First Things First
Peter Drucker has told us in his book, Innovation and Entrepreneurship, that the lead time for knowledge to become applicable technology and then to be accepted in the market is 25 to 30 years. Even in our sophisticated era, scientific discoveries don't move any faster. Certainly if a cure for cancer or the AIDS virus came along, we might see a speed-up as we did with penicillin at the outbreak of World War II. But medical science is just as slow as industry--if not slower--to adapt to innovation.
The interview with Dr. Janet Travell in this issue of JCO illustrates the point quite well. Since the 1920s she has been writing and lecturing on the etiology, diagnosis, and treatment of myospasms, but her valuable message has been largely ignored in spite of its logic, utility, and simplicity. Had it not been for her widely publicized success in rehabilitating President John F. Kennedy, Dr. Travell might have an even smaller professional following than she has today.
There is no doubt that most of the pain experienced worldwide is due to hypercontracted muscles--from headaches and stiff necks to TMJ syndromes and charley horses. The real question is how such a ubiquitous source of human discomfort could be neglected for so long. It probably is because hypercontracted muscles are not life-threatening. Very few people die from stiff necks or charley horses, but the quality of life can still be greatly diminished by these muscle maladies. And there can be no doubt about the enormous financial cost of the ignorance of myospasms.
My family recently experienced such a cost when my wife, Lue, developed an excruciating pain in her lower right abdomen. Our physician immediately considered appendicitis or an ovarian tumor, but none of the blood tests, sonograms, or CAT scans showed anything but a healthy woman. After a three-day stay in the hospital and a $3,000 payment, she came home undiagnosed but still hurting.
That was enough to cause me to refer to Dr. Travell's book, Myofascial Pain and Dysfunction: The Trigger Point Manual, to look for referred pain patterns and their corresponding trigger points. The pain maps that Travell and Simon have developed showed that myospasm of the deep paraspinal muscles was a possible etiology in my wife's case. Digital palpation of those muscles did elicit pain in the abdomen, and an injection of a .5% solution of procaine confirmed the diagnosis by getting rid of all the pain. Spraying of the muscles with the vapocoolant Fluori-Methane, followed by stretching and heating of the muscles, resulted in a rapid and complete recovery.
I don't tell this story to encourage orthodontists to usurp physicians' prerogatives, or to castigate professional colleagues for not knowing more about muscles. It is a simple appeal for all health professionals to consider the most common and likely dysfunctions before leaping to the exotic and rare. Dr. Travell says her patients frequently tell her that previous physicians never touched them or felt for involved muscles. How many of us who treat TMJ patients have heard the same complaint? Many of those patients have been to neurologists, radiologists, ear-nose-and-throat specialists, and even dentists, and none of them palpated even the temporalis or masseter muscles. Most of the patients have had plenty of "tests" before they get to you, but obviously no successful diagnosis or therapy.
We tend to rely entirely too much on all the sophisticated gadgetry that has been developed, to the exclusion of common sense and of solid knowledge about muscle anatomy and physiology. Magnetic resonance imaging, tomograms, transcranial x-rays, arthrograms, and the like can provide valuable information about craniomandibular dysfunction, but these exotic, expensive techniques are too limited to be used as substitutes for the clinical diagnosis. And the clinical diagnosis can be made only by taking a thorough history and doing a thorough examination, complete with palpation of the muscles.
History taking and physical examination may seem colorless compared to MRI or CAT scans, but they are the substance of real diagnosis. I don't know anyone who can help health professionals understand this better than Dr. Travell. She is a remarkable physician with an urgently needed message.