Foundational Textbooks
References
Overview IllustrationTravell JG, Simons DG. Myofascial Pain and Dysfunction: The Trigger Point Manual. Volume 1 — Upper Half of Body, 2nd Edition. Williams & Wilkins, 1999.
The foundational reference for myofascial trigger point science
Travell JG, Simons DG. Myofascial Pain and Dysfunction: The Trigger Point Manual. Volume 2 — Lower Extremities. Williams & Wilkins, 1992.
Simons DG, Travell JG, Simons LS. Travell & Simons' Myofascial Pain and Dysfunction: The Trigger Point Manual. 3rd edition concepts incorporated throughout the site.
Fernandez-de-las-Penas C, Dommerholt J. International Consensus on Diagnostic Criteria and Clinical Considerations of Myofascial Trigger Points: A Delphi Study. Pain Medicine, 2018.
Key Clinical Studies
References
Key Clinical StudiesShah JP, Thaker N, Heimur J, et al.
2015“Myofascial Trigger Points Then and Now: A Historical and Scientific Perspective.” PM&R
Key finding: Comprehensive review of biochemical milieu
Shah JP, Phillips TM, Danoff JV, Gerber LH.
2005“An in vivo microanalytical technique for measuring the local biochemical milieu of human skeletal muscle.” J Appl Physiol
Key finding: First direct measurement of trigger point biochemistry
Gerwin RD.
2014“Diagnosis of myofascial pain syndrome.” Phys Med Rehabil Clin N Am
Key finding: Diagnostic criteria and clinical examination
Hong CZ.
1994“Lidocaine injection versus dry needling to myofascial trigger point.” Am J Phys Med Rehabil
Key finding: Landmark comparison study
Lewit K.
1979“The needle effect in the relief of myofascial pain.” Pain
Key finding: Demonstrated mechanical needling effect independent of substance
Simons DG.
2004“Review of enigmatic MTrPs as a common cause of enigmatic musculoskeletal pain and dysfunction.” J Electromyogr Kinesiol
Key finding: Integrated hypothesis
Ge HY, Fernandez-de-las-Penas C, Yue SW.
2011“Myofascial trigger points: spontaneous electrical activity and its consequences for pain induction and propagation.” Chin Med
Cagnie B, Dewitte V, Barbe T, et al.
2013“Physiologic effects of dry needling.” Curr Pain Headache Rep
Systematic Reviews & Meta-Analyses
Fernandez-de-las-Penas C, Nijs J. “Trigger point dry needling for the treatment of myofascial pain syndrome: current perspectives within a pain neuroscience approach.” J Pain Res, 2019.
Tough EA, White AR, Cummings TM, et al. “Acupuncture and dry needling in the management of myofascial trigger point pain: a systematic review and meta-analysis of randomised controlled trials.” Eur J Pain, 2009.
Dommerholt J. “Dry needling — peripheral and central considerations.” J Manual Manip Ther, 2011.
Liu L, Huang QM, Liu QG, et al. “Evidence for Dry Needling in the Management of Myofascial Trigger Points Associated With Low Back Pain: A Systematic Review and Meta-Analysis.” Arch Phys Med Rehabil, 2018.
Barbero M, Falla D, Mafodda L, et al. “Atlas of Muscle Innervation Zones.” Springer, 2012.
Special Topics
Younger J, Noor N, McCue R, Mackey S.
2013“Low-dose naltrexone for the treatment of fibromyalgia.” Arthritis Rheum
Focus: Landmark LDN trial
Arendt-Nielsen L, et al.
2015“Central sensitization in humans: assessment and pharmacology.” Handb Exp Pharmacol
Langevin HM.
2006“Connective tissue: a body-wide signaling network?” Med Hypotheses
Focus: Fascial science
Stecco C, et al.
2013“Fascial components of the myofascial pain syndrome.” Curr Pain Headache Rep
Acknowledgments
To the pioneers
Janet Travell and David Simons transformed our understanding of myofascial pain. Their work remains the foundation.
To the researchers
The scientists who continue to advance our knowledge — Shah, Gerwin, Fernandez-de-las-Penas, Dommerholt, Hong, Lewit, and many others.
To the clinicians
Healthcare professionals worldwide who diagnose and treat myofascial pain daily.
To the patients
Those living with chronic pain who shared their experiences and helped shape this resource.
Open source
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Key Takeaways
We aim to ground our clinical guidance in peer-reviewed research, landmark textbooks, and systematic reviews from the myofascial pain literature where available.
The Trigger Point Manual by Travell and Simons remains the gold-standard reference, supplemented by modern research on biochemistry, central sensitization, and treatment efficacy.
We continuously update our content as new evidence emerges from ongoing research in myofascial pain science, dry needling, and pain neuroscience.
This resource is designed for education; for diagnosis and treatment decisions — especially new, worsening, or red-flag symptoms — see a qualified healthcare provider.