Sunday 4th August, 2019
  Categories: Practitioners, General

Muscle fatigue: the cause doctors usually overlook- and what you can do about it

Trigger point
Trigger points are the tender lumps in your muscles therapists find


There are many possible causes of muscle fatigue, but by far the most common and most important cause is (myofascial) trigger points, those lumps in muscles that therapists find.

Scientific studies show:

  • trigger points restrict blood flow to muscles (a causes of muscle fatigue)
  • trigger points are extremely common
  • trigger points are found to cause a reduction in strength, rapid fatigue, and the rapid development of pain
  • treating trigger points reduces fatigue and the development of pain


How trigger points cause fatigue
How common are trigger points
Supporting studies
Why doctors don't find this
How to treat trigger points

Pressure on blood vessels
Pressure on soft walled blood vessels caused by trigger points restricts blood flow to muscles

How trigger points cause fatigue

As discussed in our article on trigger points they are part of a muscle that has gone into spasm. Because of this the whole muscle tightens, placing pressure on the blood vessels and restricting their blood flow.

Therefore, trigger points cause muscle fatigue because:

  • the muscle is already tired from part being in spasm, and
  • the restricted blood flow means the muscles cannot get enough oxygen and nutrients, and waste products build up.

Studies confim that with trigger points do lose strength, quickly fatigue and become painful. It is important to understand that trigger points don't need to be normally painful to do this.

How common are trigger points

Studies show that is you have some sort of pain syndrome such as back, neck or shoulder pain you will almost certainly have many trigger points. However, studies also show that trigger points are extremely common in people without pain.

Graph of how common trigger points are
The percentage of people with trigger points in each individual muscle (pain free adults)


As study of trigger points in 206 health pain free adults found that 77% had at least one and often many. This chart shows the percentage of people with trigger points for each individual muscle. Another study of healthy pain free adults found that nearly 90% had trigger points in their shoulder muscles.

Supporting studies

Trigger points are certainly a huge cause of muscle fatigue because:

  • they are shown to be very common (even in people without pain), and
  • they are shown to cause muscles to quickly lose strength, fatigue and become painful.

This is confirmed by these further studies.

Study one: trigger points reducing endurance (1)

This study investigated the rate of fatigue in shoulder muscles of otherwise healthy pain free adults. They found that when trigger points were present the endurance of the muscles was reduced.

Table: the effect of trigger points on the strength of various muscles
Table: the effect of trigger points on the strength of various muscles (Group one had the trigger points)

Study two: trigger points reduced strength (2)

This study investigated how trigger points in 50 otherwise pain free adults affected the strength of various muscles. As this table shows the strength of those with the trigger points (Group 1) was a lot less.

Study three: trigger points cause pain and accelerated fatigue (3)

This study compared the rate of fatigue and the amount of pain between:

  • muscle muscles that contained trigger points, and
  • muscles with no trigger points.

The chart shows that muscles with trigger points became painful upon exertion, and had accelerated fatigue.

Graph: pain upon exertion trigger points vs no trigger points
Chart showing the amount of pain upon exertion. The muscles with trigger points (dark bar) suffered much more pain
Conclusion from journal article showing that trigger points accelerated fatigue

Trial four: treating trigger points makes a big improvement (4)

We have shown several trials that show that (pain free) trigger points reduce the strength in muscles, accelerate fatigue, and cause muscles to become painful upon exertion. This trial also tested what would happen if the trigger points were treated. They found that treating the trigger points made a big improvement, but they did not go back to normal. As discussed in our article Trigger point basics trigger points take a lot of treatment over time to eliminate (much more than they did in the trial).

Journal conclusion regarding treatment of trigger points
The researchers found that trigger points caused fatigue and pain, but treatment improved it

Doctors don't find trigger points

The problem

Information about trigger points is typically excluded from medical journals, so doctors are not informed and do not diagnose them. This problem is made worse because as well as fatigue trigger points are a major cause of conditions such as fibromyalgia, low back pain, shoulder pain, Tennis elbow, headaches and many others. Because doctors don't understand and diagnose these the cause of many problems is not found and inappropriate treatments are given. The inappropriate treatments are usually drugs. Drug companies heavily influence all the information doctors receive.

Medical journal
Typical medical journal article discussing the causes of fatigue that doctors can prescribe drugs and supplements for

The evidence that this information is suppressed

We've seen the studies that confirm trigger points to be a major cause of fatigue, and frankly anyone with even the basic understanding of physiology would work it out. However, as an example this typical medical journal article (5) just lists a host of things doctors can describe drugs for.

How to treat your trigger points

We have a guide to the best trigger point therapies which includes professional alternatives. We've also got a very comprehensive guide How to treat trigger points at home. This gives treatment alternatives for those who have and haven't got the proper equipment. Please check this out for hints, precautions and good management strategies. What we'll do here is show you the basics of the best trigger point therapy, which happens to be something you can do yourself.

The easiest and best way to treat your trigger points

  1. Get some guidance
  2. The effective therapy you can do at home
  3. Keep repeating until all the trigger points are gone

Professional guidance

Trigger points are often part of more complex musculoskeletal problems so there may be other issues that need to be dealt with. Also, there may be things that cause or perpetuate your trigger points that need to be identified and taken care of. Therefore, to stay safe and get the best results please get some advice from a professional who deals with these issues.

An effective therapy you can do at home

You'll see in the next section that trigger points can be very tough and stubborn to get rid of. Because of that you will need a therapy that is:

  1. very effective
  2. you can do yourself (or the large number of treatments will be very expensive).

By far your best option is to use a vibration massager such as one of our General Purpose Massagers or Ultimate Quad Head Massagers

Very effective

As we discuss in our article Trigger point Basics, trigger points are caused by a combination of:

  • muscle spasm
  • muscle tightness
  • a restriction in blood flow, and
  • a build up of toxic wastes

Therapeutic vibrations have been scientifically shown to penetrate deep into your muscles and help all these things.

Dr Graeme using General purpose Massager to treat trigger points
Dr Graeme using General Purpose Massager to treat trigger points

You can do it yourself

Vibration massage is probably the easiest trigger point therapy to apply. Further there's usually no pain, and with no needles or pressing it is extremely safe. We have full details in our guide How to treat trigger points at home, but basically all you need to do is sit the head of the massager over the trigger point and leave it there for about 30 seconds.

Percussion vs vibration
Massage guns or percussion massagers don't deliver therapeutic vibrations. They jack hammer and cause damage.
Warning about massage guns

Massage guns or percussion massagers are a dangerous gimmick where therapeutic vibration massagers have been converted into mini jackhammers. Most are cheap knock off that do little, but if you get a serious one it won't do much good and you will easily damage your muscles. To get something that's safe and effective please see our article How to choose a massager

Keep repeating until all the trigger points are gone

Although trigger point therapies often give relief this usually just stops them hurting. As soon as they are aggravated again the pain comes back. This is true whether it's a home treatment you got off Youtube or a series of treatments such as needles or laser. The only way to get rid of trigger points is to keep applying the therapy for long after the pain goes.

Results of 12 weeks trigger point therapy
Results of 12 weeks of extensive trigger point therapy. Note that "active" and "latent" trigger points are the same. trigger points. It is just whether they are causing pain at the time
The evidence

As this chart shows the best trigger point scientists in the world used 12 extremely extensive sessions and still only got rid of about 1/3 of the trigger points (6). Each session used multiple therapies and took 45 minutes just for a shoulder. If that could only get rid of 1/3 your trigger points hand full of needles, laser or massage is barely going to make a dent in the numbers.


DrGraeme massagers were originally built by Dr Graeme for use in his clinic, and to prescribe to his patients for additional self use at home. Now these are used by colleagues and other professionals for similar purposes. If you are a professional and wish to know more about this therapy, or possibly get a sample massager to trial please check out our practitioner page.


  1. Hagberg, M. and Kvarnstrom, S. (1984) ‘Muscular endurance and electromyographic fatigue in myofascial shoulder pain’, Archives of Physical Medicine and Rehabilitation, pp. 522–525.
  2. Celik, D. and Yeldan, P. (2011) ‘The relationship between latent trigger point and muscle strength in healthy subjects: A double-blind study’, Journal of Back and Musculoskeletal Rehabilitation, 24(4), pp. 251–256.
  3. Ge HY1, Arendt-Nielsen L, Madeleine P. Accelerated muscle fatigability of latent myofascial trigger points in humans. Pain Med. 2012 Jul;13(7):957-64
  4. Zuil-Escobar, J. C. et al. (2018) ‘[Muscles Recruitment Pattern in People with and Without Active Upper Trapezius Myofascial Trigger Points in the Standing Posture]’, Journal of Physical Therapy Science. Elsevier Ltd, 13(1), pp. 1–9.
  5. Wan, J. J. et al. (2017) ‘Muscle fatigue: General understanding and treatment’, Experimental and Molecular Medicine. Nature Publishing Group, 49(10), pp. e384-11.
  6. Bron, C., de Gast, A., Dommerholt, J. et al. Treatment of myofascial trigger points in patients with chronic shoulder pain: a randomized, controlled trial. BMC Med 9, 8 (2011

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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

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