Trigger Point Therapy, The Technique That Helped JFK’s Back
by John Zlatic, 1989

The majority of this article is original. I have made minor corrections where a medical term was used incorrectly or where another term would be more appropriate. I have also added some additional material, which I feel  enhances the article but does not alter the original theme or intent.

Dr. Janet Travell, the first woman ever to serve as White House Physician, takes a large portion of the credit for modern Trigger Point Therapy, the technique that helped JFK’s painful back.

It was 1952 and the voters of Massachusetts chose a Navy war hero as their representative in the United States Senate. The handsome young Senator had connections, charisma, sharp wits and a determined vision that would lead him to the White House. But young Senator John F. Kennedy also had a bad back. And though many Americans are aware that Kennedy had back problems, he wasn’t one to publicize the severity of his injuries. Kennedy originally injured his back in 1939 and strained it further when a Japanese destroyer rammed and sank the WWII torpedo boat, PT-109 he commanded, hurling him across the deck.A disc operation in 1944 and a spinal fusion in 1954 failed to provide permanent relief from his left-sided back pain, which made it nearly impossible for him to bear weight on his left foot. An old football injury hampered the bending of his right knee. Unable at times to put weight on either foot, Kennedy’s crutches became a familiar sight in the U.S. Senate chambers. Both Kennedy and his crutches disappeared in late 1954, however, when complications from his back surgery forced the hard-working Senator to take a seven-month leave of absence.

Health Restored

At 37 years old, pale and anemic with an adrenal insufficiency (Addison’ disease) and restricted range of motion in his aching back, neck and legs, Kennedy failed to fit the picture of a potential presidential candidate. In and out of doctors’ offices for month after month, there seemed no help… even for a man well able to afford the very best medical care. But somehow in the months following his 38th birthday, Kennedy’s health improved considerably. In the ensuing presidential race, he soon was arguing that “the White House needs a young man of strength, health and vigor.”

What happened to the crutches? The bad back? What treatment proved effective enough to convince political opponents and the probing press that a man recently dependent on crutches was now physically fit for the Presidency? How was the ailing JFK revitalized? A large, if not predominant, portion of the credit belongs to Dr. Janet Travell — mother, teacher, research pioneer and, as personal physician to both Presidents’ Kennedy and Lyndon B. Johnson, the first woman ever to serve as White House Physician. Except for her White House tenures, Travell, now 87, focused her efforts during the last half century on the diagnosis and treatment of pain syndromes due to “trigger points.”

Dr. Janet Travell’s Trigger Point Therapy

In 1955, JFK found Travell’s Trigger Point Therapy a godsend for his aching muscles. Today, the patients of many doctors, chiropractors, dentists, physical therapists, myotherapists and massage therapists are benefiting from the research of Travell and others.

Trigger Point Therapy is safe and effective in alleviating myofascial pain and syndromes that erroneously, or by default, become categorized under such headings as tennis elbow, frozen shoulder, dysmennorhea, TMJ, fibrositis, trick knee, whiplash, etc. Mainstream clinical research has shown that trigger points are often responsible for headaches, muscle weakness and pain, restricted range of motion, tearing, sweating, salivation, dizziness and blurred vision.

Kennedy sought Travell’s help during his sick leave from the Senate, which he spent writing Profiles in Courage. “I met Jack Kennedy when he was a junior senator from Massachusetts,” Travell explained following one of her well-attended seminars in Palm Springs. “He had war wounds and was on crutches for so long he had calluses under his armpits. I got him off those crutches and when he asked me to go to the White House with him, well… I didn’t think I could say no.”

Travell declines to detail President Kennedy’s personal medical file. But with her ongoing research, writing and seminars, she tirelessly continues to honor the late president’s wish that she teach others the therapy he found so helpful. And she has, at least in major medical research journals. Since her first collaborative research paper that appeared in the Journal of the American Medical Association in 1942, Travell’s name has appeared at the top of some 50 major reports on the mechanics and treatment of pain caused by trigger points. These tender spots in muscles (and other types of tissue) are extremely sensitive to touch and possess the nasty ability to refer pain and other symptoms and sensation to distant parts of the body. For instance, the all-too-common trigger points in the muscle between the neck and shoulder (the trapezius) often send pain shooting up back of the neck, around the ear and above the eye.

Mapping Trigger Points

Over the decades of observing thousands of patients, Travell and other researchers have compiled maps of the most common TPs and the areas to which they refer pain. For instance, Travell discovered that common trigger points in the sternocleidomastoid (the major neck muscle) refer pain to select areas of the head and are sometimes responsible for the “morning-after” hangover headache. TPs in the neck’s scalene muscles can irritate nerves that send pain, tingling or numbness down the arm of the same side. Trigger points in the levator scapulae muscle are most often the culprits of a “stiff neck.”

The referred pain from TPs, which usually fail to follow “normal” neural pathways, may travel a considerable distance. For example, pressing on a TP in the calf of the lower leg (the soleus muscle) can reproduce a patient’s nagging pain and tenderness in the lower back, directly over the sacroiliac joint. Trigger points in the abdomen, pelvic area and legs also are responsible for several common back pains. By inactivating the trigger points bothering Kennedy’s back and then preventing their reoccurrence by prescribing proper exercise, footwear and seating (she revolutionized the rocking chair). Travell played a significant role in the unfolding of American political history.

Reshaping Medical History

In her continuing research into the mechanisms and treatment of trigger point pain, Dr. Travell also is reshaping medical history. She defines an active myofascial trigger point as an area of hypersensitivity (about 1/16-1/8in. diameter) usually found in an abnormally tightened band of muscle. When pressed, a trigger point causes immediate local pain disproportionate to the finger pressure. In other words, lightly pressing on a muscle one inch from a trigger point might cause no discomfort, but the same pressure directly on the area of maximum sensitivity prompts immediate pain. In addition to pain, an active trigger point causes muscle weakness and restricted motion. A latent triggerpoint causes weakness and restriction, but not pain – at least not until it becomes activated.

Causes of Trigger Points

What causes trigger points? Normal, healthy muscles contain no TPs. Muscles develop TPs following acute trauma, chilling or chronic overload. Acute trauma may consist of falls, car accidents, joint sprains, a direct blow to the muscle or abnormal excessive exercise, such as packing when moving or engaging in a strenuous bout of weekend athletics. A cold draft such as that from air conditioning or open window may activate latent TPs in tired muscles.

Trigger points also develop in muscles that are chronically overloaded by poor posture, especially while working, or repeating muscle movements as in typing, playing the violin, or even knitting. Structural discrepancies, like uneven legs and pelvic bones, or short arms on a long upper body, often produce a chronic mechanical stress that activates TPs. This is why Travell prescribed left heel lifts for all of Kennedy’s shoes and custom designed seating for the president’s personal quarters, his office, helicopter, planes, boats and limousine.

In short, trigger points generally follow in the wake of muscle strain or abuse. Research has shown that manual laborers who use their muscles every day are less likely to develop TPs than are sedentary workers who occasionally overdose on tennis, volleyball or other strenuous activities.

Putting TPs to Rest

How is a trigger point inactivated? Travell teaches two main methods of putting TPs to rest: 1) “stretch and spray” and 2) procaine injection. Other methods that she recognizes as effective include ultrasound at low intensities, deep finger pressure (Myotherapy) or a properly applied massage. When the involved TPs are located and inactivated, the pain often disappears immediately. But with chronic cases involving TPs in several muscles over a long period of time, sustained relief usually requires successive treatments. The stretch and spray technique consists of applying a cold spray (vapocoolant) to a TP and its pain reference area while simultaneously and slowly stretching the muscle to its full normal length. For stubborn TPs in areas inaccessible to passive stretch, Travell injects the point with a .5% procaine solution, followed by stretch and spray.

Deep finger pressure in TPs was popularized by Bonnie Prudden in her books on Myotherapy. Prudden recommends seven seconds of sustained pressure on TPs to erase them. Other therapists press the point until the referred pain subsides. Massage (as well as other TP treatments) is “only effective if you know what you’re doing,” Travell says. “Vigorous massage of hyperirritable trigger points may markedly increase pain.”



Orange County chiropractor, Dr. Marcus Ettinger, shares simple techniques to a better quality of life. Below are 11 easy rules, that if followed, will improve the overall integrity of your back (spine and supporting muscles) while at the same time reducing the potential for the development of degenerative arthritis, low back injury and low back pain.

1. Always warm-up and stretch before exercise or other strenuous physical activity. If you are beginning an exercise program for the very first time or are starting back after a prolonged period of inactivity, begin your exercise program with routine, low-impact exercises. Yoga, swimming, speed walking, or stationary bike riding just 30 minutes a day can increase low back muscle strength, over-all posture and flexibility. Ask your chiropractor for a list of low-impact, ‘core stabilizing’ exercises appropriate for your age. Core stabilizing exercises focus on strengthening, in tandem, the lower back and abdominal musculature.
2. Don’t slouch when standing or sitting. When standing, keep your weight balanced on your feet. Your back supports weight most easily when curvature is reduced.
3. At home or work, make sure your work surface is at a comfortable height for you.
4. Sit in a chair with good lumbar support and proper position and height for the task. Keep your shoulders back. Switch sitting positions often and periodically walk around the office or gently stretch muscles to relieve tension. A pillow or rolled-up towel placed behind the small of your back can provide some lumbar support. If you must sit for a long period of time, rest your feet on a low stool or a stack of books.
5. Wear comfortable, low-heeled shoes with supportive arches.
6. Sleep on your side or back to reduce any curve in your spine. Always sleep on a firm surface.
7. Drink eight, eight ounces of purified water each day. 75% of the weight of the upper body is supported by water volume that is stored in the disc core; 25% is supported by fibrous material around the disc. (Batmanghelidj MD)
8. Don’t try to lift objects too heavy for you. Lift with your knees, pull in your stomach muscles, and keep your head down and in line with your straight back. Keep the object close to your body. Do not twist when lifting or when setting the object down.
9. Maintain proper nutrition and diet to reduce and prevent excessive weight, especially weight around the waistline that stresses lower back muscles. Sufficient daily intake of vitamin D, magnesium, calcium and phosphorus, along with weight-bearing exercise will help promote new bone growth.
10. If you smoke, quit. Smoking reduces blood flow and oxygen to the muscles and spine, causing the muscles and intervertebral ‘spinal’ discs to degenerate.
11. Visit a chiropractor for routine check-ups. Keeping your spine and other joints of the body are in proper alignment and moving freely with unrestricted range of motion will reduce ware and tear by keeping the body bilateral and symmetrical; it will also promote unrestricted nerve and blood flow throughout the body

Did You Know?

• About 80% of North Americans suffer from lower back pain.
• 67% of Americans over the age of 21 are over-weight, and 45% of them are satisfied with their body weight.
• Estimates are that by the year 2030, 86% of Americans over the age of 21 will be over-weight.
• 45 percent of Americans are satisfied with their body weight.
• Nearly half of Americans feel better on the days when they exercise.
• Nearly 1 in 10 Americans are aware the USDA recommends 30 minutes of physical activity.
• Only 50% of Americans know that in order to lose one pound, you must burn 3,500 calories more than you eat.
• 6 out of every 100 American adults get 30 minutes of exercise a day.
• 2 out of 10 Americans exercise three to four times per week.
• 2 out of 10 Americans walk or bike instead of taking transportation.
• 4 out of 10 Americans take the stairs whenever possible.
• 3 out of 10 Americans regularly park their cars farther from their destination to get in extra walking.

Key points from the study including my observations from 20 years of treating low back pain in my Orange, CA chiropractic office and 25 years training with weights:

“Strengthening only one part of the body will not cut it.” Strengthening every muscle group of the body including the so-called ‘core muscles’ is the best way to stabilize the spinal column and prevent injury to muscles and joints.

“Anyone with neck or low back pain should consult a chiropractor or physician before proceeding with an exercise plan.” Pain can come from many sources and an evaluation beforehand will help to determine if an exercise plan is right for you.  A chiropractor is specifically trained in these areas and the most competent type of doctor to make this determination.

“Exercising is counterintuitive based on how you feel,” Kell (one of the researchers) says.  “It hurts, so you want to stop.  We associate pain with something being wrong or getting worse, so we think we should rest more often. But really what happens if they get up and exercise with low back pain, the joints loosen up and feel better.”

“If you continue to strengthen the body, the pain will subside, either substantially or to a small amount, but it will subside.” Other factors that will facilitate quicker reduction in pain or a decreased chance of back injury are:

• Reducing excess weight.
• Receiving routine chiropractic adjustments.
• Increase the amount of magnesium and potassium in your diet by eating more green-leafy vegetables.
• Drink at least two quarts of water per day.
• Get a new bed if the one you have is too old or is not supportive.

“Aerobic Exercises such as jogging, walking on a treadmill or using an elliptical machine to ease low back pain, has only a minimal benefit.” Aerobic exercise should be part of any comprehensive work-out program and should be preformed 20-30 minutes three times per week, preferably just before the weight-training portion of the work-out.

Please share what you do to help when you experience back pain.

Marcus Ettinger DC, BSc