David G. Simons, M.D. : Letter to Professionals
David G. Simons, M.D., is known internationally for his ground-breaking work in musculoskeletal medicine, trigger points, and chronic pain management. In the mid-1960s, he developed research programs in Physical Medicine and Rehabilitation while he was working at the Veterans Administration. It was there that he met Janet Travell, M.D., who was educating practitioners about trigger points and myofascial pain. A professional collaboration was born, and the two pioneers worked together for the next 20 years.
In 1983, they published "The Trigger Point Manual," the first definitive scientific body of work on the diagnosis and management of myofascial pain, written for clinicians. The book is now in its second edition. More than half of his almost 200 publications are about trigger points and chronic pain management.
Dr. Simons continued to publish trigger point research well into his 80s. In 2001, he co-authored a book called, "Muscle Pain: Understanding its Nature, Diagnosis, and Treatment," which is considered to be a revolutionary body of work on the neurophysiology of muscles.
On April 5th, 2010, Dr. Simons died peacefully at home. We at TMJ Pain Solutions were lucky enough to get a chance to talk to him, in November 2009. This is what he had to say about the MyoFree® Solution:
To the Dental Profession:
I keep hoping that the dental profession will continue to make progress in their understanding of the nature of, diagnosis of, and treatment of myofascial trigger points MTPs. The definition of myofascial pain that ignored palpable findings has done grievous harm to the profession because it skipped an essential finding for making the diagnosis.
Many other health care professionals also often overlook the important role played by latent MTPs (MTPs not causing clinical pain symptoms—especially among the masticatory muscles which interact strongly). When bite splints have quieted the TMD pain the job is NOT done yet. Remaining latent MTPs seriously disturb normal masticatory muscle coordination putting unnatural strain on the TMJ and related muscles. Gail Falzon, RN is very experienced and has pioneering experience in this field and has much to teach all of us. She is promoting the MyoFree® tool because she has found how much relief and satisfaction patients have experienced using it and would like to spread that benefit to many more patients. There are several things MyoFree® can do that are noteworthy. There are two muscles that have their central MTPs in difficult-to-reach locations. One of the most important masticatory muscles to commonly develop active MTPs is the lateral pterygoid. The closest one can come to palpating its taut band is indirectly at its attachment on the lateral pterygoid plate which is very difficult to reach with a finger and then one can only exert pressure indirectly on the attachment region to detect the tenderness of an attachment MTP. The MyoFree® tool permits accurate positioning of the pressure from a small source to help identify the precise location of the tenderness and estimate how tender it is. I know of no better way to determine the presence of lateral pterygoid MTPs. Best of all the patients can learn to do this examination effectively themselves. The pressure applied has a therapeutic component. Some patients hesitate to stick their finger in the mouth to palpate for MTPs, and especially to poke it down their throat to palpate directly the internal pterygoid. The MyoFree® tool does that beautifully. The next best is to identify tenderness of the attachment of the internal pterygoid taut band on the inside of the mandible. The most effective palpation is pincer palpation where the taut band can be rolled between two fingers. In the case of the masseter, the MyoFree® tool provides one very small effective finger for use inside the mouth while the other hand palpates the taut band outside the mouth. The small size of the ball at the end of the MyoFree® increases the accuracy with which the MTP can be located and its tenderness estimated. Your practice and your patients' masticatory health will greatly benefit from use of this device. Latent MTPs are trouble looking for a time and place to happen, and sooner or later they do. Ask Gail; she knows. David G. Simons, MD
It is my hope that at least one of you will take this seriously and do a controlled blinded study to test the scientific credibility of these clinical observations.
