Janet Travell, M.D. — Her Spirit and Work Live On
by Erin McCloskey
In this issue of AK [the AK Journal] we proudly feature a past pioneer in alternative medicine. The work of Dr. Janet Travell has influenced traditional and alternative medicine and is one of the foundations of kinesiological medicine. Her revolutionary discoveries into the alleviation of myofascial pain led to the identification of what she defined as "trigger points" and the development of trigger point therapy which has not only led to a recognized modality for treating myofascial pain but it has allowed thousands of people to seek relief from pain that was often previously diagnosed as chronic or untreatable. Dr. Travell challenged a conservative medical profession hesitant to accept alternative health care back in the 1950s and she had a strong and positive influence on the public to investigate such options.
In 1922, she was accepted into Cornell University Medical College, one of nine women in a class of 63 students, and she proceeded to graduate with the John Metcalf Polk Memorial Award for highest academic achievement held throughout the 4-year program. She was taken on faculty at Cornell in 1930 and by 1951 she was Associate Professor of Clinical Pharmacology. Afterwards, she held the positions of Associate (1961-70) and then Emeritus (1970-88) Clinical Professor of Medicine at the George Washington University School of Medicine.
Dr. Travell remained, throughout her career, undaunted by a predominantly male institution. From medical school onward she was undoubtedly a great mentor for professional women throughout the 20th century. Perhaps some of her confidence came from the support she was given by one of her own mentors: her father. Willard Travell, M.D. (1869-1961) was a specialist in electrotherapy, and later physiotherapy, and a pioneer in the field of manipulative medicine and x-ray therapy. He encouraged both Janet and her sister Virginia to fulfill their intentions to become doctors. Janet and her father would later publish several scientific papers together. Her husband, John WG Powell, an investment counselor, also encouraged and supported Janet's devotion to medicine.
The formative investigations that led Dr. Travell to her theories on myofascial pain started while she was practicing as a cardiologist: noticing that many presenting cases of angina were unaccompanied by any sign of heart problems, she discovered that they were, in fact, spasms of the pectoral muscles of the chest. She herself had developed pain in her right shoulder radiating into the right arm that partially disabled her for a year. She got her father to inject procaine into the tender nodules along taut bands she found within her own muscles. A full recovery followed. Through these and other observations and experiences of muscle spasm and pain, her pioneering work into myofascial pain began.
Already gaining notable recognition in her field, Dr. Travell acquired a large public audience when she became the first woman to be appointed White House physician. It happened that one of her colleagues, an orthopedic surgeon, referred to her a patient who was not responding to treatment for his crippling back pain. After multiple surgeries to correct injuries suffered during WWII when the PT-boat he was commanding was hit and sunk, this young man had come to rely upon crutches, and at times a wheelchair, in order to move around. This person was of course John F Kennedy, then a Senator in Massachusetts. He had become so disabled that in 1954 he had taken a 7-month leave from politics. After receiving treatments from Dr. Travell, he was not only out of the wheelchair and off crutches, but playing golf, football and tennis - and winning his way into the Presidency. Dr. Travell was able to locate muscular sources (trigger points) for his chronic pain and injected low-level procaine directly into the Senator's lumbar muscles, which proved effective. Among the less intensive treatments, she made a heel lift for one of his shoes after discovering that one of Kennedy's legs was shorter than the other and thus causing stress on his back. She also gave him an old-fashioned rocking chair like the one in her office, which he had admired, custom upholstered for him - she advocated the rocking chair because it kept the sitter active and using the muscles passively to rock. This rocking chair found its way into the Oval Office with Kennedy and subsequently into thousands of American homes and into history.
Dr. Travell went beyond traditional concepts of healing and found inconspicuous causes of common pain. She recognized the obvious but often disregarded importance of a properly fitting bed or chair being a preventative measure against myofascial pain syndromes and redesigned Kennedy's chairs for his home and offices, as well as for his boats, limousine and helicopter. John Deere and Lockheed had also hired her as a consultant in industrial seating design for more comfortable seats for tractors and airplanes.
Kennedy insisted that Dr. Travell remain his personal physician while at the White House which caused a few eyebrows to raise. She was stepping into a lineage of physicians that were not only exclusively male but, since the 1920s, exclusively military. Although her mode of therapy was heavily scrutinized by conservative groups, the Kennedy family fully supported her and were convinced that without the medical expertise of Dr. Travell, Kennedy's political career would have come to a premature end. She proved her credibility and remained the White House physician from 1961-1965 which included Lyndon B. Johnson's administration.
Following her experience in the White House, she wrote her autobiography, Office Hours: Day and Night, in 1968 and had begun writing the two-volume textbook, Myofascial Pain and Dysfunction. The Trigger Point Manual, which she co-authored with ex-Air Force Flight Surgeon David G. Simons, MD. An early student to her methods, Dr. Simons wanted to document Travell's work. He worked with her to write the manuals and tried to find scientific explanations for the success she was seeing from her treatments. She was not a neurologist and could not prove the neurological pathways that were central to her theories. These pathways were not the linear innervial patterns previously recognized, and latent or seemingly disassociated and often very distant body connections seemed unacceptable to conservative medicine. Dr. Travell remained undaunted by any challenge to her theories - she knew her techniques worked and she saw the relief it gave her patients. Dr. Travell developed a trigger point therapy and treated trigger points in three ways:
1) injection of a local anesthetic (procaine) into the trigger point,
2) Stretch and Spray, which is the technique of applying a vapocoolant spray (1) while stretching the muscle that is in spasm, and/or
3) applying direct pressure on the trigger point to eliminate tenderness.
Fortunately, Dr. Travell persevered against the tendencies of traditional medicine to disregard breakthroughs that offer alternatives to continued unsuccessful surgeries or chronic pain. Untreated or unrecognized trigger points take away quality of life and are costly if they disable people from working. She had the ability to see beyond contemporary or conservative perspectives and had the courage to not discount new possibilities.
Today the term "trigger point" is a recognized medical term and trigger point therapy is widely used in conjunction with chiropractic, acupuncture, dentistry for treating TMJ, physiotherapy and various kinesiologic therapies. She encouraged teamwork and a multi-disciplinary holistic approach to healing and appreciated the contributions of a wide range of healthcare professions. Many doctors and therapists are grateful for her fundamental work, and many more patients are liberated from unnecessary pain. The work of Dr. Janet Travell continues through: the Academy of Myofascial Trigger Point Therapy [now The Pittsburgh School of Pain Management]; the annual American Academy of Pain Management's Janet G Travell, MD, Soft Tissue Award; the Janet Travell Educational Fellowship Grant given by the International Myopain Society; the Janet Travell seminar series sponsored by Pain and Rehabilitation Medicine at the Washington Adventist Hospital; the National Association of Myofascial Trigger Point Therapists; and others.
The energy and motivation she devoted to her research and to her patients reminds doctors and healers alike of their responsibility to the patient and the profession. She was so dedicated and believed so strongly that her work would relieve unnecessary pain that being a woman in a man's world (either in medicine or at the White House) or being looked down on by conservative groups or the press never stopped her from work that was truly in humanitarian interest. It is this compassion, inquisitiveness and determination that allows for new discoveries in science and medicine which improves the quality of life of millions of people every day. (2)
Notes:
(1) Ethyl chloride was first used but owing to its toxicity it was substituted in around 1955 for flourimethane spray, which was then temporarily banned for its deleterious environmental impact on the ozone. Dr. Travell discouraged the use of flourimethane to support the efforts to reduce use of chlorofluorocarbons. She described alternate techniques: stretching techniques with and without intermittent cold; ice massage; deep-stroking or stripping massage; strumming and friction massage; periosteal therapy; myofascial release; trigger point release; muscle energy techniques; contra-relax; hold-relax; and others.
(2) From: The International Journal of Applied Kinesiology and Kinesiologic Medicine, Issue No. 13, Spring 2002, p. 8.