A Guide to Trigger Point Therapy

Muscle pain is an unfortunate part of many people’s lives. Whether a result of injury, over-extension, a sedentary lifestyle or genetic factors, pain can be anything from outright annoying to debilitating in one’s everyday life.

Every year millions of Australians around the country suffer from body pain of one form or another and yet, in a frightening statistic from Pain Australia, doctors routinely rely on medications over therapy by pain specialists. In fact, 15% of GP consultations regarding chronic pain resulted in referrals to a clinical specialist and almost 70% resulted in medication. Not to say that medication doesn’t have a place; rather that there are forms of therapy that could be helpful as well. Like trigger point therapy. 

Trigger point therapy isn’t new to the scene of muscle pain and treatment, but it’s certainly growing in the amount of attention it’s getting and the amount of interest it’s generating. In this guide we’ll cover everything you need to know about trigger points, trigger point massage therapy, myofascial trigger points, the benefits, and the symptoms. We’ve included a handy summary below so you can skip to any part of the article you want to. Before you begin, it’s important to note that the entire scientific endeavour into muscle pain is one that is very much still ongoing and in development. There are many theories and disagreements regarding causes, treatment and definitions. Despite all of this, and without further ado, we give you a complete guide to trigger point therapy and myofascial trigger point therapy.


What are trigger points?

Commonly referred to as a muscle knot, trigger points are spots in your muscle (specifically the soft muscle tissue) that cause aching, pain or discomfort. Sometimes, when there is a cluster of many trigger points the term myofascial pain syndrome is used. (More on this later.) Myofascial pain syndrome is considered to be a chronic pain disorder by many. However, chronic pain is defined as lasting for a significantly long period of time or to be continued and long-term recurrence, so this could be a point of classification contention for some.

Trigger points can involve more than just pain. They can be stiff and tough to the touch, or they can feature a tough spot but then have the pain sensations spreading out in a ripple-like effect from the centre.

Sometimes trigger points may not be aching in an active manner but might be sensitive or tender when pressure is applied or it is touched, even lightly. While the exact nature and cause of trigger points is still a matter of professional and scientific debate, the most common understanding is that it is a small area in which a muscle is very tightly contracted. In certain instances, the muscle can suffocate itself from blood supply which can cause more irritation and more pain. This is referred to as a “metabolic crisis”.

A contracted muscle or a muscle that is dysfunctioning internally in some way can cause muscle spasms which can affect or cause pain in various other parts of the body seemingly far away from the root trigger point location. Another theory explaining the cause of a trigger point is that there is some sort of disturbance to the peripheral nerves. This explanation means that there is nothing necessarily happening on the deeper level of the muscle and muscle tissue, and that this is merely a sensory symptom. 


The causes of trigger points

If it’s not clear by this point, it bears repeating: There is a lot of contention about just about every aspect of trigger point therapy and trigger points in general.

The exact causes for this debate fall squarely in this category. There are lots of competing and contradicting explanations about what causes this sort of muscle pain. These are the most popular and oft-cited theories and explanations.

Fitness/health

Trigger points are considered by many professionals to worsen in older age. Lack of fitness and/or health problems can also cause trigger points to form.

Muscle cramps

Some trigger points are thought to be micro-cramps in and of themselves. Muscle cramps in general can be caused by a variety of things including: 

  • Lack of blood supply
  • Compression of a nerve
  • Lack of minerals
  • Muscle stress or strain

Other health problems

A trigger point is also thought to be a possible symptom of another health complication. This view wouldn’t necessarily consider trigger point therapy as a viable treatment solution but would rather aim to tackle the bigger health issue going on and causing it all.

Strain or exertion

If the muscle-theory is correct, trigger points can be caused by overexertion or the overly straining of a muscle. Improper stretching prior to engaging in strenuous exercise or muscle overuse is also a possibility. 

Fibromyalgia

Fibromyalgia is the term used for general, widespread and unexplained pain around the whole body. For some professionals, the existence of trigger points is more reflective of the likelihood of their being a ‘fibromyalgia’ diagnosis than actual contracted spots of muscles or nerves. 

Physical trauma or accidents

Another potential cause is muscle fiber exposure to trauma or an accident. Depending on the severity of the accident or trauma in question, this theoretical cause could line up neatly with many of the other potential causes listed above.

Chemical release

Another theory of what happens when a trigger point is released is that a chemical, named acetylcholine, is released. This chemical causes the muscle fibers to contract and stay contracted for a significant period of time.


What is trigger point therapy?

Now that we have an understanding of what trigger points are conceptualised to be and some of the theories behind their causes, we can tackle trigger point therapy.

In brief, trigger point therapy is a hands-on therapy by trained massage therapists that manually focuses on locating trigger points and then releasing them. This sort of therapy is often used in massage therapy, chiropractic care and also in dry needling. The aim of the therapy treatment is to relieve the pain being experienced by the patient by rubbing and applying pressure on the specific points in question. 

Much like massage therapy, trigger point therapy can be incredibly relieving or it can be extremely pain inducing and leave you aching more afterwards (before hopefully the muscle recovers and feels significantly better). Dry needling is a popular form of massage therapy and uses acupuncture-like needles to stab the specific points of pain and relieve the muscles themselves. Not infrequently, dry needling can actually cause the muscle to spasm. While not likely to cause too much pain, the feeling can be somewhat discomforting.  Heat is also used by some massage therapists to relieve pain in and of itself or in conjunction with further rubbing or pressure application. 

Trigger point therapy and myofascial pain massage therapy is not a hard physiological science and is still somewhat experimental in both theory and practice. What is certain is that it’s not a magical solution. Muscles aren’t small on and off buttons that can be switched one way or the other.


How do you know if you need trigger point therapy?

Trigger point therapy, while still a work in progress scientifically, is always an option for people experiencing trigger point pain. So, how do you know if you actually have a trigger point?

The first thing to do is to rule out any other possible causes. If there’s another reason for your pain that is explainable based on a diagnosis then you won’t be in need of this trigger point therapy treatment. 

If you exhibit many of the following symptoms with no specific explanation as to why, it could be worth checking out trigger point therapy.

  • Deep aching feelings in a spot on your muscle
  • Specific areas of the body that are sensitive to touch
  • Widespread and long-lasting myofascial pain
  • Isolated pain 
  • Muscle knots

There are a number of further questions that you should ask yourself as well to try and help identify what you’re experiencing.

  • Is the pain you’re feeling a dull ache?
  • Does the pain seem to be coming from your muscles or not quite as deep as that?
  • Do the limbs closest to the painful spots seem weak, overly heavy or abnormally stiff?
  • Does the pain come and go? Has it lasted long?
  • Does anything specifically cause the pain to arise like change in temperature, a specific exercise or a position you’re standing, sitting or lying in?
  • Does the pain move around your body? Is it mainly in the neck or back?
  • Do hot baths and/or showers or using heat-application devices relieve the pain, even temporarily?
  • Does a massage help you feel better?
  • Does being active trigger, help or worsen the pain?

How does trigger point therapy help?

A common challenge to trigger points and its massage therapy in general is why not just seek actual medical advice?

Yes, the science behind trigger point therapy in contentious but most medical professionals won’t deal with the pain associated with trigger point therapy treatment anyway, for two main reasons:

  1. There are other health issues to deal with over trigger points.

Generally, unless the pain is at an intolerable or truly debilitating level, doctors and clinical professionals are focused on attending to more exact, diagnosis-informed, treatment-ready and understood conditions. Some might even consider these sorts of issues beneath them. Either way, it’s quite possible that the lack of scientific consensus on this topic is more a result of neglect rather than outright categorical rejection. 

  1. They actually don’t know what to do with trigger points.

It is quite possible that due to the fact that there is such scant research and enquiry into this sort of massage therapy, doctors and other clinical professionals simply do not know what to do. They might not even be tempted to try due to ambiguity surrounding symptoms, causes and treatments.

Which is why more and more people are turning to trigger point therapy treatment. Even if the science isn’t fully developed around this health issue, if you are suffering from acute pain it can often be worth a shot to try an affordable, non-invasive and safe therapy treatment.

Trigger point therapy focuses on the theory that when pressure is applied to a muscle the cycle of pain/spasm is interrupted which allows the muscle to stop contracting and return to how it regularly feels and works. This is often referred to as a trigger point release. The release is achieved when the contraction mechanism of the muscle itself is unlocked. The muscle is then able to soften and stop causing pain or aches around the body.

Once the release has happened, the muscle will then need to be manually moved to engage it in all its range of movements. This trigger ‘rehabilitation’ exercise should ideally be repeated by the patient at home after the massage therapy treatment as well to retrain the muscle to function normally and not contract again. 

There are a variety of specific techniques and tools massage therapists are used to using to achieve this and some are even replicable by yourself to be performed on yourself!


Alternate terms: Myofascial trigger points and myofascial trigger point therapy

If you read up on any of the existing literature on trigger points and trigger point therapy, you may come across the term myofascial trigger points or myofascial trigger point therapy.

What is myofascial pain syndrome and dysfunction?

Myofascial pain and dysfunction is just another word for muscle pain. While some people prefer the term trigger points, many others refer to the pain associated with a trigger point as myofascial pain and dysfunction. 

Another term you might come across in the discussion on myofascial trigger point therapy is referred pain. Referred pain relates to pain that occurs in numerous parts of the body with no apparent connection. 

What is myofascial trigger point therapy?

There is no real difference between common trigger point therapy and myofascial point therapy other than different terminology. This form of point therapy still targets a trigger point or multiple trigger points to alleviate referred pain through the physical application of small amounts of pressure to the underlying tissue. 


What’s the difference between trigger point therapy and acupuncture?

As we mentioned earlier, some trigger point therapists engage in dry needling using needles that resemble acupuncture. However, it’s important to point out that dry needling and acupuncture are not the same thing.

Acupuncture is a method of traditional Chinese medicine. This method involves using needles to stimulate energy that is carried through the body, called chi, from point to point. Acupuncture is used as a treatment for a number of health and wellness problems.

While both acupuncture and dry needling use needles inserted into various ‘trigger points’ of the body, there’s nothing in trigger point therapy that focuses on chi or ‘energy’. Additionally, dry needling is focused on stimulating the musculoskeletal pain system rather than other superficially unrelated physical or health problems. 


The benefits of trigger point therapy

Again, trigger point therapy has not been verified by scientific consensus through rigorous replicable experiences and conclusive medical results. However, proponents of the therapy treatment do refer to a number of physiological and musculoskeletal benefits.

Of course, the exact benefits you can reasonably expect yourself will depend on where in the body your trigger points are located and which areas are being worked on by your massage therapist.

Headache relief

Some preliminary research has gone into the effects of trigger point therapy treatment on tension and headaches suggesting effective headache relief is possible.

Temporomandibular pain relief

The temporomandibular connects your jaw to your skull. It’s the sliding hinge that allows you to open, close and control your jaw. Trigger point therapy applied to the jaw can help relieve discomfort in the area.

Lower back pain and neck

Similar to general back therapeutic massages, lower back pain and neck pain can be relieved or alleviated completely through competent trigger point therapy application. 

Relief of physical pain from other conditions

Some patients of this therapy treatment have reported benefitting from relieved pain relating to health issues including carpal tunnel syndrome, migraine, tinnitus, sports injuries, neck pain, back pain, knots, sciatica and osteoarthritis. 

Heel pain 

Less common parts of the body, such as heels, have also been anecdotally noted to benefit from trigger point therapy with the alleviation of heel and foot specific pain. 


What to usually expect from trigger point therapy

If you’re experiencing trigger point-related pain and are considering going in for massage therapy, it can be very helpful to understand ahead of time what to expect from trigger point therapy.

Usually, not every patient experiences the same thing. For some, the pain might be relieved during their first therapy session. For others it might be weeks or months before long-term pain relief is achieved. Trigger point cases do vary from person to person and case to case.

One thing that is fairly common is for there to be initial tenderness or pain for the day or two following your treatment. The muscles, which are already experiencing significant pain, are undergoing a ‘trauma’ of sorts due to the extra pressure being applied to them. Even if the actual treatment doesn’t cause pain, some patients can experience delayed aching that can last for a few days.

Fatigue is another symptom that patients can be expected to feel as the muscles experience exhaustion due to the activity of their over-stimulation during treatment. On the flip side, other patients have noted that they actually detect a surge of energy, sometimes in addition to increased movement or flexibility. Either way, over time, your body and musculature will return to its regular feeling, though the original pain will hopefully subside.

Good massage therapists will help you maintain your reduced pain or pain-free new body. Whether by pacing physical activities, minimising stress, preventing injury, or avoiding certain actions that tend to overexert your muscles, make sure your massage therapist is patient and clear with their communication, honest about what can be achieved and positive in attitude. 

There are a number of factors which can theoretically affect the speed and effectiveness of your recovery:

  • Your age – the older you are the longer and slower the process.
  • Health and fitness level – generally fit individuals in good health are likely to experience more speedy recoveries.
  • Nutrition – if you’re intaking the right amount of vitamins and minerals as part of a well balanced and healthy diet you may experience quicker recovery.
  • Trigger points – the type of pain, length of time you’ve had it for, location, and intensity can all be factors that contribute to your overall experience.
  • Causing health factors – assuming you’re able to pinpoint what exactly is causing your trigger points, but unable to prevent yourself from engaging in those activities. completely, you’ll naturally find the entire process slower and more difficult
  • Patience – the more patient you are with yourself and the more you take care to stretch properly, sleep well, eat healthily, exercise properly, and do your activities as prescribed by your trigger point therapist the quicker you’ll begin to see results.
  • Medical and other health conditions – those patients who suffer from other medical conditions, like diabetes or thyroid dysfunction, will find their recovery with trigger point therapy somewhat impacted.

The exact process, order and nature of each treatment experience will depend largely on your massage therapist. However, you should expect good massage therapists to do most of if not all of the following things:

  • Conduct a rigorous pain history and/or medical health assessment.
  • Work with you to create a map of your pain areas and trigger points.
  • Examine your work desk for the quality of its ergonomics, lifestyle, and daily activities.
  • Assess your sleeping habits and make suggestions to help you improve the amount and quality of sleep you’re getting.
  • Assess your diet and nutritional intake in order to make suggestions about how to ensure you’re ingesting the right minerals you need. (Some massage therapists might even opt for blood work or work in conjunction with a healthcare worker to provide this information – with your consent of course.)
  • Refer you to a specialist of some kind.
  • Assess your exercise or sport activities and help you create a customised active exercise program.
  • Help you develop strategies and treatment methods for yourself and manage the pain and trigger points independently.
  • Provide breathing exercises to help promote muscle relaxation and relieve stress or tension.

How long does it take for trigger point therapy to work?

Like many of the experiences to do with trigger point therapy, the length of time you can expect to feel the positive effects of the treatment do vary. 

For many patients, significant pain reduction can occur immediately or in just a few minutes of pressure being applied. For others it can be the day after, or anytime between 3 to 10 days. Longer lasting, more persistent and chronic pain tends to be more complex in nature and might be more resistant to massage therapy. Consistent and ongoing sessions may be needed over a significant period of time, such as weeks or months.

We recommend consulting with your trigger point therapy or massage therapist about what to expect with regards to your health and the alleviation of knots and referred pain.


What does a trigger point release feel like?

Ultimately, the release of your trigger point is what you’re trying to achieve in massage therapy. So how do you know when this is achieved? 

Most commonly, when the trigger point is released you’ll experience an easing of chronic pain and sensitivity or a softening of the muscle tissue itself. Some patients of successful massage therapy have described immediate feelings of muscle relaxation and becoming pain free as the previously tight muscles tissue release themselves. However, there is no single or completely unanimous experience, especially as there can be pain for a day or two following the release so any beneficial feelings could be delayed.


How do you give yourself trigger point therapy

One of the huge benefits of trigger point therapy is that you don’t necessarily have to see (and pay) anyone else to do it. Applying targeted massage therapy on yourself can be very effective. Of course depending on where the trigger point pain is located, will determine how easily you’ll be able to apply trigger point therapy yourself. Your back, for example, is likely to be near impossible for you to apply your own massage to without the proper back massage equipment. 

Step One – Locate the trigger point

In most cases, this will be an easy first step, unless what you’re actually experiencing is a form of fibromyalgia, but locating the source of your chronic pain is an essential if not obvious starting point.

Step Two – Apply pressure

Using your finger or the palm of your hand apply pressure for a long enough period that the muscle tissue spasms release. Usually this could be anywhere from 10 seconds up to 30 seconds. This might be uncomfortable or genuinely cause pain. 

Step Three – Repeat the pressure

To completely release the trigger point and bring your muscle back to its regular healthy state, you’ll need to repeat the application of pressure on the muscle tissue.


How do you rub the trigger point?

Alternatively, instead of simply applying pressure in a single spot to release your trigger point you could rub the spot that’s in pain using a few possible motions.

  1. Kneading strokes – much like you would knead dough when baking, applying kneading strokes over your muscle tissue in pain will help relieve much of the tension.
  2. Circular motions – another way to rub the spot is by going in a circular motion back and then forth. It doesn’t matter whether you go clockwise or anti-clockwise. As long as it’s comfortable and easy to repeat or sustain for a while.
  3. Parallel stroking – if you’re able to tell or determine the direction of the muscle fibers, it might help to try using your fingers and stoke parallel to the fibers themselves for an extra effective therapy.

Which finger is best to be using for your trigger point therapy?

There’s no single finger that is best to use for trigger point therapy. You could try using your fingertips for pinpoint and lighter pressure. The thumb, depending on where the trigger point is located, is great for adding extra pressure without sacrificing too much by way of accuracy. Both the first and the elbow offer significantly more pressure strength, if you can stand it, but it will also be significantly harder to aim it at the perfect spot.


How hard should you push your own body?

It’s tempting to say that the more pressure you can withstand the more likely you’ll be to loosen the muscle’s knot. But the truth is that the ideal here is to strike a balance. You want to apply enough pressure that you’re going to effectively release and loosen the trigger point but not push too hard that you injure yourself, cause unnecessary suffering or can’t stand it long enough to make a positive impact.

Our recommendation is to start off on the safer side and apply gentle amounts of pressure. When you can stand this level of intensity push a little harder, and slowly up the pressure until you find the right trigger point.

An important component to massage therapy and trigger point therapy is to vary the pressure you apply. No matter how hard you’re able to go and how much you think that you can withstand, it’s super important that you ease up from time to time and apply gentle pressure for a bit. This will relieve your skin and also help your muscle to recover.

How often should you do trigger point therapy?

While it’s cliche and unhelpful, this question is much like asking, how long is a piece of string? It really depends on you. If you think that repeated 10-30 seconds of pressure and rubbing over a few minutes is enough, then stop there. If the sensation is working, the pain is subsiding and you have the strength to keep going, then do that too. Most people tend to apply massage therapy to themselves for 5 or so minutes, and often do so at least twice a day. Listen to your body and go according to what feels right.


Conclusion

Trigger point therapy or myofascial trigger point therapy is still relatively new and very much underdeveloped as a form of treatment for chronic pain, referred pain, myofascial pain and muscle pain. While the scientific research has not yet progressed to the point where we can categorically and objectively say that it definitely works or definitely doesn’t, there is enough general understanding and plausible theories to suggest that it can be a useful, safe and cheap method of trying to alleviate chronic pain.

Remember that clinical practitioners and massage therapists offering trigger point therapy are not magicians, so any promises that they can completely and permanently cure you of pain are overly positive at best and most likely misleading at worst. However, most massage therapists are realistic about the truth of trigger point therapy and myofascial pain therapy are likely to offer thorough and helpful explanations to guide you throughout the process. 

If you do decide to also apply massage therapy or myofascial trigger point therapy to yourself, make sure to do so safely and carefully so that you don’t overly strain yourself, cause more pain or cause more damage.

Take care of yourself and we hope you’re pain free as soon as possible!