Trigger points are probably a much greater factor in back pain than most doctors & therapists realize.
Low back pain is usually attributed to “structural” factors such as:
- pinched nerves
- herniated discs
- arthritic degeneration
But these kinds of problems are amazingly minor factors in back pain (as they are everywhere else1). In fact, most acute and chronic back pain is probably caused by myofascial trigger points — the humble muscle knot.
Many health care professionals are under-informed on this topic, and underestimate the severity of muscle pain. But trigger point pain can be as nasty as any injury, and more persistent than most. It can be as painful as a muscle strain or a joint sprain, and more persistent.
Of course there are many possible causes of back pain,2 and some cases of back pain have nothing to do with trigger points — at least at first. But regardless of how back pain begins, trigger points routinely become a factor as time passes. They are a common complicating factor, cropping up as a reaction to other problems, and even persisting and causing pain to continue long after the original problem has resolved — out of the frying pan, into the trigger point fire.
What’s a muscle knot?
The science is half baked and controversial,3 but the best evidence available so far suggests that trigger points are tiny spasms: a patch of clenched, exhausted, and highly irritable muscle tissue.
Of all possible causes of back pain, trigger points are also relatively treatable. Although lacking any proven treatment method, trigger points often seem to yield to heating, massage, and light exercise like mobilizations, stretching, and endurance training … all of which makes them an ideal target for safe, cheap “presumptive treatment.”
Treat yourself as if you have trigger points, and you might well relieve some or all of the pain. If you fail, at least you won’t hurt yourself or your wallet trying.
The “special” relationship between trigger points and back pain
Trigger points tend to grow in certain anatomical regions better than others. The muscles of the low back and hips are probably the most fertile ground in the body for this phenomenon (competing with the upper shoulders for first place). There are many theories about why this might be the case: it may be related to postural stresses, sedentary lifestyle, or psychological factors like being unusually nervous about back pain, or variations in muscle metabolism in different areas.
Whatever the reason, the result is that there are a few “perfect spots” in and near the low back — classic trigger point locations, often very relieving to massage, and helpful for back pain:
- Massage Therapy for Low Back Pain — Perfect Spot No. 2, in the erector spinae and quadratus lumborum muscles in the thoracolumbar corner
- Massage Therapy for Back Pain, Hip Pain, and Sciatica — Perfect Spot No. 6, an area of common trigger points in the gluteus medius and minimus muscles of the hip
- Massage Therapy for Low Back Pain (So Low That It’s Not In the Back) — Perfect Spot No. 12, a common (almost universal) trigger point in the superolateral origin of the gluteus maximus muscle
- Massage Therapy for Low Back Pain (Again) — Perfect Spot No. 13, The Most Classic Low Back Pain Trigger Point
This website features two advanced tutorials on both back pain and trigger points. This page is just a tiny primer focusing on the relationship. These are both super detailed:
- The Complete Guide to Low Back Pain — An extremely detailed guide to the myths, controversies, and treatment options for low back pain
- The Complete Guide to Trigger Points & Myofascial Pain — An extremely detailed guide to the unfinished science of muscle pain, with reviews of every theory and treatment option
There are also dozens of useful shorter articles, on a wide variety of issues related to back pain, muscle, and trigger points:
- 6 Main Causes of Morning Back Pain — Why is back pain worst first thing in the morning, and what can you do about it?
- The Bath Trick for Trigger Point Release — A clever way of combining self-treatment techniques to self-treat your trigger points (muscle knots)
- How to Find a Good Massage Therapist — Lots of tips for finding good quality medical massage therapy in your area (especially trigger point therapy)
- Nerve Pain Is Overdiagnosed — Our cultural fear of neuropathy, and a story about nerve pain that wasn’t
- Muscle Pain as an Injury Complication — The story of how I finally “miraculously” recovered from the pain of a serious shoulder injury, long after the injury itself had healed
- Don’t Worry About Lifting Technique — The importance of “lift with your legs, not your back” to prevent back pain has been exaggerated
- The Mind Game in Low Back Pain — How back pain is powered by fear and loathing, and greatly helped by rational confidence
- MRI and X-Ray Often Worse than Useless for Back Pain — Medical guidelines “strongly” discourage the use of MRI and X-ray in diagnosing low back pain, because they produce so many false alarms
- Spinal Subluxation — Can your spine be out of alignment? Chiropractic’s big idea has been misleading patients for more than a century
About Paul Ingraham
I am a science writer in Vancouver, Canada. I was a Registered Massage Therapist for a decade and the assistant editor of ScienceBasedMedicine.org for several years. I’ve had many injuries as a runner and ultimate player, and I’ve been a chronic pain patient myself since 2015. Full bio. See you on Facebook or Twitter, or subscribe:
- “Structuralism” is the excessive focus on causes of pain like crookedness and biomechanical problems. It’s an old and inadequate view of how pain works, but it persists because it offers comforting, marketable simplicity that is the mainstay of entire styles of therapy. For more information, see Your Back Is Not Out of Alignment: Debunking the obsession with alignment, posture, and other biomechanical bogeymen as major causes of pain.
- Ingraham. When to Worry About Low Back Pain: And when not to! What’s bark and what’s bite? Checklists and red flags and non-scary possible explanations for alarmingly back pain. ❐ PainScience.com. 5486 words.
- Ingraham. Trigger Point Doubts: Do muscle knots exist? Exploring controversies about the existence and nature of so-called “trigger points” and myofascial pain syndrome. ❐ PainScience.com. 15538 words.