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

Fresh Fruit & Vegetables = Good Health

These are just some of the fresh fruits and vegetables we will be using for this weeks meals (1/3-8/2010).  Green, brown, red and white onions; cilantro; jalapeno and Serrano chilies; garlic; green cabbage; Roma tomatoes; celery; carrots; cucumber; red and green apple; banana; lemon and lime.  Already in the refrigerator: Romaine lettuce, cauliflower, flat-leaf parsley and broccoli.

Here are just some of the benefits that one may obtain from eating these fruits and vegetables.

Celery and Green Peppers/Chilies: Researchers at the University of Illinois have found that the plant compound, luteolin,  found in abundance in celery and green peppers can disrupt a key component of the inflammatory response in the brain.  Luteolin reduces IL-6 production in microglia by inhibiting JNK phosphorylation and activation of AP-1

Onion: Are rich in the bioflavinoids curcumin and quercetin.  This natural combination is effective in reducing oxidative stress.  Oxidative stress is known to trigger autoimmune disease development and contribute to disease flare-ups.  Studies show that onions support cardiovascular health, help prevent diabetes and atherosclerosis and reduce the risk of colon and stomach cancers.

Chilies Peppers: Frequent consumption of chilies may help fight migraine and sinus headaches; prevent sinusitis and relieve congestion; fight cancer; lower high blood pressure;  reduce inflammation; relieve Intestinal Diseases; help burn fat and lose weight; protect your heart.

Tomato: Are the best source for the antioxidant, Lycopene.  Lycopene has been shown to help protect not only against prostate, but breast, pancreatic and intestinal cancers, especially when consumed with fat-rich foods, such as avocado, olive oil or nuts (This is because carotenoids are fat-soluble, meaning they are absorbed into the body along with fats).  The lycopene in tomatoes may also provide cardiovascular benefits.  Diets rich in tomato products may significantly improve cholesterol profiles and reduce the tendency to form blood clots.

Carrot: Are by far one of the richest source of carotenoids-just one cup provides 16,679 IUs of beta-carotene and 3,432 REs (retinol equivalents), or roughly 686.3% the RDA for vitamin A.  High carotenoid intake has been linked with a 20% decrease in postmenopausal breast cancer and an up to 50% decrease in the incidence of cancers of the bladder, cervix, prostate, colon, larynx, and esophagus.  Falcarinol another active chemical in carrots promote colon health.  The development of emphysema my be reduced with a diet high in vitamin A, even in smokers.:

Apples: Are a rich source of phytochemicals (phenolics, flavonoids and carotenoids) and epidemiological studies have linked the consumption of apples with reduced risk of some cancers, cardiovascular disease, asthma, and diabetes.

Garlic: And its preparations have been widely recognized as agents for prevention and treatment of cardiovascular and other metabolic diseases, atherosclerosis, hyperlipidemia, thrombosis, hypertension and diabetes.

Broccoli: Like other cruciferous vegetables (kale, cabbage, Brussels sprouts), broccoli contains the phytonutrients sulforaphane and the indoles, which possess significant anti-cancer effects.  Broccoli also supports stomach health (anti H. pylori); supports sun-damaged skin; cardiovascular-protective; may prevent cataracts, osteoporosis (high in vitamin K), birth defects (high in folic acid) and is an immune system stimulator.

]]> http://www.advancedhealing.com/blog/2010/01/03/luteolin-curcumin-quercetin-sulforaphane-capsaicin-indole-lycopene-carotene/feed/ 0 http://www.advancedhealing.com/blog/2009/12/17/migraine-headache-relief-integrative-medicne-orange-chiropractor/ http://www.advancedhealing.com/blog/2009/12/17/migraine-headache-relief-integrative-medicne-orange-chiropractor/#comments Thu, 17 Dec 2009 18:50:42 +0000 Dr. Marcus Ettinger http://www.advancedhealing.com/blog/?p=384 12/12/09

Hi Marcus,

I wanted you to know that this time around I felt better almost immediately, and within 24 hours, I felt better than I have in quite some time.  I so appreciate your healing, caring, and your generosity.

Have a great, rainy day!

Happiness = Good Health

Treatment Protocol: Bio-identical hormone replacement (Phyot-B)*, magnesium and potassium aspartate, and specific atlas (C1) and axis (C2) chiropractic adjustments

Phyto-B is designed to provide hormone support for the those who have reduced estrogen and progesterone levels. Phyto-B is an herbal supplement designed to address declining hormone levels and combat menopausal symptoms. This is done by giving support to the estrogens and progesterone through plant derived products. Phyto-B is prepared by Bezwecken.

Excessive negative stress has become, over the last 25 years, as much a part of our daily lives as eating and sleeping. Excessive negative stress can be physical (chronic illness, lack of exercise, over-exercising, etc.), emotional (losing a job, winning the lottery, etc.), or chemical (bad diet, drugs, medicines, alcohol, pesticides, etc.).

Excessive negative stress is most likely to be the initial predisposing factor in the cause and prolongation of a disease or illness. Again, the greater the exposure and duration to these negative stressors the greater the susceptibility to acute or chronic illness or body dysfunction.

It is also important to note that not all stress is bad or has negative effects on our bodies. Some types of stress are actually beneficial for us and can increase our immune function, overall strength, emotional well being and longevity. The most beneficial form of stress is exercise, especially swimming and weight training. This type of stress can, in moderation, even negate some of the excessive negative stress’ we face.

When our bodies are exposed to any form of negative stress our organ systems innately responds with what is known as the “fight-flight response”. During this stress induced response, many different and potentially damaging physiological reactions occur. During the initial phase, which can last for seconds to years, digestion and absorption of nutrients are greatly reduced; body tissues begin to break down; the immune system is suppressed; our heart begins to overload and the aging process is significantly accelerated. These are but a sampling of what does occur.

Individuals who are exposed to excessive negative stress may also develop a condition known as adrenal exhaustion. This condition occurs when the adrenal glands work beyond their normal capacity thus eventually shutting down (no more Cortisol, a hormone, being produced). Adrenal exhaustion presents with symptoms similar to those found in patients with chronic fatigue syndrome (CFS), hypothyroidism, fibromyalgia and hypoglycemia (see table 1).

Table 1

An integrative medicine approach for the treatment of adrenal exhaustion or the effects excessive negative stress are identical. First, it’s crucial to reduce or eliminate as many negative stressors (individual stress factors) as possible.

Second, get plenty of rest, at least 8 hours, starting before midnight; engage in regular, but not excessive, exercise; greatly reduce your carbohydrates intake (bread, sweets, pasta, corn and potatoes); increase protein intake; increase fibrous vegetable intake; drink eight glasses of filtered water daily, and perform deep breathing exercises every morning and evening.

Third, nutritional and/or pharmacological support. To determine pharmacological support we must first determine thyroid and adrenal function via blood tests (thyroid panel including both thyroid antibodies and rT3), and (DHEA, cortisol and progesterone) levels. Nutritional support can be in the form of DHEA and/or Pregnenolone (10 – 50 mg daily) and/or glycerrhizin (25 – 100 mg daily – preferably in the morning). These two supplements safely support proper adrenal hormone levels. DMG (vitamin B15) and Siberian Ginseng have both been shown in Russian clinical studies to help regulate the hypothalamus, pituitary, adrenal axis. Pantothenic acid (vitamin B5) is the initial precursor, along with our LDL cholesterol to our adrenal hormones, whole C complex (Ester-C w/bioflavonoids) is an antioxidant for the adrenal and the highest concentration of vitamin C out side of the spinal chord and brain is found in the adrenal; and potassium are essential for proper adrenal gland function. Adrenal glandular preparations (Whole Desiccated Adrenal (short-term), Drenamin and Drenatrophin PMG) from Standard Process Inc. will also help to support the adrenal glands. These are but a few options that I have used to support the stress response of the body.

Additionally, antioxidants and supportive products like: CoQ10, glutathione, NAC, vitamin E, bioflavonoids, alpha lipoic acid, SAMe, Gabatone (Apex Energetics), L-tryptophan, magnesium and MSM, will also help reduce the overall oxidative burden placed on the body by the excessive negative stress.

With the above knowledge the road to well being and health is now a much shorter one.

My theory has developed over a 20 year period of time and holds credibility as a corollary to the long-standing law in anatomy and physiology known as – Wollf’s law.  Wolff’s law, in short, states that, “bone remodels according to the physical stress placed upon it.”  As an example: a pitcher’s, pitching arm (humerus, radius and ulna) will be denser than his non-pitching arm.  The opposite of this is, if we lived in outer-space our bones would dissolve (osteoporosis) because of the lack of gravity; no weight-bearing load on the bones.  All of the calcium supplementation, estrogen replacement (for women), and Fosimax (medication) in the world would not prevent this process from happening.

My theory takes Wollf’s law to the next level and states, “Our entire body remodels according to the stress placed upon it: invisibly, physically, emotionally and chemically.” All four of these stressors or outside influences/forces, will directly affect the remodeling of every cell, tissue and physiological function of the body.  This means that our inward and outward appearance and physiological state is in direct correlation to the (way, what and/or how) we sleep, eat, drink, act, exercise, think, deal with stress, or are exposed to stress’ or outside forces.

Physical stress makes-up the largest portion of the overall stressors we will be subjected to on a daily basis. The foods we eat and how often, our exercise level or lack of exercise, chronic postures (work, driving and sleep), chemicals, pesticides, excessive alcohol, medicines, drugs and our body’s own waste products, all influence how we remodel.

If we ingest all of the essential nutrients that our body requires, with all other factors aside, our body will remodel properly. The opposite can be said for eating devitalized food, such as fast food, boxed or canned food; as well as being exposed to drugs, medicines, alcohol, pesticides, toxins, etc… Examples: If we increase protein and weight bearing exercise, an increase in muscle mass and strength will be the result. If we increase fats and/or carbohydrates, combined with a lack of physical exercise, an increase in body fat, blood sugar, blood fats and blood pressure will be the result. This is called: diabetes, obesity, high cholesterol and hypertension. Exposure to toxins, pesticides, molds, drugs or excessive alcohol, may lead to cancer, ADHD and many other diseases.

Emotional stress placed on the body will have similar effects. If we feel or are exposed to happiness, joy or generosity, all good stress’ will facilitate a positive remodeling (ex. neurotransmitter and hormone production). If we feel or are exposed to anger, expressed or unexpressed resentment, blame or shame, all negative emotions, this will facilitate our body to remodel in a non-optimum way (increased inflammation on decreased endocrine and brain function – Parkinson’s and Alzheimer’s).  The negative remodeling can lead to everything we don’t want to have our body experience, such as cancer, autoimmune disease and body degeneration. The positive remodeling will help increase the immune system and overall strength of the body, leading to a longer, healthier and more vibrant life.

Invisible forces (electromagnetic waves [radio waves, microwaves, infrared radiation, visible light, ultraviolet radiation, X-rays and gamma rays], gravity and ionizing radiation) are constantly present and can affect us as much as the overt chemical, emotional and physical forces do. The invisible forces, most of the time, actually precede and initiate the physical, emotional or chemical stress’ that causes the remodeling of our body’s cells or, more specifically, the cell membranes.

It’s easy to see from this, that everything we do or don’t do, and everything that is done to us, sometimes unknowingly, affects how our body remodels. This means how we look and how we functions.  The point I am trying to make here is that we can at least be “cause” of over a very large part of this and be responsible for what we do on a daily basis (eat, exercise, rest…) and what we allow around us. If we do not learn from this then we can go through life at “effect” like a stick floating down a river, out of control. By ignoring this theory, negative remodeling will be the outcome and all the negative consequences that come with it. The choice is ours.

©06 January 2009 Marcus Ettinger and AdvancedHealing.Com. All rights reserved (no portion of this may be re-printed or used without permission)