BOOK REVIEWS Trigger Points and Muscle Chains Kabat’s model is described as follows: reproduces the behavior of the in Osteopathy spinal column and the pelvis, as Kabat developed a treatment tech- described by Sutherland, Zink, and By Philipp Richter, DO (foreign), and Eric nique wherein weak muscles are Littlejohn in their models. Hebgen, DO (foreign). 230 pp, $89.95. integrated into a muscle chain. The For us, it is obvious that it is the muscles that form these patterns. ISBN: 978-3-13-145051-7. Stuttgart, Germany: muscle chain is stimulated with the Georg Thieme Verlag; 2009. aid of specific stimuli (by visual, auditive, and tactile irritants). This Mr Richter then explains that, in his rigger Points and Muscle Chains in process takes optimal advantage of and Mr Hebgen’s opinion, there are Osteopathy, an English translation of the nerve and muscle properties only two muscle chains in each half of T described by [Sir Charles] Sher- the second edition published in Ger- the body—a flexion chain and an exten- rington, in order to integrate opti- sion chain. The muscle chains are many in 2007, is described as a guide for mally the weak muscle (or muscle “osteopaths, physiotherapists [and] chi- group) into the motion pattern. described in detail, and anatomic dia- ropractors” to apply therapy techniques grams help make the descriptions easily involving trigger points. This liberally understandable. illustrated book, combining theory with Mr Richter next describes research The last two chapters of part A practical techniques, was written by findings of Irwin M. Korr, PhD; cover diagnosis and therapy related to two foreign-trained osteopaths. One Sir Charles Sherrington, OM; and Har- dominant muscle chain patterns. The author, Philipp Richter, DO (foreign), rison H. Fryette, DO, that are related to methods of diagnosis mentioned by is a private practitioner and assistant the subject of the book. In the two pages Mr Richter include history taking, director of the Institute for Applied on Dr Korr, the author notes the signif- observation, motion testing through Osteopathy in Burg Reuland, Belgium. icance of somatic dysfunction in the particular traction techniques, and the The other author, Eric Hebgen, DO spinal column, the role of the spinal use of Zink patterns. Several black-and- (foreign), is a private practitioner in column as an information and control white photographs of human models Konigswinter, Germany. center, and the significance of the nerves depict the diagnostic techniques This book is essentially two books in for trophism. Mr Richter also outlines described in the text. one. Part A, written by Mr Richter, con- the functions and dysfunctions of con- The five-page chapter on therapy sists of 11 chapters. The first seven chap- nective tissue and fascia and analyzes covers only the most basic aspects of ters review physiologic and biome- muscle activity in walking. muscle energy and myofascial release chanic issues associated with what the After these basic physiologic and techniques. Listed, but not described, authors call “muscle chains,” or biomechanic discussions, Mr Richter under myofascial release are the fol- “myofascial chains,” as modeled by var- describes the craniosacral model of lowing methods: strain-counterstrain, ious researchers. Chapters 8 through William G. Sutherland, DO, from a facilitated positional release, functional 11 define the authors’ own model of biomechanical perspective. This descrip- release, balanced ligamentous release muscle chains and the authors’ tion includes text, as well as anatomic (ie, balanced ligamentous tension), [fas- approach to treatment. Part B, which illustrations, on flexion, extension, tor- cial] unwinding, and cranial osteopathy consists of chapters 12 through 19, was sion, sidebending rotation, and other (ie, osteopathy in the cranial field). This written by Mr Hebgen and covers the movements of the craniosacral mecha- last chapter of part A also briefly explains definition, locations, and physiologic nism. Next, the musculoskeletal models “neuromuscular technique” and myofas- mechanisms of trigger points, as well as of John Martin Littlejohn, DO; Vladimir cial release with ischemic compression. diagnosis and treatment related to Janda, MD; and J. Gordon Zink, DO, Summing up why the book pre- trigger points. are compared. sents information on the various forms Although the authors provide no With the necessary groundwork of therapy, Mr Richter notes the fol- clear definition of muscle chains, laid, Mr Richter describes the muscle lowing: Mr Richter, in part A, delineates models chain model proposed by Mr Hebgen of muscle chains developed by Herman and himself. In regard to their model, he states the following: If the therapist has found and Kabat, MD, PhD; Godelieve Struyff- treated (viscerally, parietally, or cra- Denys (a Belgian physiotherapist); nially) the dominant dysfunction, Thomas W. Meyers (a rolfer); and Furthermore, we determined that and in addition treats the trigger French osteopaths Leopold Busquet and one of the main functions of the points in acute cases and normal- Paul Chauffour. For example, Dr locomotor system, namely the gait, izes the shortened musculature in 628 • JAOA • Vol 109 • No 12 • December 2009 Book Reviews BOOK REVIEWS the affected muscle chain in chronic ments in part A are referenced with First Aid for the COMLEX: cases, the chances are quite good superscripts corresponding to numbers An Osteopathic Manipulative that the painful state is relieved in the bibliography at the end of the Medicine Review: Second Edition quickly and that the danger of book, references for part B are listed in relapse is reduced. the bibliography without superscripts in By Zachary Nye, DO; John M. Lavelle, DO; the text. Therefore, the reader is unable Stockton M. Mayer, DO; and Rachel In part B, Mr Hebgen first briefly to identify the sources of particular Laven, DO; edited by Elise B. Halajian. discusses the classification, pathophys- statements. 260 pp, $44.95. ISBN: 978-0-07-160025-5. iologic factors, and diagnostic aspects of The concepts of muscle chains and New York, NY: The McGraw-Hill Compa- trigger points. He then describes, in trigger points are not for every osteo- nies; 2009. only two pages, some therapy methods pathic physician. Those who are not for trigger points. “Stretch-and-spray interested in the musculoskeletal com- irst Aid for the COMLEX: An Osteo- technique”; “postisometric relaxation/ ponent of medicine or trigger point treat- Fpathic Manipulative Medicine Review: muscle energy technique/myofascial ments will not find this book useful. Second Edition—written by Zachary release”; “ischemic compression/ However, osteopathic physicians who Nye, DO; John M. Lavelle, DO; manual inhibition”; and “deep friction frequently work with the muscu- Stockton M. Mayer, DO; and Rachel massage” are succinctly put forth as loskeletal system and trigger point treat- Laven, DO, and edited by Elise B. Hala- such therapy. The mention of trigger ments might find this book to be of aca- jian—is an excellent “just meat, no point injection, however, is conspicu- demic value. Part A may be of interest to bone” review of osteopathic manipu- ously absent. The author also explains osteopathic physicians who would like lative medicine (OMM) for the Com- how a facilitated segment resulting to learn how the authors developed their prehensive Osteopathic Medical from visceral dysfunction may be asso- model of muscle chains based on pre- Licensing Examination-USA (COMLEX ciated with specific trigger points. vious research. Part B will have more -USA) Levels 1, 2, and 3. The authors The final chapter, comprising more widespread applicability as a quick ref- are former teaching fellows at Mid- than 90 pages, provides details on the erence for trigger points and their asso- western University/Chicago College location and referral patterns of com- ciated anatomic and physiologic factors. of Osteopathic Medicine in Downers monly found trigger points. The trigger Overall, I recommend Trigger Points Grove, Illinois, and current residents at points are grouped into seven body and Muscle Chains in Osteopathy to osteo- various institutions. The editor is an regions—head and neck; upper thorax pathic medical students, residents, and OMM fellow at Midwestern. This team and shoulder; elbow-finger; upper practitioners who have a particular has produced a highly useful resource torso; lower torso; hip, thigh, and knee; interest in trigger points or in learning for osteopathic medical students who and lower leg, ankle, and foot. about the concept of muscle chains. The are preparing to take COMLEX-USA. Mr Hebgen discusses the origins, inser- book may stimulate thought with The book is organized into five sec- tions, innervations, and actions of the regard to muscle chains and osteopathic tions, consisting of 13 chapters, that involved muscles and also mentions medicine, and it may provide a valuable cover the following topics: (I) “Guide any internal organs that may be asso- reference for common trigger points. to Efficient Examination Preparation,” ciated with each trigger point. However, this book is not a treatment (II) “OMT Fundamentals,” (III) Many clear photographs of human manual for osteopathic physicians. “Regional and Systems-Based Assess- models are presented in this final In conclusion, although Trigger ment,” (IV) “Historical Highlights, Key chapter. Additional graphics depict the Points and Muscle Chains in Osteopathy is Points, and Musculoskeletal Tests,” and