Trigger point basics: what they are, what they do, and how to treat them

What are trigger points

Trigger points are tender lumps with your muscles that shoot pain when pressed upon. They are parts of your muscle that have gone into spasm or “cramped” forming the lump. As we’ll discuss in the section on what trigger points do, these spasms “lock on" and continue to grow causing a host of adverse effects including often eventual pain.

Symptoms of trigger points

Muscular pain, fatigue and reduced performance

Trigger points can cause muscular pain, plus as we will see later will affect the way your muscles works. Symptoms may be deep muscular pain, reduced performance and easy fatigue. Symptoms will often increase with activity.

Reduced flexibility

Trigger points cause muscles to abnormally tighten, reducing flexibility. It is important to note that this tightness can make muscles easy to tear, or cause problems where they attach (such as tennis elbow).

How trigger points are diagnosed

A trained therapist will find trigger points in a matter of seconds, however they do not show up on any laboratory tests or medical imaging. Diagnosis is by examining the muscles and finding:

• a tight band within the muscle
• a tender lump which shoots pain when pressed upon
• (sometimes) a “jump sign” which is the muscle twitching when the trigger point is pressed upon.

What causes trigger points

There are a variety of possible causes of trigger points including blood chemistry issues and emotional stress, however, these are the big ones.

Overuse

Examples include repeated use of forearm muscles by some trades people or production line workers.

Injuries

Includes repeated strains and injuries due to sport or manual labour.

How common are trigger points

If you have pain

If you have musculoskeletal pain such as back neck or shoulder pain studies show that you are almost guaranteed to have trigger points.

Example: neck and shoulders

In an investigation of workers with pain in their neck and shoulder region the workers were checked for trigger points in their neck, shoulder and arm muscles (1)⁠. The results were:

• Blue collar workers: Ave. 16 trigger points
• White collar workers: Ave. 17 trigger points

If you have no pain

Example: shoulders

But what if you have no pain? An investigation of pain free adults found that nearly 90% had trigger points in their shoulder muscles alone (2)⁠.

What trigger point do: pain and other effects

We’ve seen that trigger points are a tender lump within the muscle that keeps growing over time. Scientists found that what they are is actually a combination of muscle spasm, muscle tightness and a build up of wastes (3–8)⁠. As shown below these feed on each other creating what is known as a positive feedback loop.

The problems this causes

Now you know what’s happening inside the muscle lets look at the problems this causes.

Pain

The most obvious symptom of a trigger point is pain. Scientists have made charts like the one at the start of this article showing common trigger points and where they refer pain to.

Other problems

We mentioned active and latent trigger points before. Long before trigger points start shooting pain spontaneously they still cause pain when pressed upon and cause a host of other problems. Lets look at these.

Tiredness, rapid fatigue and pain on exertion

Muscles containing trigger points suffer from restricted blood flow and are already partially fatigued because of the ongoing spasm. Therefore you may suffer from:

• tiredness
• rapid fatigue
• pain on exertion
• as discussed in separate articles this can i) slow down reaction times for sports, and ii) cause joint movement to be less controlled resulting in pain and injuries (9–14)⁠.

Abnormal tightness: tears and attachment pain

Muscles with trigger points are constantly tight, and because part is trying to contract all the time they will resist stretching. Because of this they are:

• prone to tearing
• the extra tension may cause the muscle attachments to become painful (eg.tennis elbow)
• they will resist stretching, or quickly re-tighten

Trigger are too often not diagnosed or poorly treated

Trigger points not diagnosed

Despite practically everyone having them and trigger points being arguably the biggest cause of most common musculoskeletal pain syndromes they do not show up in laboratory tests or medical imaging. Further, drug companies make no money from treating them. Because of this trigger points are rarely mentioned in medical journals and doctors are instead advised to prescribe symptom relieving drugs. As examples, the following articles discuss conditions where trigger points are a huge cause but rarely mentioned in medical journals.

• Shoulder pain
• Tennis elbow
• Headaches

Trigger points poorly treated

If trigger points are diagnosed they are often poorly treated. The key issue is that therapies are used to (temporarily) stop trigger points shooting pain, but not to eliminate them (15,16)⁠. They call this “deactivating” the trigger point. This applies whether it’s a course of needles or laser, or a release technique you’ve seen on youtube. We discuss in our article Why do trigger points keep coming back.

I hope you can see the problem with this. The trigger points are still there. They still cause all the extra problems discussed above, and of course will start hurting again as soon as they are re-aggravated. Later we’ll show you a much better way of doing things.

Further discussion of medical and professional trigger point therapies

How trigger points progress to chronic pain or fibromyalgia

As we have seen neither failing to diagnose trigger points and masking them with symptom relieving drugs, nor typical trigger point therapies that just deactivate trigger points actually get rid of the trigger points. Therefore too often trigger points are allowed to continue to cause pain for years and often decades.

As discussed in our article on fibromyalgia, over time the continued bombarding with pain sensitises your nervous system so it becomes like a pain amplifier. When this happens normal sensations become painful and painful stimuli become much more severe. This is the basis of fibromyalgia, but can also be a major factor in a lot of other chronic (long term) pain syndromes.

Effective treatment and management of trigger points

As mentioned above, the typical goal of trigger point therapy is to merely deactivate the trigger point, not get rid of it. To the uninformed the pain goes away and the problem is fixed, but of course it is still there. Please allow us to share with you an example that shows how futile a lot of courses of trigger point therapy actually are, but do show us how trigger points can actually be eliminated.

Your effective solution

We have a separate article How to treat trigger points at home that gives the complete strategy plus multiple effective self treatment options. So here we will just give a summary of the important points, plus the best home trigger point therapy option.

Professional advice

You may be able to do a lot of therapy yourself, but to help you get the best possible results and to stay safe we recommend that you get some professional advice.

• trigger points are often part of a more more musculoskeletal problem they can help manage (18)⁠
• they can help you find the trigger points and show you how to do the therapy more effectively.

Avoid aggravating activities

You may need to at least temporarily avoid activities that aggravate the condition

Effective self therapy

We’ve seen that 12 sessions from the world’s best only partially remedied the problem, so:

• you need a lot more than 12 applications, which for most will mean a self therapy
• it will need to be very effective

The best solution

Luckily we’ve got the ideal solution: using a vibration massager. We have a lot more information about this in our article How to treat trigger points at home, but proper vibration massagers (not a massage guns or percussion massagers) are:

• very easy to use (you just sit the machine on and let it penetrate), and
• the vibrations penetrate and do the key things required to help eliminate the trigger point’s positive feedback loop.

Getting a vibration massager

There are some good units on the market, but a lot that are not that effective. Please see our article How to choose a massager. Be especially aware that most massage guns are based on percussion massage rather than vibration. This is a gimmick that makes them a lot less effective and potentially dangerous.

Appendix: Alternate trigger point therapies

Medical

The medics have a wide selection of medications they use to relieve the symptoms of trigger points. Of course they do nothing to eliminate the trigger points, and all the non-pain effects will still be there.

• nonsteroidal anti-inflammatory drugs (NSAIDs)
• analgesics
• muscle relaxants
• anticonvulsants
• tricyclic antidepressants
• botox injections

Alternative professional therapies

Our article What is the best treatment for trigger points discusses the research backing for the professional therapies below. As mentioned above though all made the goal of pain relief rather than elimination. In the trials they often did 5-10 therapy sessions, which is a large expense and inconvenience for what amounts to temporary pain relief.

• Dry needling
• Laser
• Manual trigger point therapies

References

1. Fernández-De-Las-Peñas C, Gröbli C, Ortega-Santiago R, Fischer CS, Boesch D, Froidevaux P, et al. Referred pain from myofascial trigger points in head, neck, shoulder, and arm muscles reproduces pain symptoms in blue-collar (Manual) and white-collar (Office) workers. Clin J Pain. 2012;28(6):511–8.
2. Lucas KR, Rich PA, Polus BI. How common are latent myofascial trigger points in the scapular positioning muscles? J Musculoskelet Pain. 2008;16(4):279–86.
3. Simons DG. Understanding effective treatments of myofascial trigger points. J Bodyw Mov Ther. 2002;6(2):81–8.
4. Bron C, Dommerholt JD. Etiology of myofascial trigger points. Curr Pain Headache Rep. 2012;16(5):439–44.
5. Dommerholt J, Bron C, Franssen J. Myofascial Trigger Points: An Evidence-Informed Review. J Man Manip Ther. 2006;14(4):203–21.
6. Jafri MS. Mechanisms of Myofascial Pain. Int Sch Res Not. 2014;2014:1–16.
7. Zhuang XQ, Tan SS, Huang QM. Understanding of myofascial trigger points. Chin Med J (Engl). 2014;127(24):4271–7.
8. Shah J et al. Myofascial Trigger Points Then and Now: A Historical and Scientific Perspective. HHS Public Access. 2015;7(7):746–61.
9. Lucas KR, Rich PA, Polus BI. The Effects of Latent Myofascial Trigger Points on Muscle Activation Patterns During Scapular Plane Elevation. Jclb. 2007;25(8):765–70.
10. Phadke V, Ludewig PM. Study of the scapular muscle latency and deactivation time in people with and without shoulder impingement. J Electromyogr Kinesiol. 2013;23(2):469–75.
11. Bohlooli N, Ahmadi A, Maroufi N, Sarrafzadeh J, Jaberzadeh S. Differential activation of scapular muscles, during arm elevation, with and without trigger points. J Bodyw Mov Ther . 2016;20(1):26–34. Available
12. De Mey K, Danneels L, Cagnie B, Cools AM. Scapular muscle rehabilitation exercises in overhead athletes with impingement symptoms: Effect of a 6-week training program on muscle recruitment and functional outcome. Am J Sports Med. 2012;40(8):1906–15.
13. Worsley P et. al. Motor control retraining exercises for shoulder impingement: effects on function, muscle activation and biomechanics in young adults. J Shoulder Elb Surg. 2013;22(4):e11–9.
14. Moraes GFS, Faria CDCM, Teixeira-Salmela LF. Scapular muscle recruitment patterns and isokinetic strength ratios of the shoulder rotator muscles in individuals with and without impingement syndrome. J Shoulder Elb Surg. 2008;17(1 SUPPL.):48–53.
15. Uemoto L, Garcia MAC, Gouvêa CVD, Vilella O V., Alfaya TA. Laser therapy and needling in myofascial trigger point deactivation. J Oral Sci. 2013;55(2):175–81.
16. De Las Peñas CF, Sohrbeck Campo M, Fernández Carnero J, Miangolarra Page JC. Manual therapies in myofascial trigger point treatment: A systematic review. J Bodyw Mov Ther. 2005;9(1):27–34.
17. Bron C, De Gast A, Dommerholt J, Stegenga B, Wensing M, Oostendorp RAB. Treatment of myofascial trigger points in patients with chronic shoulder pain: A randomized, controlled trial. BMC Med. 2011;9.
18. Denneny, Diarmuid et al. Trigger point manual therapy for the treatment of chronic noncancer pain in adults: a systematic review and meta-analysis. Arch Phys Med Rehabil. 2019;100(3):562–77.