important subjects that are glossed over in the introductory material are never cleared up. And, like every True Believer, Davies promises too much, trying to convince readers that trigger points are responsible for practically everything that ever hurt you or ever will, and that simple self-massage will never fail to cure the problem.4

Trigger point therapy is great stuff, but it isn’t that good. This kind of over-the-top enthusiasm is exactly the kind of thing that undermines medical acceptance, and makes doctors put a book down after the first chapter.

Worst yet, excessive enthusiasm sets patients up for disappointment. Exactly as I would expect, I have met many patients who got a lot of benefit from The Trigger Point Therapy Workbook … but couldn’t take it all the way, and the book did not help them troubleshoot their difficult cases, or give them enough information to deepen their understanding.

Like every True Believer, Davies promises too much.

I finally stopped myself in the middle of a the concluding chapter, a long and rambling first-person account of Davies’ personal struggle with anxiety and muscle tension. He starts losing credibility fast by complaining on page 286 that “personal experience is derisively called ‘anecdotal evidence’ by academics.” Let’s look into that …

A weak finish

Anecdotal evidence is limited, but no good academic thinks its useless — indeed, anecdotal evidence is often exactly what gives researchers their inspiration to look for better evidence. Davies petulantly misses the point and trys to polarize medical science into people who cherish subjective data and people who allegedly sneer at it — and obviously placing himself in the enlightened camp. He therefore alienates serious readers in droves. So much for spreading the word to health care professionals!5

By petulantly dismissing “academics” who allegedly sneer at subjective evidence, Davies is alienating serious readers in droves.

Davies may have been trying to imitate Deane Juhan’s brilliant exploration of the same topic (subjective experience, anecdotal evidence, etc) in the first chapter of his book, Job’s Body. But where Juhan offers something insightful to virtually any reader, Davies comes off as a dabbler in deep thoughts, and that whole section of the book is basically a waste of ink.

The final chapter then simply becomes tedious and a bit embarrassing as Davies gets increasingly personal and verbose and starts trying to explain and defend elaborate original theories. He should have stayed on the scientific bedrock laid for him by Travell and Simons.

Conclusions

Fortunately, for most of the book, Davies did stick to just translating Travell and Simons. The middle chapters, which are also the bulk of the book, are simply a reference work: a detailed, readable, useful and well-illustrated guide to self-treatment of trigger points.

So the book is an awkward mix: important and useful on the one hand, but too flawed and gushing to be taken seriously on the other. Clair Davies is obviously a zealot because he is a convert, and he leaves the world still in need of a book about trigger points that is both readable and credible. I hope my own trigger point tutorial is that book!

Interesting excerpts from The Trigger Point Therapy Workbook

David Simons brief foreward to the book is an incredibly lucid summary of the subject. Here are three nice excerpts from it:

Muscle is an orphan organ. No medical speciality claims it. As a consequence, no medical specialty is concerned with promoting funded research into the muscular causes of pain, and medical students and physical therapists rarely receive adequate primary training in how to recognize and treat myofascial trigger points. Fortunately, massage therapists, although rarely well-trained medically [BC being one of the obvious exceptions, see Massage Therapy In British Columbia (Canada) — PI], are trained in how to find myofascial trigger points and frequently become skilled in their treatment.
from the forward, by David Simons

•

Since there is no well-established body of research on this subject, there is no well-recognized etiology. Nevertheless, a credible hypothesis based on solid scientific research is available to serve as a model for further research to clarify the nature of myofascial trigger points. Much research needs to be done on this neglected subject.
from the forward, by David Simons

•

Skilled clinicians recognize myofascial trigger points as the most common cause of ubiquitous enigmatic musculoskeletal pain, but finding a truly skilled practitioner can be frustratingly difficult.
from the forward, by David Simons

•

The following excerpts are from the body of the book:

The daily clinical experience of thousands of massage therapists, physical therapists, and physicians strongly indicates that most of our common aches and pains — and many other puzzling physical complaints — are actually caused by trigger points, or small contraction knots, in the muscles of the body.
p2

•

... an appallingly high percentage of doctors and other practitioners are still pretty much out of the loop regarding trigger points, despite their having been written about in medical journals for over sixty years.
p2

•

Only massage therapists seemed to be informed about trigger points and referred pain, and only exceptional individuals among them (in my own experience at least) were treating trigger points effectively. What’s more, the burgeoning variety of unproven modalities offered by massage therpaists gave the profession such an aura of flakiness that the elegant science of myofascial pain got unfairly confused with treatments whose results could easily be attributed to the placebo effect.
p10

•

All the people who came for massage had already been to a physician or a pain clinic. Almost all had experimented with chiropractic. Many had been to the emergency room for their pain. Most had been through physical therapy. They had tried everything, including various forms of alternative medicine. Some had even tried massage but hadn’t been impressed. It had been “feel-good” massage: it had been relaxing but hadn’t put a dent in their pain.
p13

•

In this articulate passage, Clair Davies discusses some patterns he has observed in private practice as a massage therapist. My experience has been identical.

Interestingly, almost all the people who came to me had some kind of back pain along with whatever other pain complaint they had. Their previous treatments for back pain had always focused on the spine. I heard about injections of papaya or cortisone. People had usually been told they had arthritis or bad disks, or that their cartilage had been worn away. They’d been shown X-rays [or MRIs! — PI] that purported to prove it. Some had already had surgery, and frequently had as much pain after surgery as before. Typically, the surgeon’s last word was always that he was sorry but he’d done all he could. Then he’d renew their prescription for painkillers and dump them off on a physical therapist. I heard these stories over and over again. And over and over, I found that trigger point therapy gave them the relief they’d been seeking for so long. Had trigger points been the problem in the first place? Arthritis? Bad disks? In Travell and Simons’ Myofascial Pain and Dysfunction, I had read that you can have herniated disks and arthritis of the spine and still find that myofascial trigger points are the primary cause of your back pain.
p13

Notes

See Save Yourself from Trigger Points & Myofascial Pain Syndrome!. Return to text.
Most places in the world, standards for training massage therapists are low. For more information, see Massage Therapy In British Columbia (Canada). Return to text.
Travell et al. Myofascial Pain and Dysfunction. 1999. The ultimate myofascial pain syndrome reference, the product of decades of extraordinary dedication by two doctors famously devoted to the subject of soft tissue pain. The two-volume set is also brilliantly illustrated. The introductory chapters constitute an excellent overview of the subject, albeit a dauntingly technical one. Note: although a landmark and important text, more recent information has been published in Muscle Pain: Understanding Its Nature, Diagnosis and Treatment by Siegfried Mense and David Simons. Return to text.
Later on in the book, in a chapter written for therapists instead of consumers, Davies discusses the limitations of trigger point therapy. But the introductory chapters present trigger point therapy as a panacea. Return to text.
Reading this foolishness was all the worse for me, because Davies’ amateurish opinions is overshadowed by a much more mature one, in the early chapters Deane Juhan’s masterful Job’s Body: A Handbook for Bodywork. Return to text.