Trigger Points

What Are Trigger Points?

Myofascial trigger points (MTrPs) are hyperirritable spots within taut bands of skeletal muscle. They are tender to compression and can produce characteristic referred pain, motor dysfunction, and autonomic phenomena. Commonly known as "muscle knots," they are a frequent source of musculoskeletal pain.¹

Types of Trigger Points

• Active: Cause spontaneous pain at rest or with movement
• Latent: Only painful when pressed; may still restrict movement
• Primary: Developed independently
• Secondary/satellite: Develop due to stress from another trigger point

Symptoms

Characteristics

• Palpable nodule or "knot" in muscle
• Tenderness at the spot
• Pain when pressed (may be intense)
• Referred pain to other areas
• Restricted range of motion
• Muscle weakness (without atrophy)

Referred Pain

A key feature—trigger points often cause pain elsewhere:

• Upper trapezius → side of head (tension headache pattern)
• Infraspinatus → front of shoulder and arm
• Gluteus medius → low back and hip
• Referred pain follows predictable patterns

Associated Symptoms

• Stiffness, especially after rest
• Fatigue in affected muscles
• Sleep disturbance
• Sometimes: sweating, goosebumps, redness

Common Trigger Point Locations

Head and Neck

• Upper trapezius (causes headaches)
• Sternocleidomastoid
• Suboccipitals
• Scalenes
• Temporalis and masseter (jaw pain)

Shoulder and Upper Back

• Levator scapulae
• Rhomboids
• Infraspinatus
• Supraspinatus

Lower Back and Hips

• Quadratus lumborum
• Gluteus medius and minimus
• Piriformis
• Iliopsoas

Causes

Contributing Factors

• Muscle overuse: Repetitive activities
• Muscle injury: Acute trauma, strains
• Sustained postures: Sitting, computer work
• Muscle overload: Heavy lifting, carrying
• Stress: Psychological tension → muscle tension
• Poor posture: Creates chronic muscle strain
• Cold: Muscle cooling
• Other pain conditions: Compensation patterns

Perpetuating Factors

• Continued mechanical stress
• Nutritional deficiencies (vitamins B, D, iron)
• Poor sleep
• Hormonal imbalances
• Metabolic issues
• Chronic stress

Diagnosis

Clinical Diagnosis

Trigger points are diagnosed by physical examination:³

• Palpable taut band in muscle
• Hypersensitive spot within the band
• Patient recognition of referred pain pattern
• Local twitch response (muscle jump when pressed)
• Restricted range of motion

Treatment

Manual Therapies

• Trigger point pressure release: Sustained pressure until release
• Massage therapy: Various techniques
• Myofascial release: Broader tissue work
• Spray and stretch: Vapocoolant spray with stretching

Dry Needling

• Thin needle inserted into trigger point
• May cause local twitch response
• Evidence supports effectiveness for some conditions
• See our dry needling guide

Injections

• Local anesthetic into trigger point
• Sometimes with corticosteroid
• Provides temporary relief

Self-Treatment

• Tennis ball, lacrosse ball, foam roller
• Massage tools (Theracane, etc.)
• Stretching affected muscles
• Heat application

Addressing Root Causes

• Posture correction
• Ergonomic modifications
• Strengthening weak muscles
• Stress management
• Addressing perpetuating factors

Self-Treatment Techniques

Pressure Release

1. Locate the tender spot
2. Apply steady pressure (uncomfortable but tolerable)
3. Hold for 30-90 seconds
4. Feel for release or softening
5. Don't press so hard you tense up

Tools

• Tennis/lacrosse ball: Against wall or floor
• Foam roller: For larger muscles
• Massage cane: For hard-to-reach areas
• Percussion massager: May help some

When to Stop

• If pain is severe
• If symptoms worsen
• Numbness or tingling
• Over bony prominences or arteries

Prevention

• Regular stretching
• Good posture habits
• Ergonomic workspace
• Regular breaks from repetitive activities
• Stress management
• Adequate sleep
• Stay active

References