David G. Simons: The Wind Beneath My Wings
ask why I have dedicated this website to David G. Simons, M.D.
Other articles in this section concern his early life as a
flight surgeon in the pre-astronaut program, “Project Man High.”
In my books, on this website and in my other writings I
frequently mention the medical texts he co-authored, “Myofascial
Pain and Dysfunction: The Trigger Point Manual,” (TPM), volumes
I and II and the 2nd edition of volume I. These
big red books are the definitive texts of myofascial medicine.
Without them, and without Dr. Simons, my works, including this
website, would not exist. Through much of my own voyage of
medical discovery, he has been my mentor, and he still is.
Simons took charge of the flight program, his goal was to
clarify previous animal experiments that explored the medical
hazard of heavy cosmic radiation as a threat to manned space
flight. This required that a human being ascended as high as
then possible and remained aloft for as long as possible at
latitude at least as far north as the northern border of the
USA. He wasn’t interested in setting records. When he
volunteered to make his flight, he had no guarantee he’d even
survive but expected to because of the expertise of his boss,
Col. John Paul Stapp, in exploring the limits of human tolerance
safety. He knew direct observation and experiments were
required to discover what was out there and what was needed to
protect the human body during space flight. He was driven to
explore. He confirmed that the effects observed in
experimental animals were not prohibitive for relatively short
exposures like those experienced in the moon journeys. However,
relatively recent research makes it now clear that a manned trip
to Mars and back is absolutely prohibitive with known technology
for protection from those cosmic rays. His flight took
courage, determination, consuming curiosity and perseverance.
Later in his life he embarked on a different path, and his
discoveries are still making a world of difference.
of myofascial trigger points (MTPs) requires a practitioner to
make a paradigm shift from medicine-as-usual. It takes a new
way of thinking and a special group of skills that don’t come
easy to many in the medical community. Yet Dr. Simons was
immediately able to grasp the significance of MTPs and began to
expand the understanding of the trigger point. He and Janet G.
Travell, M.D., President John F. Kennedy's White House
physician, co-authored the first Trigger Point Manual (TPM) on
the MTPs in the upper body in 1983. In so doing, they
propelled the field of myofascial medicine that she had
launched. People may know about Kennedy’s specially
designed (by Janet Travell) rocking chair, but they don’t know
that J.F.K. had MTPs that required the specially designed
chair. Most TPM readers also don’t know that the second TPM
(volume II, lower body) published in 1992 was written primarily
by Dr. Simons, with help from Lois Statham Simons because of Dr.
Travell’s advanced age. This fact was not told to me by Dr.
Simons, but became evident during my research on the development
of that volume at the Travell Archives.
once mentioned to me that as soon as he learned about MTPs his
biggest surprise was that they are so common. They are
ubiquitous. Individual MTPs can occur, but if there are no
perpetuating factors and the MTPs are treated, they resolve. If
they are not treated, they may become latent. Finding a single
MTP is unusual, and this may be due to the fact that so few
people recognize and treat them promptly. Most chronic illness
has a myofascial component adding to the pain and dysfunction.
Dysfunction caused by MTPs includes restricted range of motion
and muscle weakness, and these can occur before any pain is
The TPMs show
the approximate locations of the most common MTPs. They also
explain common causes and perpetuating factors of individual
MTPs and describe in detail a variety of treatments. At the end
of volume II there is a very brief chapter on chronic myofascial
pain (CMP); describing some of the disastrous consequences when
primary MTPs and their perpetuating factors remain untreated and
uncontrolled. The authors still didn’t have all the answers as
to the biochemistry of MTP formation, but they made careful
observations and tests and explained what they had found. They
continued to research, and, slowly, others took to the hunt for
answers. Yet the medical establishment long considered
myofascial medicine “controversial” because there wasn’t a
simple blood test or imaging technique to define it.
Myofascial medicine wasn’t tried and found wanting; it was tried
and found difficult. There are many possible common MTP
locations and their common referral patterns and associated
symptoms to learn, and many potential perpetuating factors.
Both TMP texts are huge. Palpation of MTPs takes a fine touch
and skill that comes with practice and experience.
search to figure out what was wrong with my own body and mind, I
had access to some of the best medical libraries in the world.
This was in the pre-Internet days when that was crucial.
Teachers weren’t teaching myofascial medicine in most medical
schools. I had already discovered fibromyalgia (FM), but none
of my doctors or professors could explain the sketched pain
patterns I carried around with me. When I opened those big red
books, there were the specific patterns I had been told were
“impossible!” So now I knew about individual MTPs. Yet I
had every MTP in both texts, plus others that weren’t even in
there. So I contacted Dr. Simons. I had a lot of questions,
and I received so much more than answers: David Simons supplied
me with a new set of questions and an invitation to journey into
uncharted realms of medicine.
“mentor” comes from Greek classics. Mentor was the wise
counselor of Odysseus and Telemachus. What I found in Dr.
Simons was a mentor of the highest order. I remember sitting
near him at a breakfast table with eight or ten people at a
Focus on Pain conference in the ‘90s. He was discussing his
work with someone next to me, and his whole body became
animated. His eyes lit up, and he leaned forward, the whole
force of his being behind the phrase, “I love to teach.”
This love of teaching has been my good fortune, and, since you
are on this website, it is yours as well. For some of us, it's
not enough just to discover something. We need to understand
it, find out why and how it happens and what to do about it, and
then teach what we know so that others can understand it also.
We immediately begin thinking about the next set of questions
that arise with each discovery.
edition of TPM volume II, published in 1999, contained more
about how MTPs formed. By then, Dr. Simons and colleagues did
the critical research to develop the integrated hypothesis that
was scientifically logical. There were some weak links, because
all of the answers were yet to be found. His hypothesis has
since been shown to be correct, and it has been expounded upon
and detailed in current research. Some of that research is
in the Myopain Overview elsewhere on this website. Myofascial
pain due to MTPs is a true disease, a myopathy, and is no longer
only a syndrome.
myofascial pain is much more common than originally thought.
Research in myofascial medicine is starting to expand
exponentially, yet even though most physicians have patients
with MTPs in their practice, the doctors seldom understand the
reasons for their patient’s symptoms. I asked Dr. Simons once
long ago how he was able to deal with this and persevere in his
work. Research in myofascial medicine has been ongoing for
nearly sixty years, and patients who see the few MTP referral
pain patterns on the front of my books often recognize them as
their own (and often consider them caused by FM, to my great
frustration), yet many doctors in practice know nothing of this
common source of musculoskeletal pain and dysfunction. I asked
Dr. Simons how he was able to deal with this and persevere in
his work. He reminded me of the need to change what we can,
accept what we can’t, and the wisdom to know the difference.
And he keeps exploring, looking for answers, and teaching what
he knows to those of us who will listen and learn.
For more than
a decade I have been honored to have Dr. Simons as my mentor.
He has challenged me and guided me as I have attempted to bring
a basic understanding of myofascial medicine to patients through
my own books. One of his earliest challenges was to distinguish
those symptoms caused by MTPs from those caused by FM. Now we
understand that some of these symptoms have components of both
FM and MTPs and may be impacted by other interactive co-existing
conditions. Although FM is very real, it is often
misunderstood. At the International Myopain Congress in
2007 it was a “given” that FM patients have at least one MTP.
Much that the medical world “knows” about FM may be suspect,
because co-existing MTPs were not taken into account during the
research and undoubtedly contribute an unknown amount to a lot
of the findings.
Staud and others have shown that pain from peripheral tissues,
such as pain caused by MTPs, can be enough to sensitize the
central nervous system or maintain this sensitization. Thus, at
least some cases of FM may be caused by MTPs, and even more
cases of FM may be maintained by pain from MTPs. At least some
of what are called “growing pains” in the young and even much of
the restricted range of motion, stiffness and “rheumatism” of
old age are very likely caused or contributed to by MTPs.
Dr. Jay Shah of the National Institutes of Health includes
analysis and identification of over 30 biochemicals released by
the local twitch response of MTPs. Just recently, the Mayo
Clinic issued a press release about a new imaging technique,
magnetic resonance elastography. This technique can image a
taut band, and thus document the presence of a MTP. For some
of us, palpation skills, range of motion, recognizable pain
patterns and the like were enough to accept the reality of MTPs
and learn how to find and treat them; now the rest of the
medical world has proof available that MTPs have been there all
along! Once they realize the ubiquity of MTPs, they will also
recognize the lack of health care professionals who can treat
have a growing cadre of educated patients, available resource
materials, a small but treasured group of MTP therapists and
other manual practitioners, and an even smaller group of
physicians specializing in myofascial medicine. We still
desperately need more care providers who are trained in
myofascial medicine, but we are moving ever more rapidly in the
right direction. Now we must raise awareness in the medical
world of the prevalence of MTPs, CMP and the importance of
interactive diagnoses in chronic illness. There is a new TPM in
progress that will eventually present updated information and
the best of both earlier volumes. When I started looking for
the sources of chronic pain and associated symptoms, I had the
TPMs. It was Dr. David G. Simons who guided me in my quest, and
I have been honored to share in the exciting voyage of
exploration and discovery. He is, indeed, the wind beneath my
(with gratitude to Nye Ffarrabas