Thursday 19th August, 2021

How to treat trigger points at home

Self massage forearm
In this article we give you several effective home treatment options

Trigger points can be a painful and sometimes debilitating condition that often require courses of therapy that can be painful, invasive (eg.needles) and expensive. Worse still, you can have all that therapy, feel better, but then the pain usually eventually returns.

The good news is that there are home therapies that are easy to do and as effective (if not more so) than those professional therapies. They will will obviously save you a lot of time and money, but the best thing is that once the pain has gone you can easily continue these home therapies on a maintenance basis, so you possibly never have to worry about trigger point pain again.

In this article we will try and give you everything you need to do this, starting from how you know if you have trigger points through to how to find and treat them.

CONTENTS

  1. What are trigger points
  2. How do you know if you have them
  3. Our home treatment strategy
  4. Self trigger point therapies

What are trigger points

Trigger point
Trigger points are those tender lumps in your muscles that therapists find

Trigger points are those tender lumps in your muscles that therapists find. They are arguably the biggest cause of musculoskeletal pain syndromes such as back neck and shoulder pain (1,2)⁠. For more details please see our article Trigger Point Basics, but in summary.

Trigger point positive feedback loop

What the lumps are

Let’s have a look at what those lumps are. This helps us understand why pain typically comes back after treatment, and how to deal with them properly. As this diagram shows those lumps in your muscles are actually a combination of muscle spasm, muscle tightness, reduced blood flow and a build up of waste products, all locked in what is called a positive feedback loop. This is like what happens when you put a microphone in front of a loud speaker and get a huge squeal until you switch it off. In the case of trigger points:

  • spasm tightens the muscle
  • the tightness presses on blood vessels restricting blood flow
  • the restricted blood flow causes a build up of waste products
  • the build up of waste products becomes toxic causing spasm.

This cycle keeps going around and around in circles, with the trigger points gradually growing.

Types of trigger points

You may read about “active” and “latent” trigger points. This makes it seem that there are two different types. This is misleading because they are the same trigger points. It is just a description of whether they are aggravated and shooting pain (active) or settled and not shooting pain (latent).

Swapping from active to latent (and visa versa)

It is quite common for trigger point pain to be brought on by activity then settle when resting. The trigger points are just swapping from being latent to active then back again. As we will see later most courses of trigger point therapy merely cause trigger points to go from active to latent, but of course still being there they can easily change back to active and cause pain again.

Causes of trigger points

There are three main causes of trigger points:

  1. injuries,
  2. overuse, and
  3. reduced blood supply
Blood vessel being compressed
Poor posture or even trigger point induced muscle tightness can restrict blood flow

Reduced blood supply

Of these probably the most insidious and important cause of trigger points is reduced blood supply due to muscle tightness. As this diagram shows tight muscles press on blood vessels, and this in turn reduces blood flow so your muscles suffer a build up of wastes, and a lack of nutrients and oxygen. Common causes of muscle tightness are:

  1. postural issues such as sitting at a desk
  2. Injuries and pain (muscles tighten for protection)
  3. trigger points themselves. As shown above trigger points cause muscle to tighten. This is part of the chain reaction which causes trigger points to gradually grow.

Symptoms of trigger points

The symptoms of trigger points are:

  • easy fatigue, muscle pain (often increases with activity)
  • reduced flexibility (includes muscle tears and pains)
  • trigger points refer pain, which can mimick a host of conditions including headaches and sciatica
  • pain, fatigue and disrupted sleep can cause feelings of being run down, emotional and psychological problems

How do you know if you have trigger points

Trigger points are extremely common

Studies have shown that trigger points are extremely common whether you have pain or not. As an example a study of workers with neck and shoulder pain found that they had on average 16-17 trigger points in their neck and shoulder muscles (3)⁠. If you have no pain a study of adults with no pain found that nearly 90% had trigger points in their shoulder muscles alone (4)⁠

Diagnosis

Trigger points do not show up in medical laboratory tests or imaging do they are diagnosed by examining the muscle looking for the following signs.

  • tight bands of muscle
  • tender lump that refers pain when pressed upon
  • (sometimes) the muscle will twitch when the trigger point is pressed (the “jump sign”)

We demonstrate this in our video on forearm muscles

Our home treatment strategy

Dr Graeme's comments

Graeme’s comments

We will certainly show you some effective trigger point therapies you can easily do yourself, but we want you to have a strategy to help you be completely rid of trigger point pain forever. To do that we need to show you why pain keeps coming back after courses of therapy, then give you a proper plan to overcome this and get far better results.

The trigger point strategy overview

Why courses of trigger point therapy fail long term

The main reason pain keeps coming back after courses of trigger point therapy is that most courses of therapies are just designed to make people feel better rather than to eliminate the trigger points. This sounds completely ridiculous, but according to a scientific review of trigger point therapies the goal of these is to just deactivate the trigger points (5)⁠, which as we have seen above just changes the trigger points from hurting to not hurting. Of course they are still there and eventually become active again.

Your alternative strategy

One scientific study that did try and eliminate trigger points (6)⁠ found that typical courses of therapy will have little effect on your long term number of trigger points, but if the therapies are continued for a lot longer they will be gradually eliminated. Therefore the basis of our effective trigger point treatment strategy is to give you a very effective home therapy you can keep doing for long enough to rid them. The things you need for this strategy are:

Get some professional advice

You can 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 complex musculoskeletal problem, which they can help manage (7)⁠⁠
  • they can help you find the trigger points and show you how to do the therapy more effectively.
Avoid activities that aggravate your problem

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

Use an effective home therapy

You will need a therapy that can be continually repeated long after your trigger point pain goes, then ideally done on a maintenance basis after your trigger points are gone. This can be done either wholly or partly using professional therapies. We’ve put a summary of these in an appendix, however because of time and cost most people will need at least some home therapy so we have several excellent alternatives in the next section.

The self trigger point therapies

Trigger point examination
Simple trigger point examination: start with flat fingers to find tightness and tenderness

Step one: how to find your trigger points

Trigger points are found by examining your muscles looking for tightness, the tender lumps that shoot pain when you press on them, and sometimes the muscle will twitch. We have the examination technique below and demonstrated in our video on treating forearm muscles. We also thoroughly recommend that when you consult a professional who deals with trigger points, ask him or her to help show you how to find them.

Flat fingers examination technique (the one we use in clinic)

Gently press on the muscle with flat fingers, examining for areas of general tightness and tenderness. When found, use one or two fingers to explore more deeply for tightness and a tender lump.

Step two: your self massage technique options

There are two basic self massage techniques: i) those that mimic manual (conventional) massage and ii) vibration massage.

Manual (conventional) massage techniques

Forearm self massage
Using thumb pressure to self massage forearm muscles
Basic massage

These are the common techniques where a therapist will hold pressure while moving along the muscle. Their technical name for this is effleurage. We liken this to squeezing out an old sponge. As shown in our video on forearm muscles to do this you lubricate the skin then use slow squeezing massage strokes along the muscle, moving in the direction towards your heart. This therapy is easy and very effective, but for self massage you are limited to where you can easily reach.

Our modified basic massage technique

As we’ll discuss next, massage therapists often use pressure techniques to treat trigger points. You can very easily modify the basic massage techniques to include pressure. As you move your contact along the muscle, if you come to a tender lump (a trigger point) stop and maintain the pressure for 5-10 seconds before slowly moving on. Do not increase the pressure. Just use the same pressure as the massage.

Self massage tool: Wilai stick
Using this simple tool and a conservative technique was effective (click image for details)
Pressure techniques

The pressure techniques used by professional therapists can be very very painful, and if you try these yourself not knowing exactly what you are doing you’ll likely hurt yourself. However, scientists have found a simple technique where you can use only moderate pressure and still get great results. In a trial of a traditional Thai home massage (9)⁠ a special tool with a long handle was used to apply moderate pressure. Each day each trigger point was given five applications of five seconds pressure each. This pic shows the tool used in the trial, but there are many similar ones on the market.

Trigger point self therapy: balls
Please compare with Thai technique: awkwardness, control, tension in the muscles
Ball and rollers

The use of balls and foam rollers is widely recommended. However, as discussed in our article on foam rollers we do not recommend these. The results of clinical trials of these have been poor and we have serious reservations about their safety. This picture illustrates some of our concerns. The lady using the Thai technique does not need to get into any awkward positions. The muscles she is treating are relaxed, and she can easily control the pressure.
On the other hand the person using the foam roller is in an awkward position. Her muscles are far from relaxed, and it would be far harder to control the pressure.

Home trigger point therapy using vibration massage (our recommendation)

The manual techniques we’ve shown you are perfectly good and give you options needing either no equipment or a simple tool. However, vibration massage is by far the easiest and most effective option if you have the correct equipment. Vibration massage is:

Very easy

Vibration massage requires no special massage skills. Basically all you need to do is sit the head of the vibration massager over the trigger point and allow the vibration to penetrate.

No pain

With vibration massage it is the vibrations that penetrate. There are no needles or painful pressure. You usually just feel the pleasant sensation of the muscle gradually relaxing.

Highly effective

As discussed in our article What is the best treatment for trigger points vibration massage is probably the most complete of all therapies. Further, self vibration massage can be equally as effective as that provided by a professional. As long as you place the massager in the correct spot it doesn’t matter who is holding the handle.

Very safe

With vibration massage is it just the vibrations that penetrate. Because there is no pressure or penetration with needles it is very safe.

Self massage allows the benefits of quality massage at home for little cost
How to use vibration massage

Using vibration massage is extra-ordinarily easy. We ask you to check our our instructions for the fine points and precautions, but basically all you need to do is place the vibration massager on the muscle over the trigger point and let the vibrations penetrate for 30-60 seconds. This can easily be repeated every day. Please note that you need a proper effective vibration massager. As discussed in our article How to choose a massager most of the common massage guns and percussion massagers will not be effective and many are potentially dangerous.

Massage gun safety
Massage guns are a marketing gimmick that reduces the effectiveness if vibration massage, plus creates serious safety risks
Massage guns and percussion massagers

Massage guns and percussion massagers are widely marketed for treating musculoskeletal pain. However, as discussed in our article Are massage guns a gimmick these are far less effective than genuine vibration massager massagers and carry serious safety risks. You are far better off getting a genuine vibration massager such as our General Purpose Massager or our Ultimate Quad Head Massager.

Step three: monitor your improvements

At the start it is very easy to monitor your improvements: your trigger points will hurt less. However, once the trigger points are no longer active (hurt) we recommend the following checking routine.

Before treatment

Examine for your trigger point. You will need to do this to find the trigger point to treat anyway.

After treatment

Re-examine your trigger point after treatment to make sure the lump is smaller and less tender.

Your professional therapy options

There is always the option to have some or all of your therapy done by professionals so we’ve done a summary of what several scientific reviews of trigger point therapies have said about each of the common ones (5,7,10–14)⁠⁠. Keep in mind though that most of the clinical trials that these scientists have reviewed just tested whether their therapies converted the trigger points from active (shooting pain) to latent (not shooting pain). Therefore we get an idea of the relative merits of each, but they don’t really say anything about eliminating your problem.

Dry needling

Most trials show that dry needling provides some short term pain relief and improved function. The risks and potential to cause pain are obvious. The mode of how needles work is still speculation. Where dry needling had been compared with laser the laser has given slightly better results.

Laser

Laser

Trial results for laser have been marginally better than those for dry needling, but still only temporary relief. Scientists attribute it’s effect to increasing micro-circulation, improving oxygenation and helping remove waste products. However, this is something that can easily be achieved, if not better, by any competent massage therapist.

Huge numbers of treatments

The big concern with laser is the sheer number of applications of therapy sessions needed for only temporary benefits. For example one trial (12)⁠ used 10 daily applications of laser on patients with upper back and neck pain to get a reduction in pain and tenderness for three weeks. Further, according to one review (13)⁠ applications of laser should be given from 2-3 times a week though to 5 times a week, with a total of 30 applications of therapy for long term cases. Keep in mind this is just to achieve deactivation, not to eliminate the problem. Assuming each laser consultation costs $50 and takes an hour out of your day that’s $1,500 and 30 hours of your life just for some temporary pain relief, leaving you to front up again next time the problem is aggravated.

Manual trigger point therapy

Manual therapies

There are various types of manual therapies that involve pressure, massage and stretching of muscles. The trial results for them tend to be similar to those of laser and dry needling. However, according to one review (6)⁠ one study did show residual benefit after six months.

Professional at desk

Professionals

If you are a professional wishing to help your patients/clients with home trigger poing therapy DrGraeme massagers were originally built by Dr Graeme for use in his clinic for this purpose and are now 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.

References

  1. Chiarotto A, Clijsen R, Fernandez-de-las-Penas C, Barbero M. The prevalence of myofascial trigger points in spinal disorders: a systematic review and meta-analysis. Physiotherapy. 2015;
  2. Celik D, Mutlu EK. Clinical implication of latent myofascial trigger point topical collection on myofascial pain. Curr Pain Headache Rep. 2013;17(8).
  3. 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.
  4. 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.
  5. 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.
  6. Bron C, Wensing M, Franssen JLM, Oostendorp RAB. Treatment of myofascial trigger points in common shoulder disorders by physical therapy: A randomized controlled trial . BMC Musculoskelet Disord. 2007;8:1–8.
  7. 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.
  8. 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.
  9. Wamontree P, Kanchanakhan N, Eungpinichpong W, Jeensawek A. Effects of traditional Thai self-massage using a Wilai massage stickTM versus ibuprofen in patients with upper back pain associated with myofascial trigger points: a randomized controlled trial. J Phys Ther Sci. 2015;27(11):3493–7.
  10. Boyles R, Fowler R, Ramsey D, Burrows E. Effectiveness of trigger point dry needling for multiple body regions: A systematic review. J Man Manip Ther . 2015;23(5):276–92.
  11. Tough EA, White AR, Cummings TM, Richards SH, Campbell JL. Acupuncture and dry needling in the management of myofascial trigger point pain: A systematic review and meta-analysis of randomised controlled trials. Eur J Pain . 2009;13(1):3–10.
  12. Cagnie B, Castelein B, Pollie F, Steelant L, Verhoeyen H, Cools A. Evidence for the use of ischemic compression and dry needling in the management of trigger points of the upper trapezius in Patients with Neck Pain: A Systematic Review. Am J Phys Med Rehabil. 2015;94(7):573–83.
  13. Espejo-Antúnez L, Tejeda JFH, Albornoz-Cabello M, Rodríguez-Mansilla J, de la Cruz-Torres B, Ribeiro F, et al. y needling in the management of myofascial trigger points: A systematic review of randomized controlled trials. Complement Ther Med . 2017;33(December 2018):46–57.
  14. Rickards LD. The effectiveness of non-invasive treatments for active myofascial trigger point pain : A systematic review of the literature. DARE, 2006;9:120–36.
  15. Hakgüder A, Birtane M, Gürcan S, Kokino S, Tura FN. Efficacy of Low Level Laser Therapy in Myofascial Pain Syndrome: An Algometric and Thermographic Evaluation. Lasers Surg Med. 2003;33(5):339–43.
  16. Uemoto L, Nascimento De Azevedo R, Almeida Alfaya T, Nunes Jardim Reis R, Depes De Gouvêa CV, Cavalcanti Garcia MA. Myofascial trigger point therapy: Laser therapy and dry needling. Curr Pain Headache Rep. 2013;17(9).
  17. Jafri MS. Mechanisms of Myofascial Pain. Int Sch Res Not. 2014;2014:1–16.
  18. Bron C, Dommerholt JD. Etiology of myofascial trigger points. Curr Pain Headache Rep. 2012;16(5):439–44.
  19. Shah J et al. Myofascial Trigger Points Then and Now: A Historical and Scientific Perspective. HHS Public Access. 2015;7(7):746–61.

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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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