Muscle knots or “trigger points” are small patches of super-contracted muscle fibres that cause aching and stiffness. They can affect performance of the whole muscle, spread pain to adjacent areas, and even cause other trigger points. They seem to be a major (and often unsuspected) 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 self-massage than you can get from a massage therapist. Professional help can be nice — and sometimes essential — but it can also be extremely 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
And it’s not perfect: there is controversy and 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-spasm could be wrong.23
This article just introduces the basic principles of treating trigger points with self-massage. If you haven’t even heard of trigger points before, you might want to look at the introduction to my huge myofascial pain tutorial first.
A lot of trigger point pain can be completely 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 get amazingly nasty, most are fairly easy to find and get rid of with a just little rubbing.
Dr. Janet Travell wrote that “almost any intervention” can relieve a trigger point, and self-massage is usually the simplest, cheapest, safest, and most effective method. Which sounds to good to be true! How can such a trivial treatment work?
The pain may be more of a phantom than something wrong with the tissue.4 It may be relatively easy to change with massage because there’s not much to “fix” — just a sensation to change. Or maybe the rubbing actually affects the source of the pain, whatever it is.
On the other hand, if we accept the conventional wisdom, then massage may work well because it’s fairly easy to “flush” the waste metabolites out of a minor trigger point5 — and that interrupts a vicious cycle, which prevents the trigger point from coming back, at least for a while.
Also, isolated trigger points are probably much easier to manage — neurologically simpler.6 If the problem is limited to one body part, there’s a better chance of dealing with it.
For an easy case, just a few moments of gentle rubbing can be enough.7 For moderate cases, several doses 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 miniature treatments per day for a week, each about 20–30 kneading strokes. That will take care of most trigger points. But it can definitely fail — the location is often surprisingly tricky to figure out — and there’s plenty more to learn.
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 really handy for spots that are harder to reach. And I don’t mean specialized massaging tools — just a tennis ball, or other handy household objects. Tennis ball massage is surprisingly good stuff!
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 it might be more effective.
Rub how hard? This matters much more. Because massage is a “conversation with your nervous system,” you want it to have the right tone. 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.
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.” Massage is a conversation with your nervous system. So you want it to have the right tone. Friendly and helpful! Not shouty and rude.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, simply ease up. In basic therapy, you can always 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 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? As you learned earlier in the tutorial, 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. Remember, 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. 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, you should certainly feel free to keep going.
Rub how often? As long as you aren’t experiencing any negative reactions, you should massage a key trigger point at least once per day, and as often as a half dozen times per day.
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?
Release is a vague term. It is more poetry than anything else: it has no specific scientific definition. It means “the trigger point goes away.” Maybe it refers to the literal relaxation of the tightly contracted sarcomeres that the trigger point could possibly be made of.
Unfortunately, a release may not be obvious. In fact, perhaps the tissue even remains a bit “polluted” with waste metabolites even after a successful release. Release might actually involve (or even require) some damage to the tissue of the muscle knots — that is one theory. This means that the area could still be sensitive even if you’ve succeeded.
For beginners, don’t worry about the details: trust that you probably achieved a release, or a partial release, and then wait for the trigger point to calm down. Over the next several hours, if you were successful, you will notice a distinct reduction in symptoms — mission accomplished. (Often success is most obvious the next morning.)If you released a trigger point, you will notice a distinct reduction in symptoms over the next several hours — mission accomplished.
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 throwing up is positive: it’s not exactly 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.
There are many reasons why basic self-massage might fail. The skeptics could be right: maybe there’s really nothing there in the muscle except a sensation. 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.
I am a science writer, former massage therapist, and assistant editor of ScienceBasedMedicine.org. 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 and Google, but mostly Twitter.
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).BACK TO TEXT
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.The accumulation of metabolic wastes would be much less in a minor trigger point than a severe one, compared to a severe trigger point, and probably fairly easy to squish out with a little gentle pressure. BACK TO TEXT