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Your complete guide to (myofascial) trigger points
Trigger points are those tender lumps in your muscles that therapists find, and are arguably the biggest cause of musculoskeletal pain syndromes such as back, neck and shoulder pain. In this article we’ll use plain English and simple diagrams to show you:
- what the lumps are
- what causes them
- the effects they have on your body
- how to find them, and most importantly
- the best way to treat them
CONTENTS
What trigger points are
The effects trigger points have on your body
What causes trigger points
How common are trigger points
How do you know if you have trigger points
The treatment of trigger points
Professionals
References
What are trigger points
What are the lumps
Trigger points are parts of muscles that have gone into spasm or "cramped”. This forms the lump. As shown in this diagram:
- the spasm causes the muscle to tighten,
- which in turn reduces blood flow causing a build up of waste products,
- then the build up of wastes becomes toxic causing the spasm to increase.
This process goes around and around in circles creating what is known as a positive feedback loop. This stops the problem from resolving and causes the lumps to continue to grow (1–5)
How trigger points grow
Trigger points start small, but because of the positive feedback they gradually grow. As this diagram shows they:
- Start small, where you only know they are there is a therapist presses on them.
- Become larger, where they do not shoot pain but have a host of adverse affect on your body as discussed below
- Eventually something aggravates them and they start shooting pain.
Active vs latent trigger points
You may read that there are two types of trigger points: latent and active. These are really just the same trigger points.
- if they are not shooting pain they are called latent
- if they are shooting pain they are called active.
Activation and deactivation
When a trigger point is aggravated and starts shooting pain it is called “activation”, while the opposite is called “deactivation”.
Trigger points can change from latent to active (and back again)
As an example, it is common for trigger points to hurt when doing an activity and stop hurting when resting. These are swapping between being latent and active. As we will see in the section on treatment trigger points often deactivate (stop hurting) when treated, only to activate again as soon as they are aggravated.
The effects trigger points have on your body
In this section:
- Pain syndromes
- Other effects
- Development of fibromyalgia and other chronic pain syndromes
Pain syndromes
The most obvious effect trigger points have on your body is causing pain. They are arguably the biggest cause of musculoskeletal pain syndromes such as back pain, neck pain and shoulder pain, but because trigger points often refer pain elsewhere they can cause seemingly unrelated pain such as headaches or even tooth ache (3,6–21). To show where they shoot pain scientists have developed charts like those below
Other problems
As discussed above, long before trigger points start shooting pain the muscle becomes tightened, blood flow is reduced, and there is a build up of waste products (and reduced nutrients). Therefore even when not hurting trigger points will have the following effects on your body.
Summary of non-pain symptoms
- rapid fatigue and poor performance
- abnormal tightness: including tears and pain
- restricted movement and difficulty stretching
- postural changes: abnormal stress on joints and increased wear
The hand drawings
We originally hand drew these diagrams to help explain things in clinic. Patients seemed to understand them so we’ve used them here.
Rapid fatigue and poor performance
The muscles containing trigger points suffer from poor blood flow, a build up of waste products (and reduced nutrients), and are already fatigued due to the part constantly contracting (spasming). Because of this the muscle will not be as strong and will fatigue quickly. As well, scientists have found that muscles with trigger points are slower to respond to nerve signals from the brain (22) . For more information please see our article article on the effects of (myofascial) trigger points on sports and athletics performance .
Abnormal tightness: tears and attachments
When a muscle is tight it is much more likely to tear. There is also abnormal tension where the muscles attach to the bones. The extra tension often causes these attachments to become inflamed and sore. An excellent example is where trigger points in the forearm muscles cause tennis elbow to develop. For more information please see our article Self massage and trigger point therapy for tennis elbow .
Abnormal tightness: restricts movements and stretching
The abnormal tightness in your muscles will also restrict movement generally. As anyone who has tried to stretch a muscle in spasm or cramping will understand, attempting to stretch a muscle containing a trigger point will meet with resistance, and maybe some pain.
Abnormal tightness: posture changes
Your body maintains an even balanced posture by balancing the tension in the muscles on opposite sides of your body. Having individual muscles tight will alter this balance causing postural changes. In our Chiropractic clinic we would see many people who had been advised to exercise to correct their posture or consciously “straighten up”, when the real issue was tightened muscles due to trigger points.
Abnormal tightness: joint alignment
The joints of your body are designed to “sit nicely balanced”. As shown in this diagram the changes in posture caused by trigger points will alter the alignment of the joints, resulting in increased wear and an increased risk of injury.
Development of fibromyalgia and other chronic pain syndromes
When your nervous system is is bombarded with pain for long periods of time it can become sensitised, so any pain becomes much worse. This is what happens in fibromyalgia and other chronic pain syndromes. Because trigger points are often not diagnosed or poorly treated they are a major source of this long term pain. For more information please see: The root cause of fibromyalgia
What causes trigger points
You may read lists of things that cause trigger points, however the main cause is prolonged abnormal stress or tension in the muscles.
Why prolonged tension is a main cause
Prolonged tension in the muscles reduces blood flow, which causes a build up of wastes and a reduced amount of nutrients. Tension restricts blood flow by:
- as shown in this diagram presses on blood vessels, and
- the veins that return your blood to your heart rely on alternating tightening and relaxing of your muscles to help pump the blood.
Example one: sitting at a computer
Sitting at a desk can often cause your muscles to be tight for long periods of time. Because of this office workers often develop trigger points in their neck and shoulder muscles.
Example two: emotional stress and tension
Emotional stress and tension can cause muscles around the head and neck to tighten. The trigger points these cause are a major cause of headaches. For more information please see: Self massage and trigger point therapy for headaches and migraines
Example three: trigger points themselves cause muscle tightness
As discussed above trigger points cause muscles to tighten. By doing this they make the ideal environment to keep growing and for more trigger points to develop.
How common are trigger points?
Trigger points can go for years or decade before causing pain, then when they do cause pain doctors usually do not diagnose them. Because of this, as the two examples below show most people have large numbers of trigger points.
For why doctors do not diagnose trigger points please see our article The root cause of fibromyalgia .
Example: people with no pain
An investigation of pain free adults found that nearly 90% had trigger points in their shoulder muscles (23).
Example: people with pain
Office workers and blue collar workers with pain in their neck and shoulder region were checked for trigger points in their neck, shoulder and arm muscles (24). The results were:
- Blue collar workers: Ave. 16 trigger points
- White collar workers: Ave. 17 trigger points.
How do you know if you have trigger points
How to find them yourself
It is very easy to examine your muscles and find trigger points yourself. Please check out our video demonstration below.
Professional help
There are excellent professionals who can help identify trigger points. These include Chiropractors, Osteopaths and suitably qualified therapist. As a warning, medical doctors will usually be unable to help. Trigger points do not show up in standard medical tests, and despite being a major cause of pain and rarely mentioned in medical journals (25,26).
The treatment of trigger points
For a complete discussion and advice on how to treat trigger points please see our excellent Trigger point therapy guide or the two videos linked below. However, we will you a quick overview.
Most courses of therapy do not eliminate the trigger points
Most courses of trigger point therapy (eg. needles, laser or manual techniques) just stop the trigger points hurting and do not actually eliminate them. As mentioned above this is called “deactivation” and is shown in this diagram. Of course they are still there so they continue to have adverse effects on your body and are eventually re-aggravated and cause pain again. The only way to eliminate them properly is to continue regular treatment long after the pain has gone. To do this we recommend an effective self treatment, otherwise it would be tremendously expensive.
How trigger point therapies work
As shown above trigger points are spasm, muscle tightness, restricted blood flow and a build up of waste products all going around in a circle forming what we call a positive feedback loop. Trigger point work on parts of this loop. For example, conventional massage relaxes muscles, stimulates blood flow and helps remove wastes. It works on three parts of this loop so it is an effective therapy.
The best therapy
There is only one trigger point therapy that is easy to do on yourself and is very effective. That is vibration massage where the pad of a therapeutic vibration massager is placed over the trigger points, while as this diagram shows the vibrations penetrate and work on all four parts of the feedback loop. For more information please see our Vibration massage usage guide .
Massage guns are not suitable
Massage guns do not deliver the therapeutic vibrations needed. This is becuase they are designed to drive their heads into your muscles like a jackhammer rather than send in vibrations. As a result:
- they send in far less vibrations, and
- the vibrations are the wrong frequency to have the therapeutic effects.
For more information please see Do massage guns actually work .
Videos
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.
References
- Jafri MS. Mechanisms of Myofascial Pain. Int Sch Res Not. 2014;2014:1–16.
- Zhuang XQ, Tan SS, Huang QM. Understanding of myofascial trigger points. Chin Med J (Engl). 2014;127(24):4271–7.
- Fernández-De-Las-Peñas C, Dommerholt J. Myofascial trigger points: Peripheral or central phenomenon? Curr Rheumatol Rep. 2014;16(1).
- Bron C, Dommerholt JD. Etiology of myofascial trigger points. Curr Pain Headache Rep. 2012;16(5):439–44.
- Shah J et al. Myofascial Trigger Points Then and Now: A Historical and Scientific Perspective. HHS Public Access. 2015;7(7):746–61.
- Celik D, Yeldan P. The relationship between latent trigger point and muscle strength in healthy subjects: A double-blind study. J Back Musculoskelet Rehabil. 2011;24(4):251–6.
- Alonso-Blanco C, Fernández-De-Las-Peñas C, Morales-Cabezas M, Zarco-Moreno P, Ge HY, Florez-García M. Multiple active myofascial trigger points reproduce the overall spontaneous pain pattern in women with fibromyalgia and are related to widespread mechanical hypersensitivity. Clin J Pain. 2011;
- Amin A, Maqsood U, Niaz Awan F, Arshad HS, Arshad AH. Chronic tension-type headache as a risk factor of myofascial trigger points in upper trapezius muscle fibers in neck pain patients. Pakistan J Neurol Sci. 2017;12(3):21–5.
- Doraisamy K. & Gnanamuthu. Chronic Tension Type Headache and the Impact of Myofascial Trigger Point Release in the Short Term Relief of Headache. Glob J Health Sci. 2010;2(2):238–44.
- Wang K, Castaldo M. Trigger points are associated with widespread pressure pain sensitivity in people with tension-type headache. 2018;38(2):237–45.
- Florencio LL, Ferracini GN, Chaves TC, Palacios-Ceña M, Ordás-Bandera C, Speciali JG, et al. Active Trigger Points in the Cervical Musculature Determine the Altered Activation of Superficial Neck and Extensor Muscles in Women with Migraine. Clin J Pain. 2017;33(3):238–45.
- Renan-Ordine R, Alburquerque-SendÍn F, Rodrigues De Souza DP, Cleland JA, Fernández-de-las-PeÑas C. Effectiveness of Myofascial Trigger Point Manual Therapy Combined With a Self-Stretching Protocol for the Management of Plantar Heel Pain: A Randomized Controlled Trial. J Orthop Sport Phys Ther. 2011;41(2):43–50.
- 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.
- Castaldo M, Ge HY, Chiarotto A, Villafane JH, Arendt-Nielsen L. Myofascial trigger points in patients with whiplash-associated disorders and mechanical neck pain. Pain Med (United States). 2014;15(5):842–9.
- Roach S, Sorenson E, Headley B, Juan JGS. Prevalence of Myofascial Trigger Points in the Hip in Patellofemoral Pain. Arch Phys Med Rehabil 2013;94(3):522–6.
- Fuentes-Márquez P, Carmen Valenza M, Cabrera-Martos I, Ríos-Sanchez A, Ocon-Hernández O. Trigger points, pressure pain hyperalgesia, and mechanosensitivity of neural tissue in women with chronic pelvic pain. Pain Med (United States). 2019;20(1):5–13.
- Celik D, Mutlu EK. Clinical implication of latent myofascial trigger point topical collection on myofascial pain. Curr Pain Headache Rep. 2013;17(8).
- Zuil-Escobar JC, Martínez-Cepa CB, Martín-Urrialde JA, Gómez-Conesa A. The Prevalence of Latent Trigger Points in Lower Limb Muscles in Asymptomatic Subjects. PM R. 2016;8(11):1055–64.
- Kaya Mutlu E, Birinci T, Dizdar G, Ozdincler AR. Latent Trigger Points: What Are the Underlying Predictors? Arch Phys Med Rehabil. 2016;
- von Stülpnagel C, Reilich P, Straube A, Schäfer J, Blaschek A, Lee SH, et al. Myofascial trigger points in children with tension-type headache: A new diagnostic and therapeutic option. J Child Neurol. 2009;24(4):406–9.
- Anderson RU, Wise D, Sawyer T, Chan C. Integration of myofascial trigger point release and paradoxical relaxation training treatment of chronic pelvic pain in men. J Urol. 2005;
- Ge HY, Arendt-Nielsen L, Madeleine P. Accelerated muscle fatigability of latent myofascial trigger points in humans. Pain Med (United States). 2012;13(7):957–64.
- Lucas KR, Polus BI, Rich PA. Latent myofascial trigger points: Their effects on muscle activation and movement efficiency. J Bodyw Mov Ther. 2004;8(3):160–6.
- 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.
. Clin J Pain. 2012;28(6):511–8. - Holmes RE, Barfield WR, Woolf SK. Clinical evaluation of nonarthritic shoulder pain: Diagnosis and treatment. Phys Sportsmed. 2015;43(3):262–8.
- Burbank KM, Stevenson JH, Czarnecki GR, Dorfman J. Chronic shoulder pain: Part I. Evaluation and diagnosis. Am Fam Physician. 2008;77(4):453–60.
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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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