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

There are several good trigger point therapies you can do at home. These can give pain relief, but trigger points are stubborn and hard to get rid of so the pain usually returns. The good news is that if you use those same trigger point therapies consistently to work on the trigger points even after they stop hurting it can be part of a very effective program to help diminish your trigger points and maybe get rid of them altogether.

In this article we’ll go over the effective home trigger point therapies you can use, then show you how you may use them as part of a proper trigger point elimination program.

CONTENTS

Trigger points explained
Your home trigger point therapies
Using these therapies in an effective trigger point therapy program
Professionals
Appendix: what the research says about individual trigger point therapies
References

Trigger points points explained

In this section we will share with you what trigger points are, how they develop, and proof that trigger point therapies and home release techniques just temporarily stop them hurting.

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

What are trigger points

Trigger points are those tender lumps in your muscles that therapists find. You often don’t know they are there unless a therapist presses on them and they shoot pain, but when they do start shooting pain they are arguably the biggest cause of musculoskeletal pain syndromes such as back neck and shoulder pain (1,2)⁠.

Trigger point development cycle
Trigger points develop over time, then can eventually be "activated" to cause pain

How trigger points develop

As this diagram shows, trigger points develop slowly over time. They become quite large and cause a lot of problems long before they are finally aggravated and start shooting pain.

De-activation of trigger points
De-activation: still there but not referring pain

Trigger point therapies and “releases” just relieve pain but not eliminate the problem

As the second diagram shows, when they do start shooting pain trigger point therapies usually just quieten them down to the way they were aggravated. You feel better, but are still there. They are still large, and still cause other problems.

Residual trigger points after treatment
Residual trigger points after treatment

Proof that trigger points don't just go away

This is confirmed by a trial (3)⁠ where some of the best PhD trigger point scientists in the world gave their patients not one but three different trigger point therapies each week for 12 weeks. This is way more than most people would get if they consulted a professional, but as the results in is chart show after that huge amount of treatment most of the trigger points were still there.

Keeping this in mind, and the fact that clinical trials typically just measure symptoms, we’ve summarised what the clinical trials say about the effectiveness of each of the common therapies in the appendix below.

"Latent" and "active" trigger points
So you understand the chart, “active” trigger points and “latent” trigger points are the same trigger points. They are just called active when shooting pain, and latent when they (temporarily) stop shooting pain.

Dr Graeme's comments

Dr Graeme's comments

The results of this trial show that 12 sessions of trigger point therapy only eliminated about 1/3 of the trigger points, suggesting that maybe 40-50 sessions would be needed to eliminate them all. This is exactly what what we've found in clinic. A small number of therapy sessions will usually make you feel much better, but if this is continued the trigger points get better and better. Without home therapy this would be horrendously expensive. This is why we developed our effective massagers for home use.

Your home trigger point therapies

There are two basic types of trigger point therapy you can use at home: those based on manual massage techniques and those using vibration massage. In this section we’ll show you how to find your trigger points and how to do both of these therapies. Keep in mind though that this is for general information only. For specific advice you need to see a professional familiar with your own needs.

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

How to find your trigger points

Trigger points are tender lumps within tight bands of muscle. When you press on them they will shoot pain and sometimes cause the muscle to twitch. We thoroughly recommend that you consult a professional who deals with trigger points to help identify the ones affecting you and show you how to find them, but we share with you the basic examination procedure. These are demonstrated in our video on treating forearm muscles

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.

Home trigger point therapies using manual massage

Manual massage techniques performed by professional therapist can be an effective trigger point therapy. There are home techniques that mimic these. As we discuss in our article Do foam rollers work we have reservations about the use of tools such as balls and foam rollers to apply painful pressure, but will show you two relatively safe and effective techniques.

Forearm self massage
Using thumb pressure to self massage forearm muscles

Combining squeezing massage with holds

One of main massage techniques is called “stripping” (technical name= effleurage). Think of gradually moving along the muscle like squeezing out an old sponge. To do this lubricate your skin, apply moderate pressure and move along the muscle slowly. As the veins and lymphatic vessels have one way valves this needs to be done towards your heart.

To turn this stripping technique into a very effective trigger point therapy, when you get to a tight spot or trigger point stop and hold the pressure for 5-10 seconds, then slowly move on. The safest and best way to do this technique is to start with light to moderate pressure then gradually repeat with more pressure. For a demonstration of this please see our video on treating forearm muscles

Pressure techniques

Professional therapists use various techniques that apply pressure direct to the trigger point. There are a lot of people advising to do this at home with balls and rollers. As discussed though we have reservations about the risks and benefits of doing this. In clinic we have seen seen way to many patients hurt themselves and get very little benefit. However, there is a very safe and effective way to use pressure techniques at home. In a trial of a traditional Thai home massage (4) a special tool with a long handle was used to apply moderate pressure to relaxed muscles. Each day each trigger point was given five applications of this moderate pressure for five seconds each. This tells us painful pressure is not needed. Multiple applications of moderate safe pressure work very well.

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

Safe and effective Thai technique
Using the tool allowed the muscles treated to be relaxed. 5 seconds of moderate pressure pressure was applied five times. This was repeated each day. To use this technique find each trigger point, make sure the muscle is relaxed, then use either your hands or some sort of tool to give multiple applications of moderate pressure.

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

Ball and roller techniques
For comparison this picture shows applying pressure to the same muscles using a ball. Note that the muscles are far from relaxed, and being an awkward position it would be far harder to control the pressure.

Home trigger point therapy using vibration massage (our recommendation)

Vibration massage is widely used by professionals to treat trigger points. It is done by simply placing the vibration massager over the trigger point allowing the vibrations to penetrate and have their effect. Because it does not require penetrating pressure it is relatively safe, and because no special skills are required it is far easier to self apply.

Dr Graeme's comments

Dr Graeme's comments: you can get professional results from self therapy

Manual therapies rely on skilled application and it can be difficult to get into some positions for self massage, so self applied manual massage is often no where as effective as professional therapy. On the other hand because a vibration massager just sits on the surface and does the work, as long as it is applied in the right place self applied vibration massage can be as effective and professionally applied vibration.

Trigger point: positive feedback loop

Why vibration massage works

As shown in this diagram the key parts of a trigger point are muscle spasm, muscle tightness, restricted blood flow, and a build up of toxic wastes. Vibrations have been shown to help all of these. For more information please see our guide The scientifically proven effects of vibration massage- with clinical applications.

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 Should I get a massage gun or a vibration massager most of the common massage guns and percussion massagers will be ineffective. This video shows our very effective vibration massager.

Using these therapies in an effective trigger point therapy program

Most people just use these therapies for pain relief, but as discussed trigger points don’t go so the pain returns. If you continue using regular trigger point therapy after the pain goes it will continue to diminish the trigger points and you will be much better off than those who just do pain relief. However, I would encourage you to take one step further and get some professional advice to help eliminate your problems properly. This is because trigger points are usually part of a more complex musculoskeletal problem, plus have things that cause and aggravate them. These issues need to be dealt with to properly eliminate your problems

How to find a professional

We recommend that you find a qualified professional who deals with trigger points, such as a Chiropractor, Osteopath or Physiotherapist. Discuss that you wish to combine home trigger point therapy with his or her management to properly eliminate the problem. If you don’t have a professional a good place to look would be to go to our massager order section, select your country, then select the first option: from a clinic that sells and recommend them. The website has these clinics on a map, plus listed in post code order.

Dr Graeme's comments

Dr Graeme's comments: combining professional help with home therapy

Typically professionals who deal with trigger points must examine and determine the problem, provide care for things other than trigger points, provide advice, and provide trigger point therapy. If you are able to do a lot of the therapy yourself this will free up your professional to spend more times doing the other things.

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.

Appendix: What the research says about individual trigger point therapies

Below is a summary of the findings of several scientific reviews of trigger point therapies (5-11)⁠⁠.

The goal of trigger point therapy

As said previously, the goal of trigger point therapy, according to the scientists, is to deactivate the trigger points. None mention having the goal of eliminating trigger points.

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.
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.

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](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. 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.
  4. 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.
  5. 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.
  6. 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.
  7. 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.
  8. 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.
  9. 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.
  10. 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.
  11. 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.
  12. 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.
  13. 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).
  14. Jafri MS. Mechanisms of Myofascial Pain. Int Sch Res Not. 2014;2014:1–16.
  15. Zhuang XQ, Tan SS, Huang QM. Understanding of myofascial trigger points. Chin Med J (Engl). 2014;127(24):4271–7.
  16. Bron C, Dommerholt JD. Etiology of myofascial trigger points. Curr Pain Headache Rep. 2012;16(5):439–44.
  17. 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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