Who doesn’t want an hour of this? But magic massage hands ain’t cheap. And you can reach your own legs …
Massaging yourself might seem as useless as trying to tickle yourself. But if there is a good reason for rubbing your own muscles, it’s probably muscle “knots” or trigger points: small patches of clenched muscle fibres that are sensitive and cause aching and stiffness. They may be a major factor in many common pain problems like low back pain and neck pain. Most minor trigger points are probably self-treatable.
You can often get more relief from this kind of discomfort with self-massage than you can get from a massage therapist. Professional help can be nice — and sometimes essential — but it can also be cost-effective to learn to save yourself from trigger points. It is a safe, cheap, and reasonable approach to self-help for many common pain problems.1
It’s also a controversial one: there is plenty of scientific uncertainty about trigger points. It’s undeniable that mammals suffer from sensitive spots in our soft tissues … but their nature remains unclear, and the popular idea that they are a kind of mini-cramp could be wrong.2 We don’t even know if massaging them actually works!3 Trigger point masssage is an experimental treatment for pain.
Why are minor trigger points so easy to deal with?
A lot of trigger point pain can be relieved with a surprisingly small amount of simple self-massage with your own thumbs or cheap tools like a tennis ball. Although trigger points can be amazingly nasty, most are fairly easy to find and get rid of with a just little rubbing.
Dr. Janet Travell4 wrote that “almost any intervention” can relieve a trigger point, and self-massage is usually the simplest, cheapest, safest, and most effective. Which sounds to good to be true, so we should probably be suspicious of it. How can such a trivial treatment work?
The pain may be more of a sensory phantom than something wrong with the tissue.5 It may be relatively easy to change with massage because there’s not much to “fix” — just a sensation to change.
A little self-massage is often the most effective treatment for minor muscle knots. But how can such a trivial treatment work?
Or maybe the rubbing actually helps muscle tissue directly in some way, like stirring a sauce until it’s free of lumps. Maybe massage works because it’s literally pushing and flushing waste metabolites out of a trigger point6 — which, in theory, interrupts a vicious cycle and prevents the trigger point from coming back. But, so far, no one has actually been able to demonstrate how a muscle “knot” can be untied by massage.
Isolated trigger points are probably much easier to manage — neurologically simpler.7 If the problem is limited to one body part, there’s a better chance of dealing with it.
Basic self-massage instructions for trigger points
Just a few moments of gentle rubbing can be enough for an easy case.8 For moderate cases, several larger doses — a minute or two — of rubbing over a couple days will usually do the trick. The toughest self-treatable cases might need an investment of about a half dozen 5–minute treatments per day for a week. But none of this is science-based, and treatment can definitely fail.9
Here are a bunch more basic tips …
Rub with what? Rub the trigger point with your fingertips, thumbs, fist, elbow … whatever feels easiest and most comfortable to you. Simple tools are handy for spots that are harder to reach — various balls and other handy objects. Tennis ball massage is surprisingly good stuff! You can use a foam roller, of course, but the contact area is just too wide for many jobs.
A tool like Pressure Positive’s Backnobber can be great. But for quick & easy self-massage, there’s usually something around the house that works pretty well — like a tennis ball!
Rub in what way? For simplicity, either simply press on the trigger point directly and hold for a while (10–100 seconds), or apply small kneading strokes, either circular or back and forth, and don’t worry about the direction of the muscle fibres. Really, anything goes. But, if you happen to know the direction of the muscle fibres — sometimes it’s obvious — then stroke parallel to the fibres as though you are trying to elongate them, because that might be more effective.
Rub how hard? This matters more! Because massage is mostly about having a conversation with your nervous system, you want it to have the right tone: Friendly and helpful! Not shouty and rude. The intensity of the treatment should be Goldilocks just-right: strong enough to satisfy, but easy to live with. On a scale of 10 — where 1 is painless and 10 is intolerable — please aim for the 4–7 range, and err on the side of gentle at first. Beginners are often much too aggressive. (And the pros too!)
What should it feel like? Pressure on a muscle knot should generally be clear and strong and satisfying; it should have a relieving, welcome quality. This is “good pain.” If you are wincing or gritting your teeth, you probably need to be more gentle. You need to be able to relax. See the next section for more information about how trigger point massage should feel.
What if it backfires? It probably won’t, especially if the pressure is reasonable. But if you experience any negative reaction in the hours after treatment, just ease up. In basic therapy, you can count on tissue adapting to stronger pressures over the course of a few days of regular treatment. If they don’t, either the problem isn’t really trigger points, or they are (much) worse trigger points than you thought.
Rub where? For basic self-treatment, you can trust your instincts: rub where it hurts! Do explore for sensitive spots, but you can limit your exploration to a fairly small area of muscle tissue around the “epicentre” of your symptoms. So, for instance, if the top of your shoulder aches, search for trigger points mainly in the top of your shoulder. (You will not necessarily be able to feel a bump or “knot” in your muscle, so don’t worry too much about that.)
What if the trigger point is not where the pain is? Trigger points may generate symptoms that aren’t where the trigger point is. What’s a beginner to do? Don’t worry about it too much — this is basic trigger point treatment. Bear in mind the possibility of confusing referred pain, but don’t worry about it unless basic therapy is failing.
Rub how much? Massage each suspected trigger point for about 30 seconds, give or take depending on how helpful it feels. This is actually enough for many trigger points — especially if you think that you have several that all need attention! Five minutes is roughly the maximum that any trigger point will need at one time, but there is not really any limit — if rubbing the trigger point continues to feel good, feel free to keep going.
Rub how often? As long as you aren’t experiencing any negative reactions, you should massage any trigger point that seems to need it at least twice per day, and as much as a half dozen times per day. More is probably too tedious and involves too great a risk of just pissing it off.
How do you know it’s working? Getting a trigger point to “release”
The goal of self-massage for trigger points is to achieve a “release.” What is trigger point “release” and what does it feel like? How do you measure success? It mostly refers to an easing of sensitivity of the trigger point, and/or a softening of the tissue texture — the melting of the knot.
But release is a vague term with no specific scientific definition. It’s a label for the unknown, for whatever is going on when the trigger point seems to goes away. Maybe it refers to the literal relaxation (or even the violent disruption!) of the tightly clenched muscle fibres. Or maybe it’s “just” a sensory adaptation, which might be a kind of healing (it just stops hurting), or trivial and temporary (like scratching a mosquito bite).
A release may not be obvious. In fact, things could even feel worse before they feel better: tissue might remain “polluted” with waste metabolites even after a successful release. Release might even require some damage to the tissue of the muscle knots — that is one theory. If so, the area would probably still be quite sensitive even if you’ve succeeded.
In my experience — both treating and being treated — it’s a weird mixture of these possibilities: initially there’s a satisfying but profound sense of scratching an itch, but the tissue is actually more sensitive afterwards, not less.
For beginners, don’t worry about the details: just stimulate the trigger point, and trust that you probably achieved a release, or a partial release, and then wait for the trigger point to calm down. If you were successful, you will notice a reduction in symptoms within several hours, often the next morning.
Good pain? With easy trigger points, successful release is typically associated with “good pain” — that clear, strong, and satisfying sensation that is somehow both painful and relieving. It is positive in the same sense that barfing is positive: it’s not pleasant, and yet your body “knows” that it needs and wants that much pressure. Usually, if you feel “good pain,” a trigger point release is more likely.
On the other hand, if you are wincing or gritting your teeth, you probably need to be more gentle. Comfort is an important component of successful treatment for most people! If you can’t massage the trigger point without wincing, you’re being too brutal on yourself, especially in the early stages. Sometimes a trigger point will feel nasty and hot and burning and still release anyway. But often such a rotten trigger point will need more persistent or advanced treatment. The “pressure question” — how much is too much? — is surprisingly complicated.
This is the tip of the trigger point iceberg
There are many reasons why basic self-massage might fail. The skeptics could be right: maybe there’s really nothing there but an abnormal sensation, nothing in the flesh to fix. Or it could fail for quite technical reasons — due to the neurological phenomenon of “referred pain,” the trigger point may not actually be located in the same place as the pain. This sends people on wild goose chases, rubbing the wrong things, and the only solution is education and experimentation.
And there’s much more like that, especially for tougher cases. Which is why I wrote a whole self-help book about myofascial pain.
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About Paul Ingraham
I am a science writer, former massage therapist, and I was the assistant editor at ScienceBasedMedicine.org for several years. I have had my share of injuries and pain challenges as a runner and ultimate player. My wife and I live in downtown Vancouver, Canada. See my full bio and qualifications, or my blog, Writerly. You might run into me on Facebook or Twitter.
What’s new in this article?
Four updates have been logged for this article since publication (2008). All PainScience.com updates are logged to show a long term commitment to quality, accuracy, and currency. more
Like good footnotes, update logging sets PainScience.com apart from most other health websites and blogs. It’s fine print, but important fine print, in the same spirit of transparency as the editing history available for Wikipedia pages.
I log any change to articles that might be of interest to a keen reader. Complete update logging started in 2016. Prior to that, I only logged major updates for the most popular and controversial articles.
See the What’s New? page for updates to all recent site updates.
2017 — Summarized all the scientific evidence about whether or not massage is an effective treatment for trigger points.
2016 — Editing for consistency with current science and my own slowly-changing views on this subject. Most of the changes concerned “release” and how trigger point therapy (supposedly) works, but many small changes throughout. Also added a new featured image.
2016 — Upgraded several footnotes.
2016 — Acknowledged scientific controversies about trigger points more thoroughly.
Many unlogged updates.
2008 — Publication.
- When choosing treatments, please be wary of the 3 D’s: treatments that may be dangerous, dubious, and distracting (costly or time-consuming). No pain treatment is perfect, but does it at least make sense? Is it safe? Cheap? Reasonably convenient? BACK TO TEXT
- Quintner JL, Bove GM, Cohen ML. A critical evaluation of the trigger point phenomenon. Rheumatology (Oxford). 2015 Mar;54(3):392–9. PubMed #25477053. ❐
Quintner, Cohen, and Bove think the most popular theory about the nature of trigger points (muscle tissue lesions) is “flawed both in reasoning and in science,” and that treatment based on that idea gets results “indistinguishable from the placebo effect.” They argue that all biological evidence put forward over the years is critically flawed, while other evidence leads elsewhere, and take the position that the debate is over. (They also point out that the theory is treated like an established fact by a great many people, which is definitely problematic.) However, their opinion is extreme, and most experts do not think we should throw out all the science so far (see Dommerholt et al).
(See more detailed commentary on this paper.)If you’d like to learn more about this, I’ve thoroughly covered the controversy: Trigger Point Doubts: Do muscle knots exist? Exploring controversies about the existence and nature of so-called “trigger points” and myofascial pain syndrome. BACK TO TEXT
Trigger point massage has rarely been directly tested and never properly. There are only about a dozen studies worth knowing about, all have serious flaws, and most report only minor benefits at best. (A few of the more interesting examples, all with notes: Hanten 2000, Aguilera 2009, Hodgson 2006, Gemmell 2008, Gulick 2011, Cagnie 2013, Morikawa 2017.)
The bottom line is clear: the sketchy evidence looks a bit promising if you’re a trigger point therapist, but it’s nowhere near enough for a skeptic. In truth, science just hasn’t answered the question, and it is going to stay that way for quite a while.BACK TO TEXT
Dr. Janet Travell and her research partner Dr. David Simons devoted their careers to trying to understand the science of muscle knots, and sharing their knowledge with other health care professionals. Her most important publication was the “big red books,” the massive two-volume textbook, Myofascial Pain and Dysfunction: The Trigger Point Manual (last edition published 1999). Dr. Travell served as President John F. Kennedy’s physician starting in 1961. She was the first female doctor to hold this position. Dr. Travell died in 1997. Although admirable and impressive, of course Dr. Travell probably was not perfect, and she may have become too impressed with her own ideas as her career progressed — an excellent example is described in Travell, Simons and Cargo Cult Science.BACK TO TEXT
- Pain is weird, often disconnected from clear causes, and often surprisingly easy to modulate with virtually any reassurance or pleasant stimulus. Trigger points may be a purely sensory phenomenon without much pathological substance. If there is no lesion in the tissue (or only a subtle one), and the problem is more about how the nervous system is mis-interpreting sensation in the area, then massage might be able to inspire a “reinterpretation.” BACK TO TEXT
- Shah JP, Danoff JV, Desai MJ, et al. Biochemicals associated with pain and inflammation are elevated in sites near to and remote from active myofascial trigger points. Arch Phys Med Rehabil. 2008;89(1):16–23. PubMed #18164325. ❐
This significant paper demonstrates that the biochemical milieu of trigger points is acidic and contains many pain-causing metabolites. For much more information about this, see Toxic Muscle Knots.
(See more detailed commentary on this paper.)
The accumulation of metabolic wastes would be much less in a minor trigger point than a severe one, and probably fairly easy to squish out with a little gentle pressure.BACK TO TEXT
- Trigger points seem to be much easier to deal with below some unknown critical mass of numbers and severity. Above that line, things get much tougher. Many trigger points seem to reinforce each other: the more there are, the faster they all get worse, and the harder it is to deal with any of them. The tough cases feel like a sinister game of whack-a-mole. BACK TO TEXT
- True story: One morning an office worker developed increasingly sharp stabbing pains in his lower back. Because the pains were sharp and pinchy, he thought they were kind of scary. He tried to stay calm and got up regularly to wiggle around and stretch, but the pains just kept coming back. He decided to try massage with a tennis ball. Although the pain didn’t seem particularly muscular, pressure on the low back muscles felt terrific — a deep, “sweet” ache. He massaged for just a couple of minutes, and didn’t expect results. And yet, to his amazement, the sharp pains had simply vanished, and they stayed gone: from alarming and rapidly worsening sharp pains to nothing at all in just a couple minutes. BACK TO TEXT
- Since the nature of trigger points is unclear, obviously we cannot know what treatment works best for them. Although there’s plenty of trigger points research, almost none of it is about comparing treatment methods. So what is this advice based on? Cautious educated guessing, my own clinical experience (ten years as a massage therapist), and the experience and opinions of other experts. It’s nowhere near enough, but it’s something. BACK TO TEXT