The application of direct pressure to the Trigger Point to eliminate tenderness - always looking for and concentrating on those that create a specific pattern of pain referral.The use of vapocoolant sprays such as “ Spray and Stretch“.Injection of the Trigger Point with a local anesthetic.There are not only all sorts of theories as to how Trigger Points start, there are a wide variety of methods used to treat them as well. Although Trigger Points can be found anywhere in the body, by far the most common place people get them is in the upper trapezius (shoulder muscle). And although not as common, they can involve a “Twitch Response” (if you run your fingers along a Trigger Point perpendicular to the direction of the muscle fibers themselves, it can cause the “triggered” portion of the muscle to fire or ‘twitch’). Not only this but they tend to refer pain along very specific patterns. In other words, Trigger Points are hard (pea or marble-sized) nodules of tissue that cause pain, but have no specifically known causes or findings that can be determined from X-rays, MRI, or neurological examinations. The pain cannot be explained by findings on neurological or radiological examinations.Palpation of the trigger point reproduces the patient’s complaint of pain, and the pain radiates in a distribution typical of the specific muscle harboring the trigger point.The painful point can be felt as a nodule or band in the muscle, and a twitch response can be elicited on stimulation of the trigger point.Pain related to a discrete, irritable point in skeletal muscle or fascia, not caused by acute local trauma, inflammation, degeneration, neoplasm or infection.Travell herself had described in her work. This went along hand in hand with what Dr.
Tender spot in a taut band of skeletal muscle. A review of the scientific literature on Trigger Points was published in a 2007 issue of The Clinical Journal of Pain, describing the four most common diagnostic criteria of Trigger Points. Travell and Simons, Trigger Points are defined as, “ hyperirritable spots in skeletal muscle that are associated with palpable nodules in taut bands of muscle fibers.” In other words, they are small, hard muscle knots. Then in the early 1980’s, along with a doctor named David Simmons (a disciple of hers), published the fore mentioned book. She figured out a way to help him with the pain he had due to injuries he received in WWII (PT 109), and along the way, developed the current theory of Muscle Trigger Points (MTrP’s). You see Dr Janet Travell was, for a time, JFK’s physician. Or, if you had an extra $200 laying around, you could purchase the ‘bible’ on Trigger Point therapy - Travell and Simons’ Myofascial Pain and Dysfunction: The Trigger Point Manual. Hypoxia or diminished tissue oxygenation. Allergies or Sensitivities to food or environment. Organic (organ) problems can refer pain / triggers along specific pathways or patterns. Muscle compensation in synergistic or antagonistic muscles. Nutritional or hormonal imbalances / Nutritional deficiencies / Endocrine issues. Can be due to injuries, repetitive strain, or emotional issues Continual intense muscular contraction. The physical findings for diagnosis of a myofascial trigger point are (1) palpation of a tender nodule in a taut band, (2) a referred pain pattern specific for the muscle, (3) a local twitch response (LTR) with snapping palpation or triggering with needle, and (4) restricted ROM (Travell J, Simons DG, Myofascial pain and dysfunction: the trigger point manual, vol 1. Active TrP produce a referred pain pattern specific to that muscle spontaneously and when the TrP is palpated. Latent TrP are associated with stiffness and restricted ROM but no pain unless palpated. Trigger points (TrP) can be latent or active (Simons DG, Travell JG, Postgrad Med 73:66–108, 1983). The diagnosis of MPS is based on the presence of 1 or more trigger points. 
Myofascial pain syndrome (MPS) as defined by Travell and Simons is characterized by trigger points (TrP), limited ROM of the affected muscle(s), and neurologic symptoms (autonomic, proprioceptive) (Simons DG, Travell JG, Postgrad Med 73:66–108, 1983).
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