Saturday 14th August, 2021

What is the best treatment for trigger points

Trigger point therapies
We review the various trigger point therapies and show you which are the best

The best trigger point therapy for you depends on your goals. If you are after pain relief clinical trials show that there is little to choose from between the effectiveness of the common trigger point therapies. What’s best for you will depend on things like cost, pain and whether you like needles. If you wish to eliminate your problem you will need to continue your therapy for much longer, so the best therapy should not only be effective, but also be something that can be self applied. If not, it will become horrendously expensive. For these reasons vibration massage is clearly the best treatment for most trigger points.

In this article we’ll discuss what trigger points are and why most therapies just give temporary pain relief. We’ll summarise the clinical trial results of the various therapy options, then we’ll discuss a therapy and strategy to eliminate your trigger points completely.

CONTENTS

What are trigger points
Most trigger point therapies just relieve pain
Proof that trigger points don't just go
The problem not getting rid of trigger points causes
Overview of an effective trigger point treatment strategy
Your effective home trigger point therapy
Alternative self applied trigger point therapies
Getting started
Professionals
Appendix 1: what the research says about individual trigger point therapies
Appendix2: trigger points cause problems even if not causing pain
References

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)⁠.

Most trigger point therapies just relieve pain

You may feel better after a course of trigger point therapies, but your problem will still be there. As the diagrams below show, trigger points develop slowly over time. They become quite large and cause a lot of problems long before they start shooting pain. When they do start shooting pain trigger point therapies usually just quieten them down to the way they were before they were aggravated. You feel better, but are still there, still large, and still causing other problems.

Trigger point development cycle
Trigger points develop over time, then can eventually be "activated" to cause pain
De-activation of trigger points
De-activation: still there but not referring pain

Proof that trigger points don't just go

Residual trigger points after treatment
Residual trigger points after treatment

Clinical trials of trigger point therapies usually give patients the therapy and see if the pain goes. If it does they can write it up as a success. The researchers who do these trials usually (conveniently?) don’t check whether the trigger points actually go. A few trials have though. In one of these (3)⁠ 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.

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

The problems not getting rid of the trigger points cause.

So, what’s the big problem with just treating trigger points so their symptoms go away, but they don’t? Obviously the pain will return when they are re-aggravated, but there are other issues you may not be aware of.

Trigger points still cause problems when not shooting pain

Even when not shooting pain trigger points still cause lots of problems. These are listed in the appendix below. Some of these will cause muscles, joints and other tissues to deteriorate over time. Also, the continual pain from trigger points causes the nervous system to become sensitised, which is the underlying cause of fibromyalgia and other chronic (long term) pain syndromes. We discuss this in our article on fibromyalgia.

Dr Graeme's comments
Dr Graeme's comments

For 30 years in practice I’ve seen what happens when people just get therapy to relieve the pain but not fix the problem. The pain continues to return, getting harder to treat each time, then sensitisation of the nervous system sets in and makes the problem much worse. In the end people suffer and cannot lead normal lives, while the drug companies get rich. We wanted to help break that cycle, which is why we developed our massagers and the following strategy to get rid of trigger points.

Overview of the effective trigger point treatment strategy

While the trial of 12 weekly sessions showed that trigger points were stubborn, they did tend to diminish and some actually went. This tells us that if treatments are continued over a longer period the trigger points will continue to diminish and hopefully go altogether. Those treatments will need to be effective like the best professional therapies, but able to be self applied or they will become horrendously expensive.

We also know that trigger points are usually part of a more complex musculoskeletal problem, plus there are usually things that cause and aggravate them. To deal with this you need to consult a professional who deals with musculoskeletal problems to help. Professionals usually spend a lot of their valuable time doing therapies, but if you can do a lot of this yourself it not only makes your care affordable, it frees up your professional to concentrate on these other valuable issues.

Summary

  1. Find a qualified professional who deals with musculoskeltal problems, including trigger points
  2. Discuss with him or her that you wish to eliminate your trigger points rather than just temporarily relieve pain
  3. Have home therapy included in your management plan.

Your effective home trigger point therapy

Dr Graeme using massager
Using a vibration massager is simple and effective

From our clinical experience there are a couple of alternatives, but vibration massage is the most effective trigger point therapy. Best of all with proper advice it can easily and safely be self applied. To treat trigger points all you need to do is sit the head of the massager over the trigger point and let the vibrations penetrate and “dissolve” it. There’s no pain, no needles, and you can easily do it on yourself. Please keep in mind this is for general information only. For specific advice please consult a professional familiar with your own needs.

Trigger point: positive feedback loop

Why vibration massage is so effective

We need to understand trigger points to know how to deal with them. There has been excellent scientific work done to understand how trigger points form, what they are, and importantly why they are so tough to get rid of. It gets complicated, but the simplified version is summed up in this diagram. Part of the muscle goes into spasm. That causes the muscle to tighten which puts pressure on the blood vessels, restricting blood flow. The restricted blood flow deprives the tissues of oxygen and causes a build up of wastes. This creates a toxic environment, causing further spasm. This keeps going around in circles. This is why trigger points slowly develop, and why treatment can diminish them, but they slowly build up steam again (4–7)⁠.

Vibration: trigger point therapy
Vibration massage works on all the issues

Knowing that, we need a therapy that that addresses these issues. Vibration massage is the ideal solution because the vibrations have been scientifically proven to disrupt spasm, relax muscles and increase blood flow (replenishing oxygen and flushing wastes). For more detail on the effects of vibration please see our article The scientifically proven effects of vibration massage with clinical applications.

Alternative self applied trigger point therapies

Manual therapies

Of the other common trigger point therapies lasers and needles are not self treatment options. This leaves manual therapies that emulate those used by massage therapists. There are a couple of exceptions which I’ll cover, but in general as discussed in our article on the use of foam rollers these are not that effective and their use potentially dangerous.

Exception one: simple self massage by hand to muscles you can easily get at

In our video on self massage for forearm muscles we show a simple effective self massage technique for treating trigger points. This is suitable for smaller muscles you can easily reach.

Exception two: safe, conservative self pressure techniques

In a trial of a traditional Thai self massage technique (8) ⁠trigger points were successfully treated by each day using five repetitions of five seconds of mild pressure to each of the trigger points. As discussed in our article on foam rollers we are concerned about self users copying the painful techniques some therapists use, but repeated mild pressure done each day should be fine.

Percussion vs vibration massage

Massage guns

As we discuss in our article should I get a massage gun don’t even consider using one for trigger point therapy:

  • they tend to use percussion rather than vibration. Percussion is less effective and more dangerous
  • They have stupid handles which mean you cannot effectively use them on a lot of your body.
  • The market is flooded with machines from manufactures who know and care very little about making an effective therapeutic device.

Getting started

Finding a professional

If you follow the get a massager link on our website you will find lists of clinics that use and recommend our massagers. If one of them was close by they may be a good place to start. Otherwise, find an appropriately qualified professional such a Chiropractor, Osteopath or Physiotherapist.

Getting a massager

The simple way is to get one of ours. They are well built, highly effective and very economical. If you can’t do that we have the following information on how to choose a massager.
Video: How to choose a massagers
Article: percussion vs vibration massage
Usage instructions: Our instructions page
Video: Our highly effective vibration massager

Professionals

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.

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 (9-15)⁠⁠.

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.

Trigger point dry needling
Trigger point dry needling

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 therapy

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.

Major concern

The big concern with laser is the sheer number of applications of therapy sessions needed for only temporary benefits. For example one trial (16)⁠ 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 (17)⁠ 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 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 (10)⁠ one study did show residual benefit after six months.

Appendix: trigger points cause problems even when not referring pain

As stated, according to the scientists the goal of these therapies is to return the trigger points to a state where they are not referring pain. The obvious issue is potential re-aggravation and more pain, but even without referring pain trigger points cause the following problems. These are discussed in our article Trigger point basics.⁠

  • restrict ranges of motion
  • cause muscle weakness
  • cause muscle fatigue
  • alter muscle activations (affecting neurological control of your movements)
  • induce muscle cramps, and
  • affect posture and joint function, creating further issues.

On top of that, scientists are now finding that latent trigger points still produce sub-threshold levels of pain that over time sensitises the nervous system. This is a major cause of issues such as fibromyalgia and migraines (7)⁠

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. 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. Jafri MS. Mechanisms of Myofascial Pain. Int Sch Res Not. 2014;2014:1–16.
  5. Zhuang XQ, Tan SS, Huang QM. Understanding of myofascial trigger points. Chin Med J (Engl). 2014;127(24):4271–7.
  6. Bron C, Dommerholt JD. Etiology of myofascial trigger points. Curr Pain Headache Rep. 2012;16(5):439–44.
  7. Shah J et al. Myofascial Trigger Points Then and Now: A Historical and Scientific Perspective. HHS Public Access. 2015;7(7):746–61.
  8. 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.
  9. 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.
  10. 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.
  11. 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.
  12. 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.
  13. 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.
  14. Espejo-Antúnez L, Tejeda JFH, Albornoz-Cabello M, Rodríguez-Mansilla J, de la Cruz-Torres B, Ribeiro F, et al. Dry needling in the management of myofascial trigger points: A systematic review of randomized controlled trials. Complement Ther Med . 2017;33(December 2018):46–57.
  15. Rickards LD. The effectiveness of non-invasive treatments for active myofascial trigger point pain : A systematic review of the literature. 2006;9:120–36.
  16. 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.
  17. 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).

We are continually adding more information on research and uses. Subscribe below to have us email them to you "hot off the press".

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



Other Articles You May Like

Does vibration massage help healing

It has been long understood that vibration massage can accelerate healing by increasing blood flow and tissue oxygenation. Until... Read Article  

Percussion massager vs vibration massage

The best trigger point therapy for you depends on your goals. If you are after pain relief clinical trials show that there is little to... Read Article  

The scientifically proven effects of vibration massage- with clinical applications

In this summary we investigate the science behind the use of vibration massage. This helps us envisage uses and to develop protocols. ... Read Article  

Do foam rollers actually work: you'll be very surprised

Foam rollers have become a popular way to have practically unlimited self massage. They are inexpensive and can easily be carried to... Read Article  

Should I get a massage gun or, or a vibration massager

You will find a well designed vibration massager easier to use, safer, and will do a much better job. This is because the scientific... Read Article  

Why we use manual therapies with corrective exercises

Corrective exercises are used to correct abnormal function. However, in most cases the abnormal function is the central nervous system's... Read Article  

Can (myofascial) trigger points cause shoulder pain

(myofascial) trigger points are a very large cause of shoulder pain. They have been found to be extremely common in sufferers of... Read Article