Other than a summary mention of myogelosis as a possible palpatory finding that might be relevant when choosing from among massage techniques, I remember no discussion of pain of myofascial origin as part of my entry-level degree in physical therapy in The Netherlands. And although at least one of the required texts for the postgraduate degree in manual therapy that I completed in Belgium discussed the topic in depth,l clinical diagnosis and management of myofascial trigger points similarly was not dealt with in class during this degree program. During further postgraduate study in orthopaedic manual therapy in the United States, myofascial trigger points were either not discussed or were summarily dismissed as a nonexistent condition.2 When I served as a physical therapy clinical instructor while working in the United States, I insisted that my interns provide some convincing evidence or otherwise stop wasting their time (and, more importantly, their patients’ time) on unproven concepts and instead concentrate on the triedand- true articular dysfunction as the main cause for most patients’ complaints. I considered any myofascial abnormality I found in my patients to be secondary to the primary articular dysfunction and was quite convinced that such minor issues would disappear once I had adequately dealt with the dysfunctional joint. Of course, I could deny some of the responsibility for my past joint-centered convictions by stating that the account above is just reflective of earlier and simpler times. However, to some (certainly not minor) extent this primacy of the articular dysfunction remains at the core of many educational programs in orthopaedic manual therapy available to physical therapists today.
Dr. Taimour is a dedicated medical professional and passionate advocate for international medical graduates seeking to pursue their dream of becoming a doctor abroad. With a wealth of experience and firsthand knowledge of the challenges and rewards of this journey, Dr. Harrison is committed to helping aspiring physicians navigate the complex world of medical licensure exams, such as the USMLE and PLAB, and find their path to success in foreign medical practice.
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