What are trigger points?

Myofascial trigger points (or simply “trigger points”) are contracted areas inside a muscle or surrounding connective tissue (called fascia) that stay shortened no matter what you’re doing. Also known as muscle knots, these areas can be very sensitive to pressure and cause pain.

While you could previously contract and relax that muscle, some of the muscle fibers are now outside your conscious control. It’s like the “on” button at the control center gets flipped and the controller goes out to lunch.

Trigger points are important to understand because sometimes we can feel pain in one area that is actually coming from a different location. Referred pain from trigger points is often felt in multiple locations. Localized pain is felt in the immediate area surrounding the muscle knot, while referred pain is felt elsewhere in the body.

What are latent trigger points?

A latent trigger point can be described as a tight area within the muscle tissue that is “hidden” beneath the surface, meaning that you don’t know it exists until it gets accidentally, or purposefully, pressed on. Because of this, it’s possible that one of these trigger points has existed in your body and remained unaddressed for a long period of time.

For example, let’s say you’re sitting at your desk and a friend swoops by and squeezes your shoulders around your upper traps (a common area to find trigger points on people), pressing their thumbs into the muscle. You’ll probably feel some pain (and possibly relief, if they hold that spot for at least 30 seconds) directly where they were pressing, but possibly also up into the neck and head area. If they pressed hard enough, you might even experience a headache from the pressure. You may not have noticed those spots before, but you’ll definitely notice them now!

What are active trigger points?

A latent trigger point can become an active trigger point if it’s rubbed, contracted, overstretched, or during periods of stress or dehydration. Active trigger points cause localized and referred pain patterns without being pressed on. Using the same example from above, you’d experience pain in the traps, neck, and head while simply sitting at your desk. No outside stimulus needed; it hurts all on its own. Having someone press on the active trigger point likely would increase the pain, but it exists regardless.

What are common symptoms of trigger points?

If you squeeze your shoulder with your hand and feel a dense ball of muscle (what we often call a muscle knot), you have found a trigger point. You can either do this yourself, or have a trained professional (such as a physical therapist or massage therapist) help you out in feeling for these spots. If you hold on to that point for a few seconds and with enough pressure, you may even feel that trigger point start to refer somewhere else.

Common trigger point symptoms may include (but are not limited to):

• Dull aching or muscle tenderness
• Muscle stiffness and reduced range of motion
• Muscle weakness or fatigue
• Involuntary muscle contractions (or twitches)
• Inability to get a muscle to relax
• Affected area feels “warm” to the touch
• Burning or tingling sensations

Because of latent and active myofascial trigger points, another tell-tale sign and common symptom of having a trigger point is experiencing local and/or referred pain patterns when having pressure applied to that area of your body.

Trigger points may mimic other conditions

Due to possible referred pain patterns, trigger point symptoms may mimic the symptoms of other conditions, such as:

• Sciatica
• Sacroiliac (SI) joint pain
• Iliotibial (IT) band syndrome
• Neck pain and tension headaches
• Temporomandibular joint (TMJ) pain
• Abdominal or pelvic pain
• Sexual dysfunction (including pain with intercourse)
• Low back pain, hip pain, and knee pain
• And so much more…

The below images show common patterns caused by trigger points, and why the root of the problem may not be where you’re feeling the pain. They’re also great examples of why trigger points can cause myofascial pain that may be mistaken for other conditions or diagnoses.

Iliacus trigger point & psoas trigger points

• iliacus trigger points refer pain to the anterior hip/thigh and groin, which may be mistaken for quadricep pain/tightness, hip arthritis or hip labrum issues

Gluteus minimus trigger points

• refer pain to the deep glute, outer hip, and down the leg, which may be mistaken for hip bursitis, IT band syndrome, or possibly even sciatica

Piriformis trigger points

• refer pain deep in the glute and down the back of the thigh, which may be mistaken for sciatica

Quadratus lumborum trigger points

• refer pain to the SI (sacroiliac) joint and glute (buttocks), which may be mistaken for SI joint pain or dysfunction

Because of this possibility, it is best to check with your healthcare practitioner for an evaluation of your pain to determine the root cause of your symptoms and set you up with an appropriate course of action to treat and improve the issue.

What causes trigger points?

Trigger points can develop as a result of muscles being used too much, contracted for a long time without relaxation, shortened too long, or in a stressful situation. Once a muscle is “on” for too long, the brain decides to keep that muscle contracted for good.

Poor posture can cause trigger points

Being in poor posture takes your body out of its natural alignment, making certain muscles work harder than they should to hold you in that position. For example, many people have rounded shoulders and a forward head posture. This makes the muscles in your upper back (in between the shoulder blades) and on the back side of your neck tighten up and hold tension to prevent the body from falling forward even more.

Inactivity can cause trigger points

As more and more of us slowly sink into our couches, it’s not a surprise when there is a myofascial component contributing to people’s pain. Spending lots of time consecutively in a stationary position (e.g. sitting, whether on an Ikea couch or a Herman Miller chair) does not challenge or strengthen the muscles in your body.

As this way of living continues consistently over time, it leaves your muscles in a weakened and unconditioned state to where they now begin to take on the shape and length of where they spend the majority of their time — in a seated, slouched, or distorted position.

Working on a computer can cause trigger points

Muscle knots in the tops of the shoulder area (upper trapezius) are common for people doing computer work. With your arms reaching out in front of the body all day long, the upper trapezius muscle is constantly “on” to prevent your shoulders from falling forward and to keep your head from rolling off your shoulders (and you thought your morning coffee was doing that!)

After a long day of work, this muscle will likely stay contracted when you‘re done typing. So even if you’re just walking the dog or making dinner, or relaxing on the couch, this muscle is stuck in the “on” position.

Sitting at a desk can cause trigger points

Sitting also results in the shortening and tightening of the body’s hip flexor muscles and ultimately the development of trigger points in the hip flexors that cause localized and referred pain in the body.

Muscular imbalances can cause trigger points

Your muscles hold your body in alignment, where there is a necessary relative relationship between the strength and length of the muscles on either side of your body — front vs. back and left vs. right — to remain in balance and function optimally.

For example, when the hip flexor muscles on the front side of your body tighten up and become shorter, this tilts your pelvis forward into an anterior position. The glute and hamstring muscles connect to the pelvis on the back side of your body, where they become longer than normal and weaken. It basically becomes a game of “tug-of-war” where those muscles now tighten up and hold tension in this lengthened position to accommodate the shortened hip flexors on the front of your body.

Another example is when the lateral hip muscles (like the gluteus medius and tensor fascia latae, or TFL) are stronger on one side of the body versus the other. With every single step you take, these muscles engage to help stabilize your pelvis. Let’s imagine that these muscles on the right side of your body are weaker than the left side of your body. When taking a step with your left leg, the muscle will engage properly and keep the pelvis level. However, when stepping with your right leg, the pelvis may be unstable because the muscles aren’t strong enough to perform their function. To prevent the pelvis from laterally tilting, your body will respond by engaging the left quadratus lumborum (QL) muscle more than it normally does.

Injuries can cause trigger points

An acute injury creates damage to the connective tissues around the injured area. As these tissues heal and begin to repair themselves, the muscle fibers may tend to tighten up as the body recovers to protect and stabilize the area following injury. This can lead to muscle knots developing, as well as other joint and soft tissue restrictions, which must be addressed even after the injury has “healed” in order to restore your full range of motion.

If left unaddressed, movement pattern compensations begin to occur in order to work around those limitations that came about from the past injuries. Over time, this ultimately affects proper body mechanics and can lead to the development of muscle imbalances (and therefore more trigger points).

Improper body mechanics can cause trigger points

Whether you are working out, doing yard work, or picking up your kids, having the ability to control your body with good mechanics allows you to perform your daily activities in the safest and most efficient way possible.

If your body mechanics are negatively impacted — by an injury, a muscle imbalance, or simply a lack of strength & control relative to the task at hand — then the work being performed by your body is no longer being distributed as efficiently as possible, increasing the risk for injury (and potentially trigger points).

Repetitive movements can cause trigger points

Doing the same thing over and over again utilizes the same muscles (and therefore doesn’t use other muscles), which can lead to the development of trigger points from overuse and other muscle imbalances in the body.

Take a golfer, for example. On a daily basis, they may take hundreds of swings — each of which is performed in the same direction and uses the body unevenly. The hips and thoracic spine will rotate differently, and the glutes and core repeatedly engage more on one side. Now scale the number of swings out to a weekly, monthly, and yearly basis or even out as far back as the person started playing golf — that’s a lot of reps in the same direction!

Stress can cause trigger points

Common reactions to mentally or emotionally stressful situations include the tensing up and clenching your muscles. Coupled with shallow breathing and triggering more of a “fight or flight” sympathetic nervous system response, this may be a recipe for muscle knots to form in the body.

Poor nutrition or hydration can cause trigger points

To perform your daily tasks, your muscles require a certain amount of water and macro/micro nutrients to fuel their performance and also adequately recover. Without a proper recovery, the muscles will not be able to perform at their best and the likelihood of developing trigger points may increase as a result.

How do trigger points affect the function of a muscle?

The muscles in your body need to be able to contract (shorten) and relax (lengthen) on either side of the joints needed to create movement and perform your daily tasks. The presence of myofascial trigger points affects the ability of your muscles to function at their best.

When there are these hypercontracted areas within the muscle, there is decreased blood and nerve supply to the tissue, affecting the muscle to where it no longer performs optimally. If you’ve been working seven days a week without a vacation for ten years, you won’t want to do any more work. Same goes for your muscles with knots in them. And their co-workers (the muscle fibers that are not knotted) end up doing more of the work with less resources. The results may include reduced range of motion, decreased force output, longer recovery times, and increased chances of pain and injuries.

In addition to the impact on your muscles, trigger points can affect how your nervous system perceives the pain. The chemical environment around the areas where your muscles have trigger points changes, where it causes pain receptors to fire more frequently and more easily than in healthy muscle tissue.

The longer that someone remains “stuck” in this environment, the more sensitive their nervous system becomes to feeling pain. This can contribute to more chronic myofascial pain patterns that may later develop into conditions such as myofascial pain syndrome of fibromyalgia.

How to get rid of trigger points

This is the moment you've been waiting for! By now, you’ve probably realized you have a trigger point or three affecting your movement and comfort, or sitting quietly to the side waiting to cause trouble. If you are experiencing pain from trigger points, it might be a good idea to begin taking actions to improve and get rid of those tight spots to prevent the pain from getting worse. Depending on your personal preference, you may look to address your trigger points through a self-care approach or see a healthcare professional for treatment.

The trick to trigger point massage: prolonged pressure

There are an abundance of muscle release tools available to you on the market that may be able to help you address your trigger points using prolonged pressure, which is the most effective technique for releasing trigger points.

Trigger point release is different from massaging the muscle, rolling on a foam roller, vibrating a muscle, releasing the fascia, or stretching. All of these are useful techniques, but they’re not nearly as effective at releasing muscle knots and trigger points as prolonged pressure at the correct angle.

Whether you are using something like a lacrosse ball, a foam roller, or a more specialized trigger point muscle release tool like the Hip Hook, it is important to understand that you must apply prolonged pressure (at least 90 seconds) to these areas for the best results. Applying pressure to the trigger points provides stimulation to the impacted area, releasing tension and increasing blood flow to the muscle to promote healing.

Professional care treatments for trigger points

There are also varied and effective trigger point treatments available through trained bodywork professionals and other healthcare practitioners. These include massage therapy (if it includes prolonged pressure), chiropractic adjustments, acupuncture, dry needling, electrical stimulation, ultrasound therapy, frequency specific microcurrent (FSM), cold laser therapy, and even trigger point injections.

There is no single “best” treatment for trigger points that we can definitively recommend, as each person’s body may react differently to each treatment or have unique needs. Because of this, it would be best to check in with a health practitioner who is familiar with your unique body to determine the appropriate plan for your situation.

Self-care routine to improve trigger points

As it may not be practical or affordable to get professional care treatments on a regular basis, there is a lot that you can do as part of a self-care routine to improve pain caused by trigger points.

• Exercise — implementing an exercise routine more regularly can help to challenge your muscles, reduce imbalances, increase blood flow, and get your body up and moving.
• Stretching — adding in some daily stretches can help to lengthen your muscles and keep them healthy, promoting increased blood flow and assisting with recovery.
• Muscle release — performing self-trigger point release on yourself using different tools and specific, prolonged pressure.
• Good posture — being mindful of your posture activates the right muscles to hold your body in its natural alignment, keeping your muscles working in better balance.
• Hydration and nutrition — taking ownership of how you fuel your body by giving it the water and nutrients it needs can help it to function and recover more effectively.
• Reduce stress — finding ways to reduce stress can help the body to relax and make your muscles less likely to hold tension.
• Breathing — being mindful of how you are breathing (taking deep, diaphragmatic breaths) helps get enough oxygen into your body to promote relaxation.

The bottom line: your muscles work a lot better when they aren’t bound in a knot. They want to be long, strong, pain-free, and not stuck in a cycle of tension.

Frequently asked questions about trigger points

What are trigger points?

Myofascial trigger points are contracted areas (or “knots”) that are found within muscles or the connective tissues surrounding the muscles, called fascia. These are hypersensitive areas to the touch that can cause pain locally or refer pain elsewhere in the body.

What does a trigger point feel like?

Trigger points feel like a knot within a portion of muscle tissue. You will know once you’ve found one, as rubbing or pressing on these hypersensitive areas often produces a pain response in the immediate area, as well as to other areas of the body in what is called a pain referral pattern.

How do I know if I have a trigger point?

If you are experiencing pain or discomfort within an area, you can use your fingers to explore your muscles to locate a trigger point. If you find something that feels like a dense ball of muscle tissue (often called a “muscle knot”), you may have discovered a trigger point. You can either do this yourself, or have a trained professional (such as a physical therapist or massage therapist) help you out in feeling for these trigger points.

What is referred pain?

Referred pain can be described as pain felt in an area of the body that is different than the actual injured or affected area. For example, you may experience a tension headache but the affected area creating this pain may be from an active trigger point found in your upper trapezius muscles.

What causes referred pain?

Referred pain can happen because of the way the muscular and nervous systems are interconnected. Different muscles work together and are innervated by nerves that run throughout the entire body. When an active trigger point in a muscle is close to a nerve, pain may be felt along the pathway of the nerve. For example, a trigger point in the glute may affect the sciatic nerve, which can refer pain down the leg and to the feet.

What causes trigger points?

Trigger points may be caused by a number of different factors, which can include: poor posture, inactivity, muscle imbalances, injuries, poor body mechanics, repetitive movements, stress, poor nutrition and hydration, and more.

Is it good to massage trigger points?

While massages feel great, simply rubbing on a tight muscle may not release the tension of a trigger point, and can aggravate it. Applying direct and prolonged pressure to the muscle may prove to be more effective. Massage can be a method used for improving trigger points, as this can help increase blood flow and work out those tight spots to promote healing.

How do I release trigger points?

Releasing trigger points requires prolonged pressure (of about 30-90 seconds) to be applied directly to a muscle. This pressure is sensed by the body, where the brain can send signals to the muscles under pressure to release their tension and relax. You can release trigger points using your own fingers, muscle release tools, or see a trained professional.

What does it feel like when a trigger point is released?

When a trigger point is released, a muscle that was previously feeling tight or knotted may now feel looser and more squishy. The muscle is typically able to move through a larger pain-free range of motion and also be able to contract or relax much better.