Tuesday 6th August, 2019
  Categories: General

The relationship between latent (pain free) trigger points and depression


Latent (pain free) trigger points are those tender spots in tightened muscles that you do not know are there until a masseur presses upon them. A study published in the journal Clinical Rheumatology investigated the prevalence of these in the shoulder muscles of apparently healthy pain free adults, and whether they were associated with depression. The trigger point examination found that 60% of the apparently normal people had one or more trigger points in their shoulder muscles. When assessing for symptoms of depression they found that in general the more latent trigger points the more depression symptoms. Those with no latent trigger points showed very few symptoms of depression, while those with five or more latent trigger points questionnaire results placed them well within the clinical depression range.

For further trial details please see the practitioner version of this summary.


Trigger points are common

The trial showed that 60% of apparently normal pain free adults had these trigger points in their shoulder muscles. Other trials have shown higher percentages, up to 90%. Trigger points are a major cause of many pain syndromes such as back, neck and shoulder pain. Until aggravated though they are pain free (unless pressed upon). Even in this pain free state though they have been shown to tighten muscles, cause fatigue, inhibit performance, and predispose to injury. Reserach now implicates them as a possible cause of depression.

The association with depression

What is known

The research showed that in the pain free people tested the higher the number of trigger points the higher the depression score tests, and visa versa. This indicates that they go together, but not causes which. The authors confirm this by stating that the relationship between latent trigger points, anxiety, stress and depression is not fully understood.


The authors speculated that depression may be a cause of latent trigger points, and hence stress and depression management may be considered as a treatment for latent trigger points. This may be correct. However, there are two other possibilities to consider.

  1. Firstly, latent trigger points may somehow cause depression. In that case trigger point therapy should be considered as a treatment for depression.
  2. The second possibility is that there could be another issue that is a common cause of both trigger points and depression. A hypothetical example may be that a boring job that involves repeated mundane tasks with poor ergonomics. That could cause both trigger points and depression.

Facts we can use

The only thing that we can be certain of from this research is that latent trigger points are relatively prevalent in pain free people, and that trigger points and depression tend to go together. The practical implications from this are as follows.

Those with depression

When someone has depression (or depression symptoms) screening for trigger points should be considered.

Those with trigger points

If someone has a high number of trigger points an assessment for depression should be considered.


Trigger points are very common. Apart from their potential to cause pain they have many other implication, including the possibility of causing depression. Regular screenings for trigger points seems wise.

The treatment of trigger points

For details about the treatment of trigger points please see our discussion elsewhere on the website

Professional consultation

We encourage you to share this information with your health care professional. Download the .pdf of the practitioner version of this summary: Download


Çelik, D., & Mutlu, E. K. (2012). The relationship between latent trigger points and depression levels in healthy subjects. Clinical Rheumatology, 31(6), 907–911. https://doi.org/10.1007/S10067-012-1950-3

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Dr Graeme

About Dr Graeme

Several years ago Dr Graeme, a Chiropractor practicing in Victoria, Australia was looking for a serious hand held massager his patients could use at home to get the extra quality massage they needed. The ones he found in the shops and on-line for home use looked nice but were not serious, and... read more