Thursday 18th November, 2021

Massage and trigger point therapy for low back pain, with self help options

Back pain
This article includes an illustrated self massage guide for back pain

Massage and trigger point therapy are widely used to treat back pain. In this article we’ll discuss how these may help with your problem, including the various muscles and trigger points likely to cause you back pain, and the best therapies. These therapies can be expensive, so where possible we will give you safe effective self treatment options.


Massage and trigger point therapy can help back pain
Part one: what are trigger points
Part two: basic massage and trigger point therapy
Part three: the muscles involved in back pain
Appendix: summary of clinical trials of massage for back pain

Massage and trigger point therapy can help back pain

Massage and trigger point therapy can be used for back pain relief and often give great results. However, as I discuss in our article on the cause of back pain there can be other issues, but even then massage and trigger point therapy are usually an important part of a program of correction and rehabilitation. We give a brief outline here, but recommend you check out the article

Back pain relief

Clinical trials show most therapies for back pain (eg, massage, exercises and medications) give moderate short term relief. Massage and trigger point therapies are probably better than most. As an example, in the one trial (1)⁠ that compared massage with pain killing medications (NSAIDS) simple home massage was found to be much more effective, and of course would not have had the potential side effects or ongoing costs. I have summarised the research on massage in the appendix, and the various trigger point therapies here.

Correction and rehabilitation

The reason therapies such as massage, exercise and medications alone only give short term relief is that as discussed in our article on the causes of back pain most issues like tight muscles, inflamed joints and so forth are secondary to more underlying problems. This article discusses what these underlying issues are and how they are corrected. However, as well as providing short term relief, the massage and trigger point therapies discussed in this article are also a very important part of any correction and rehabilitation program.

Dr Graeme's comments

Graeme’s comments

Back pain can be complex so I ask that you have any problem checked out by an appropriate professional for specific advice. The following is advice I’d give to most patients, as long as it was appropriate. To give you the best possible resource I’ll:

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

Part One: what are trigger points

Simply speaking, trigger points are those tender lumps in your muscles that therapists find. We have a lot more information about them in our article Complete guide to trigger points. In summary, they start as small lumps that you only know are there when a therapist presses on them and they shoot pain. However:

  • over time they develop until they shoot pain without being pressed upon, and are arguably the biggest cause of musculoskeletal pain, and
  • even before spontaneously shooting pain trigger points cause muscles to tighten, lose strength and fatigue quickly.

Part two: basic massage and trigger point therapy


In part three we will go over the specific muscles that are usually involved in back pain. Most properly qualified therapists should be able to help massage these. However, as discussed in our article Why trigger points keep coming back it usually takes a great number of applications of therapy to properly eliminate most problems. This can be very expensive, so in this section we will focus on self massage techniques.

How to examine your own muscles

It is best to have a professional show you how to examine for trigger points so you learn the correct techniques and can be sure that what you find is a trigger point. However the basic examination technique is very simple. You start by using flat fingers and moderate pressure as shown to examine your muscles for tight or tender areas. If you find a tight or tender area use one or two fingers to examine deeper, looking for tight bands of muscle. Along these tight bands of muscle you may find a tender harder part (lump) that may shoot pain when it is pressed upon. These lumps are likely trigger points.

Flat fingers
First use flat fingers to examine for tightness and tenderness
Deep trigger point examination
When found, use one or two fingers to examine deeper

Self therapy technique one: basic massage

I’ve demonstrated this technique in this video on my forearm muscles because it is easy to see. I can be used on some back muscles, but others will be hard to reach and you’ll need another person to do. Imagine your muscle is like an old sponge and you are squeezing out the gunk. Apply pressure with your thumb or something else appropriate and slowly move along the muscle.

  • Massage like this must be done towards your heart because your lymphatic (drainage) vessels and veins have one way valves. Massaging the other way would be trying to force fluids the wrong way through these one way valves.
  • Work systematically to cover all the muscle
  • Repeat the process using gradually more pressure to penetrate deeper.

Trigger point therapy variation

This basic massage procedure can be easily modified to turn it into a very effective trigger point therapy. All you need to do is when you get to a tight spot/ trigger point stop and hold the pressure for 5-10 seconds before slowly moving on.

NOTE: these are a bit hard to illustrate for back muscles and if you don’t get them right they won’t do much good. If you wish to use them I’d ask a trained therapist to show you and critique your technique.

Self therapy technique two: “Thai” self trigger point therapy

Professional therapists use various techniques based upon applying pressure direct to the trigger point. There are a lot of people advising to do this at home with balls and rollers. As I discuss in Do foam rollers work I have grave reservations about these. In practice as a chiropractor I’ve seen way to many people hurt themselves using these and not a lot of benefits. On the other hand there is a traditional Thai home therapy technique that appears to be very safe and was shown to be very effective in a trial treating upper back pain (1)⁠ . It uses a special tool with a long handle to apply moderate pressure to relaxed muscles. Each day each trigger point was given five applications of this moderate pressure for five seconds each. The big differences between this technique and foam roller/ balls are:

  • you are not getting into difficult positions and the muscles you are treating can be relaxed,
  • it is much easier to control the pressure, and
  • rather than more painful and prolonged pressure the Thai technique uses multiple short duration applications of moderate pressure.

The trial of this therapy used a tool called a wilai stick, but there are many similar tools available.

Self therapy three: 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

You can get professional results from self therapy

We’ve discussed that because manual therapies rely on skilled application and it can be difficult to get into some positions for self massage, 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.

Vibration: trigger point therapy

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.

For how to choose an quality massager that will do a great job and that you will be extremely happy with please see our article How to choose a massager, or you can go straight and check out our economical, easy to use professional standard machines: the General Purpose Massager or our Ultimate Quad Head Massager.

Part three: the muscles involved in back pain

In this section I’ll go over each of the muscle groups commonly involved in back pain, giving

  • basic anatomy (where they are)
  • any problems they typically cause
  • illustrated self therapy techniques
The erector spinae muscles
The erector spinae muscles

The erector spinae muscles

These are the long muscles closest to the surface that run down each side of your spine. They can become tight and fatigued, especially when your posture is slumped forward or sitting at a desk.


Because they are just below the surface they are the muscles that typically feel great when massaged by a professional therapist. Because they are behind you they are practically impossible to self massage, but as these illustrations show both Thai self massage and vibration massage work very well.

Erector spinae vibration massage
Laying flat so muscle is relaxed with gravity applying pressure
Erector spinae muscle massage using stick
Laying on side so muscle is relaxed, using tool to apply pressure
The quadratus lumborum muscles
The quadratus lumborum muscles

Quadratus Lumborum

As this pic shows these muscles are deep beneath the erector spinae muscles. They are largely responsible for sideways bending and stabilising your lower vertebrae. Trigger points in these muscles are commonly involved in lower back pain.


It is possible to self massage these muscles, but they are deep so definitely get a professional to show you how. As it shows in the picture below it is possible to use Thai self massage, but the muscle is deep so it will need a bit of pressure. It is best to lay on your opposite side so the quadratus lumborum and the muscle overlying it is relaxed. Your best option is using vibration massage while in the same position. The vibration penetrates deeply with out the pressure.

Quadratus lumborum vibration massage
Laying on side so muscle is relaxed with head of the massager placed over the quadratus lumborum muscle
Quadratus lumborum trigger point therapy using tool
Laying on side applying trigger point therapy to quadratus lumborum
Iliopsoas muscle group
The iliopsoas muscle group


This is the muscle that supports the front of your spine, and is often responsible for pain when standing, walking or running. Because it sits behind a lot of very important and sensitive things in your abdominal and pelvic areas please leave this one to professionals.

Gluteal muscles
The gluteal muscles

Gluteus maximus

This muscle is the one that most shapes your buttocks, and is very important for activities such as getting out of a chair or walking up stairs. Trigger points in gluteus maximus often cause pain while doing these movements.


Self massage of these muscles is best done while laying on your opposite side so the muscle you are massaging is relaxed.

Using vibration massage on gluteus maximus
Using vibration massage on gluteus maximus
Trigger point therapy for gluteus maximus using a tool
Trigger point therapy for gluteus maximus using a tool

Gluteus medius and minimus (pictured above)

These muscles sit beneath gluteus maximus and act more to bring your leg out the side or stabilise your pelvis sideways. Therefore trigger points in these muscles can cause pain while walking and your weight is on one foot.


The massage technique is very similar to gluteus maximus, only these muscles are much deeper. The vibration massager will penetrate to these quite easily, but the Thai self massage technique will need considerable pressure.

Using vibration massage on gluteus medius and minimus
Using vibration massage on gluteus medius and minimus
Trigger point therapy on gluteus medius and minimus using tool
Trigger point therapy on gluteus medius and minimus using tool
Piriformis muscle anatomy
Piriformis muscle: note it is deep beneath the other muscles

Piriformis and other deep hip muscles

These sit deep beneath the gluteal muscles and can cause deep hip and buttock pain. The piriformis muscle is in close contact with the sciatic nerve, so tightness can press on the nerve causing sciatic pain. This is known as piriformis syndrome.


The technique is very similar to the previous muscles. However, the muscles are very deep. Vibration massage will handle this fine, but leave it on a bit longer for the vibrations to soak in. The amount of pressure needed for Thai self massage would be very painful and probably not safe for self use.

Massaging piriformis and other deep hip muscles with vibration massager
Massaging piriformis and other deep hip muscles with vibration massager
Vibration massage can reach important muscles conventional muscles cannot
Vibration massage can reach important muscles conventional muscles cannot

The small muscles that control the spine

As this picture shows the vertebrae have levers with a large number of small muscles attached. These muscles are critical for the function of your spine, usually completely ignored by therapists. The reason for this is that being so deep and sitting between levers therapists cannot examine them and it is impossible to massage or use manual trigger point therapy on them.

Using vibration massage on the intrinsic muscles of the spine
Using vibration massage on these small muscles is very easy: just sit the vibrating head over the muscles and let the vibrations penetrate


These cannot be physically examined. However, a properly qualified professional will deduce that those muscles are tight if movement in that part of the spine is restricted. Massaging them using a vibration massager is extremely simple. With the spine relaxed the vibrating massager head is placed over the muscles adjoining the spine while the vibrations are allowed to “soak in.


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: Summary of clinical trials of massage for low back pain

The following is the conclusion of 2015 review of 25 clinical trials of massage for back pain (2)⁠. Keep in mind that as discussed in our article about the cause of back pain researchers draw the same sorts of conclusion about other therapies such as acupuncture, medications and exercise.

We have very little confidence that massage is an effective treatment for LBP. Acute, sub-acute, and chronic LBP had improvements in pain outcomes with massage only in the short-term follow-up. Functional improvement was observed in participants with sub-acute and chronic LBP when compared with inactive controls, but only for the short-term follow-up. There were only minor adverse effects with massage.

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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