Trigger points (TrPs), or muscle “knots,” are a common cause of stubborn & strange aches & pains, and yet they are under-diagnosed. The 14 Perfect Spots (jump to list below) are trigger points that are common & yet fairly easy to self-treat with massage — the most satisfying & useful places to apply pressure to muscle. For tough cases, see the advanced trigger point therapy guide.
If you have shin splints — which is a painful, potentially serious condition — you may prefer to visit this detailed tutorial: Shin Splints Treatment, The Complete Guide. This article just summarizes the basics of self-massage for your shin musculature. (Note that rapidly developing severe shin pain can be a medical emergency. If this is your situation, you are in the wrong place: don’t read this article, go to a hospital emergency room. I am not kidding.)
Perfect Spot No. 3 is in your shins — seemingly an unlikely place for muscle knots! But there is meat there, and if you’ve ever had shin splints then you know just how vulnerable that meat can be. Even if you’ve never suffered so painfully, your shins probably still suffer in silence — latent trigger points in the upper third of the shin that don’t cause symptoms, but are plenty sensitive if you press on them. They inevitably form here because you walk on two legs, and usually on hard surfaces.
Relieving tension in Spot No. 3 may also be helpful for plantar fasciitis, because the shin musculature is surprisingly important for arch support. Along with the tibialis posterior muscle … and less so the arch muscles than you might think.1
We usually think of the shin as a bony place, but in fact there is a good-sized muscle on the lateral face of the shin: the tibialis anterior muscle. The tibialis muscle works almost alone: it is the only muscle that strongly lifts the foot. Functionally, its major job is not to shorten, but to lengthen in a controlled way: to gently lower the forefoot after the heel strikes the ground. This requires an eccentric contraction — the muscle contracts while lengthening, as your biceps do when you lower a barbell.
Without the tibialis anterior’s powerful and well-coordinated eccentric contractions, your foot would slap ungracefully onto the ground with every step. On hard surfaces like concrete, the strain of preventing foot slapping is considerable. For runners, that may be how shin splints begins, and is one of the main reasons to avoid running on pavement and concrete. Eccentric contractions are known to cause additional muscle soreness after exercise, which is why the shin muscle tends to get really sore after running hard — and why the muscle tends to develop large, chronic trigger points.
Another situation where the tibialis anterior has to work especially hard and tends to get really sore is coming down a mountain: because of the downward slope, the foot must be lowered further with each step, which means more eccentric contraction.
If you feel the inside surface of your shin, you will find hard bone, covered only by skin. On the outside surface of the shin, however, there is a thick pad of muscle starting about five centimetres below the knee: that’s the tibialis anterior. The Perfect Spot here is actually a whole patch of common trigger points in the top third of the muscle (see attached diagram). They are not hard to find, and they are usually very potent.
Pressure on any of tibialis anterior’s key trigger points will likely cause an almost paralyzing “good pain” that radiates down the shin into the top of the foot and toes. You will probably be surprised by the amount of sensation flooding down the leg: the tibialis anterior is a Perfect Spot because it almost always produces so much more sensation than anyone expects. It’s one of those spots that makes my clients say things like, “Wow, did you know that was there?” Amaze your friends!
The tibialis anterior is a really tough muscle. Unless you actually have shin splints (see below), these spots will usually tolerate plenty of pressure. To treat someone else, you may find that your thumbs alone are not quite strong enough; using an elbow or the blade of your forearm will make things much easier. Start gently but work steadily up to a satisfying pressure, and hold it until the intensity of the sensation gradually fades.
You can also use some massage oil or lotion to slide the blade of your forearm or the heel of your hand up the length of the tibialis anterior. This is quite a satisfying variation, combining the pleasure of good old-fashioned Swedish massage with the unique sensation of a trigger point at the top of the stroke.
To treat yourself, lean your shin into something hard, like the edge of a park bench or a tennis ball: whatever’s handy. I had an old hot-water radiator once that was perfect!
What about shin splints?
If you have shin splints, or you are helping someone with shin splints, you should handle this Perfect Spot cautiously. It can be helpful, but you must also be careful not to make the condition worse.
There are different kinds of shin splints, such as tibial stress fractures and medial tibial stress syndrome, neither of which can be helped much by massaging the tibialis anterior.
But another common kind of shin splints, anterior compartment syndrome, may respond well to the right kind of massage. This condition is caused by swelling of the compartment (think “sausage wrapping”) that the tibialis anterior muscles lives in. If this problem develops quickly, it can be dangerous — it can actually destroy the muscle, and lead to potentially life-threatening infection. If you have severe, rapidly developing shin pain, please go to the emergency room!
Slower cases are not dangerous: they just cause chronic pain. And trigger point therapy may calm the tibialis anterior muscle down enough to help relieve the problem. The trick is to give the tibialis anterior some help without increasing the pressure in the muscle compartment any more than it already is. Traditional Swedish massage strokes are completely out of the question in this situation: strongly stroking up or down the length of the muscle with broad pressure will just increase the pressure, like rolling up a toothpaste tube without undoing the cap. The trick is to just use point pressure on the Perfect Spot itself: locate it and apply only moderate focused pressure to the trigger point, and this may help the muscle without irritating the whole muscle.
This is just the briefest of introductions to shin pain. For (much) more information, see Shin Splints Treatment, The Complete Guide
What about plantar fasciitis?
Plantar fasciitis is a painful and often exasperatingly persistent condition of the arch of the foot. Although there are better ways of treating it, self-massage of the shin muscles may be helpful as well.
The foot’s arch is a little biomechanical marvel. It is held up by a fascinating combination of elastic and muscular support and “clever” skeletal arrangement, and it can take a lickin’ and keep on tickin’. But it does have limits, and when the muscles and connective tissues in the arch suffer excessive strain, they can really begin to burn. Once they start, it’s hard to stop, because your feet get used a lot.
The tendon of the tibialis anterior muscle passes underneath the foot, creating a kind of “stirrup” for the arch, helping to hold it up. To the extent that the tibialis anterior muscle fatigues and fails to support the arch, treating it may be very helpful for plantar fasciitis. A happier, more functional tibialis anterior means a happier, more functional arch!
For more information, see Complete Guide to Plantar Fasciitis
What about Morton’s neuroma?
A Morton’s neuroma is a sensitive growth on a nerve between the bones of the foot which gets painfully pinched, especially when wearing shoes that constrict the forefoot.
Morton's neuromas occur in the referral zones for some of the lower leg musculature, most notably the tibialis anterior muscle. Tibialis anterior trigger points are potentially relevant to Morton’s neuroma therapy in two ways:
- they may sensitize the neuroma, making it feel worse than it would otherwise
- the presence of the neuroma in the tibialis anterior referral zone may aggravate tibialis anterior trigger points
So there is the potential for a vicious cycle ... but also the potential to relieve it and desensitize the neuroma by relieving the trigger point.
The Tiger Tail Rolling Muscle Massager: a particularly ideal massage tool for this spot
The Tiger Tail Rolling Muscle Massager (made by Polar Fusion, in Washington state) is terrific for self-massage of the arms and legs, but I’ve used it mostly for my shins.
It is really just a specialized rolling pin, made for squishing muscle instead of dough. There is no question that I thought of (and tried) using an actual rolling pin on my own shins long, long before I heard of the Tiger Tail. But a rolling pin tends to be too hard, too broad, and too fragile (the handles tend not to be sturdy enough, unless you’ve got a really good quality rolling pin) for most massage purposes. The Tiger Tail solves these issues: it’s got a foam cover on a narrow cylinder, and it’s extremely sturdy.
This product is a perfect case study in how the right tool can make all the difference: I can self-massage my own legs with this tool effortlessly compared to trying to do the job with hands or any other tool. It’s easy to apply and control plenty of pressure.
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.
- Shin Splints Treatment, The Complete Guide — An extremely detailed guide to all types of shin splints for both patients and professionals, including thorough reviews of every possible treatment option, and all about the nature of the beast
- For more information about how hard-surface running affects your shins, see Is Running on Pavement Risky? — Hard-surface running may be a risk factor for running injuries like patellofemoral pain, IT band syndrome, shin splints, and plantar fasciitis.
- Is there anything you can do about that nasty soreness that crops in your shins after a downhill hike or a your first run in a while? Probably not. For the reasons why, see A Deep Dive into Delayed-Onset Muscle Soreness — The biology & treatment of “muscle fever,” the deep muscle soreness that surges 24-48 hours after an unfamiliar workout intensity.
Appendix A: Is trigger point therapy too good to be true?
Trigger point therapy isn’t too good to be true: it’s just ordinary good. It can probably relieve some pain cheaply and safely in many cases. Good bang for buck, and little risk. In the world of pain treatments, that’s a good mix.
But pain is difficult and complex, no treatment is perfect, and there is legitimate controversy about the science of trigger points. Their nature remains somewhat puzzling, and the classic image of a tightly “contracted patch” of muscle tissue may well be wrong. What we do know is that people hurt, and it can often be helped.
The Perfect Spots are based on a decade of my own clinical experience as a massage therapist, and years of extensive science journalism on the topic. Want to know more? This is the tip of the iceberg. I’ve written a whole book about it …
Not too good to be true.
Just ordinary good. Trigger point therapy isn’t a miracle cure, but it is a valuable life skill. Practically anyone can benefit at least a little & many will experience significant relief from stubborn aches & pains. The first few sections are free.
Appendix B: All the perfect spots
There’s also a more detailed index of the spots and other trigger point resources.
- Massage Therapy for Tension Headaches — Perfect Spot No. 1, in the suboccipital muscles of the neck, under the back of the skull.
- Massage Therapy for Low Back Pain — Perfect Spot No. 2, in the erector spinae and quadratus lumborum muscles in the thoracolumbar corner
- Spot No. 3 is this page.
- Massage Therapy for Neck Pain, Chest Pain, Arm Pain, and Upper Back Pain — Perfect Spot No. 4, an area of common trigger points in the odd scalene muscle group in the neck
- Massage Therapy for Tennis Elbow and Wrist Pain — Perfect Spot No. 5, in the common extensor tendon of the forearm
- 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 Bruxism, Jaw Clenching, and TMJ Syndrome — Perfect Spot No. 7, the masseter muscle of the jaw
- Massage Therapy for Your Quads — Perfect Spot No. 8, another one for runners, the distal vastus lateralis of the quadriceps group
- Massage Therapy for Your Pectorals — Perfect Spot No. 9, in the pectoralis major muscle of the chest
- Massage Therapy for Tired Feet (and Plantar Fasciitis!) — Perfect Spot No. 10, in the arch muscles of the foot
- Massage Therapy for Upper Back Pain — Perfect Area No. 11, the erector spinae muscle group of the upper back
- 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
- Massage Therapy for Shoulder Pain — Perfect Spot No. 14, The Most Predictable Unsuspected Cause of Shoulder Pain
- The tibialis anterior and posterior both have long tendons that support the arch like stirrups (a really neat little bit of anatomy, actually). Thordarson et al found (as summarized by summarized by Bolgla): “The posterior tibialis provides the most significant dynamic arch support during the stance phase of gait. The posterior tibialis eccentrically lengthens to control pronation and reduce the tension applied to the plantar fascia during weight acceptance.” And we also know from Basmajian that the arch muscles only “kick in” to under quite heavy loads: about 180 kilograms! We probably hit that number with the impact of jogging, say, but it’s still surprisingly high.