"If we treat myofascial pain syndromes without . . . correcting the multiple perpetuating factors, the patient is doomed to endless cycles of treatment and relapse. [Perpetuating factors are] the most neglected part of the management of myofascial pain syndromes . . . The answer to the question, 'How long will the beneficial results of specific myofascial therapy last?', depends largely on what perpetuating factors remain unresolved . . . One may view perpetuating factors also as predisposing factors, since their presence tends to make the muscles more susceptible to the activation of [trigger points] . . . Usually, one stress activates the [trigger point], then other factors perpetuate it. In some patients, these perpetuating factors are so important that their elimination results in complete relief of the pain without any local treatment."

~~ Doctors Janet Travell and David G. Simons