Trigger points (TrPs), or muscle knots, are a common cause of stubborn and strange aches and pains, and yet they are under-diagnosed. The 13 Perfect Spots (jump to list below) are trigger points that are common and yet fairly easy to massage yourself — the most satisfying and useful places to apply pressure to muscle. For tough cases, see the advanced trigger points treatment guide.
Your masseter muscle is your primary chewing muscle — not the only one,1 but the main one — and it covers the sides of the jaw just behind the cheeks. And so it’s also the muscle that clenches your jaw and grinds your teeth, unfortunately, and it’s one of the most common locations for trigger points in the human body.2 It is an accomplice in many cases of bruxism (that’s Latin for “grinding your teeth”) and temporomandibular joint syndrome (jaw joint paint), and probably other unexplained painful problems in the area — it will be either a contributing factor or a complication.
Not only does the masseter muscle probably harbour some of the most common trigger points in the human body, the masseter is also the strongest muscle in the human body (pound for pound), although many variables make this difficult to be sure of.3 Together with the temporalis muscle and a few other smaller muscles, most people can generate at least about 68 kilograms of force (kgf) between their teeth. For contrast, the world record for human bite strength is 442 kgf. 442!4 More than six times normal. A human shark!
It’s amazing how specialized muscles can be. The masseter gets extraordinary strength from a “multipennate” arrangement of fibres that’s like a complex feather — fibres converging diagonally on several internal tendons.5 This feathered arrangement favours torque over speed, making the masseter a very “low gear” muscle, slow but powerful and efficient, lots of chewing bang for your masseter buck. The physics details are a bit mind-bendy.6
It’s easy enough to imagine why this muscle might enjoy the occasional massage. Whose jaw isn’t at least a little bit tense? But the masseter’s potential to cause trouble — and its need for some massage — is often underestimated by everyone, both patients and professionals. (Although I’m pleased to see a surprisingly strong interest in the subject amongst dental specialists.) When irritated, masseter muscle knots can directly cause and/or complicate several problems:
Tension headaches, of course — this makes strong intuitive sense to most people. There seems to be a pretty strong connection between tension headaches and jaw muscle tension. This is mostly due to the temporalis muscle, which is reflexively massaged by everyone with a headache (the temples). But the masseter is often neglected, even though it is more powerful and clenchy. They both need some attention — massaging above and below the cheekbone. I actually considered defining Spot No. 7 as the temple and the masseter.7
Earaches and toothaches — which are much less obviously associated with the masseter. A masseter trigger point can radiate pain directly into a tooth. Travell and Simons quip, “This can lead to disastrous results for an innocent tooth.”8 I once suffered a dramatic case of a “toothache” that was completely relieved by a massage therapist the day before an emergency appointment with the dentist: a particularly vivid experience, and in fact the one that originally got me interested in trigger points.
Tinnitus (ringing in the ears) and dizziness. Both can be serious and complex problems. There are many other potential contributing factors and causes of these conditions. Although they are unlikely to be caused by masseter trigger points themseselves, they are probably involved and need to be considered.9
Bruxism, or grinding and cracking of molars, with many early warning signs of wear and tear.10
Temporomandibular joint syndrome is a failure of jaw joint function, mostly pain and/or limited movement. TMJS can be minor or awful. The worst cases interfere with eating and sleeping, often involve ear aches and ringing as well, and they are unlikely to respond to massage alone. There’s a section for these patients at the end of this article.
As you can see, masseter distress is not to be taken lightly.
Fortunately, it’s easy — really easy — to massage and soothe your own masseter muscle, which is what makes it such a particularly perfect Perfect Spot. It has both great needs and it’s unusually easy and satisfying to self-massage.
The masseter muscle “hangs” from the underside of the cheekbone on the side of the face. The bottom of the muscle attaches to a broad area on the side of the jawbone.
Perfect Spot No. 7 is conveniently located in a notch in the cheekbone, about one inch in front of your ears. The notch is on the underside of the cheekbone, it’s easy to find, and your thumb or fingertip will fit into it nicely. If you press firmly inward and upwards with your thumb in the cheekbone notch, you will usually be rewarded with a sweet ache.
The rest of the masseter muscle, however, tends to feel like not much, or unpleasantly tender. Although the entire muscle can be rubbed gently, most people will find that the satisfying sensation of a Perfect Spot for massaging is limited to the upper edge of the muscle.
Spot 7 is a sturdy piece of anatomy, so don’t be afraid to work steadily up to firm pressure — if that’s what you feel like you want. Either constant pressure or small, kneading circles are both appropriate. Since this spot is sturdy, another good trick is to use a knuckle for extra pressure. A useful tool in this location is Pressure Positive’s Knobble productshow — it’s easy to lie down on your side and let the weight of your head apply a steady, firm pressure, with the tip fitting nicely into the cheekbone notch.
Everything’s connected, and the neck and the jaw have a particularly close working relationship. People with tempormandibular joint syndrome not only have more and worse trigger points in their jaw muscles than other people, but in their neck muscles as well.11 Any serious effort to help your jaw should be accompanied by some neck massage as well, especially another perfect spot, Spot #1, in the suboccipital muscle group under the back of the skull, plus of course anything else that might help your neck, like some mobilizations or heating.
Oh, and when you’re done with your neck, don’t forget that it’s attached to your shoulders…
Does anyone go to the dentist anymore and not get a prescription for a mouth guard? Judging by the inevitable prescriptions, apparently everyone has some kind of jaw-clenching problem.12 Sometimes I feel suspicious that the problem is greatly over-diagnosed, because selling mouth appliances is probably profitable). Then again, many people (including my wife) have actual cracks in their molars from clenching so hard. It’s definitely out there.
This article is mostly about massaging Perfect Spot 7 in the masseter, but it’s obviously potentially extremely helpful for temporomandibular joint syndrome, bruxism, clenching, and grinding if you can also figure out how to stop clenching in the first place. But this is not easy. An easier life would be helpful, but those are hard to come by. A nice massage (or any other relaxing experience) is a helpful start, but it doesn’t do much for long.13 And simply willing yourself to stop clenching seems almost completely ineffective. Simply willing yourself to stop clenching seems to be almost completely ineffective I’ve known many people who have tried to get serious about reminding themselves to stop clenching, using egg timers and so on … with rather underwhelming results.
So what can you do? How can you possibly learn to clench less? Here are two ideas that I think work better than simply trying hard not to clench.
Slur your speech as though you are so sleepy that you can hardly form words. You know that lovely feeling when you’re waking up slowly, in no hurry, and you’re conscious but not ready to move or speak yet? That floaty, delicious feeling of happy paralysis? Of complete contentment to just lie there? Now act like you feel that way, in your mouth. To get into the spirit of the thing, speak the words, “I’m so relaxed I can hardly talk,” and slur your words. Literally slur them. Slur them like your mouth is so relaxed you are having trouble making words! You will find that this is quick and effortless way to relax your jaw. It won’t necessarily last, but it is a most helpful way to quickly get back to the state you want.
I use this technique even when there are people around. I find that I can easily just mouth the words “I can hardly talk,” making no noise, and immediately access the sensory experience of jaw relaxation, with no one around me having a clue about what I’m up to.
Spend long periods of time with your jaw wide open, if you can do so without pain. (If you can’t hold your jaw open without pain, you need a different approach: see the next section.) Hold your mouth open at least wide enough to fit a finger between your teeth for one full hour. Not just open, but open wide — as though you are really just shocked by something, continuously, for an hour. Every time during the hour that you catch yourself with your teeth together, simply calmly stretch your mouth open again. After an hour of this, clenching starts to feel abnormal, and you will find it much easier to keep your jaw relaxed for some time afterwards.
You may also find it helpful to actually prop your mouth open with something durable and spit-proof, such as a Lego block, or a small rubber ball. Most people will salivate too much to keep this up for an entire long session, but it can be a useful way to help you focus on the challenge for a few minutes at a time. Some people may find it practical for longer.
This intensive approach is generally a much more effective method of breaking the clenching habit than scattered self-reminders to “stop clenching,” which just never really take. If you are really determined, spend an hour a day holding your face like someone just stuck a needle in your keister. If you put in the time, you really can’t fail. I estimate that most people need 5–10 hours of practice in a week to put a good dent in a clenching habit. Of course, life is likely to regenerate the problem back sooner or later … but you will know what to do when that happens.
Good luck, and have fun with it.
As with most kinds pain, temporomandibular joint pain can get entrenched and serious. If you have a lot of pain, massage alone is unlikely to do the job: perfect spot #7 isn’t that perfect. In fact, if things are bad enough, pain caused by strong massage could escalate the situation.
Most chronic pain involves some degree of sensitization. Pain can make us more sensitive to more pain.14 In this unfortunate state, pain is no longer being dictated by the state of tissue, but by a bit of a neurological meltdown. You can recover from this state, but it takes more time. You will need to minimize stress on the jaw as much as possible for quite a while, and then gradually reintroduce healthy stimuli and normal usage again.
And, of course, if you’re in such rough shape you should probably seek professional guidance and troubleshooting — but beware of no-pain-no-gain therapies. They are directly at odds with sensitized chronic 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.
In 2007, these researchers found that “in 56% of patients with tinnitus and MTPs, the tinnitus could be modulated by applying digital compression of such points, mainly those of the masseter muscle.” And how many people with tinnitus had trigger points? Quite a few. The researchers found “a strong correlation between tinnitus and the presence of MTPs in head, neck and shoulder girdle.”BACK TO TEXT
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 …
Under the back of the skull must be the single most pleasing and popular target for massage in the human body. No other patch of muscle gets such rave reviews. It has everything: deeply relaxing and satisfying sensations, and a dramatic therapeutic relevance to one of the most common of all human pains, the common tension headache. And no wonder: without these muscles, your head would fall off. They feel just as important as they are. (Click/tap heading to read more.)
|for pain: almost anywhere in the head, face and neck, but especially the side of the head, behind the ear, the temples and forehead||related to: headache, neck pain, migraine||muscle(s): suboccipital muscles (recti capitis posteriores major and minor, obliqui inferior and superior)|
This Perfect Spot lives in the “thoracolumbar corner,” a nook between your lowest rib and your spine — right where the stability of the rib cage gives way to the relative instability of the lumbar spine. Muscle tends to bunch up around this joint between the last of the thoracic vertebrae and the first of the lumbar. The sweet spot consists of trigger points in the upper-central corner of the quadratus (square) lumborum muscle and in the thick column of muscle that braces the spine. (Click/tap heading to read more.)
|for pain: anywhere in the low back, tailbone, lower buttock, abdomen, groin, side of the hip||related to: low back pain, herniated disc||muscle(s): quadratus lumborum, erector spinae|
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. (Click/tap heading to read more.)
|for pain: in the shin, top of the foot, and the big toe||related to: shin splints, drop foot, anterior compartment syndrome, medial tibial stress syndrome||muscle(s): tibialis anterior|
Deep within the Anatomical Bermuda Triangle, a triangular region on the side of the neck, is the cantankerous scalene muscle group. Massage therapists have vanished while working in this mysterious area, never to be seen again. The region and its muscles are complex and peculiar, and many lesser-trained massage therapists have low confidence working with them. (Click/tap heading to read more.)
|for pain: in the upper back (especially inner edge of the shoulder blade), neck, side of the face, upper chest, shoulder, arm, hand||related to: thoracic outlet syndrome, lump in the throat, hoarseness, TMJ syndrome||muscle(s): the scalenes (anterior, middle, posterior)|
Just beyond your elbow, all the muscles on the back of your forearm converge into a single thick tendon, the common extensor tendon. At the point where the muscles converge, in the muscles that extend the wrist and fingers, lies one of the most inevitable myofascial TrPs in modern civilization: Perfect Spot No. 5. It is constantly and greatly aggravated both by computer usage today and by the use of a pen in simpler times — and by the occasional tennis match, then and now. (Click/tap heading to read more.)
|for pain: in the elbow, arm, wrist, and hand||related to: carpal tunnel syndrome, tennis elbow (lateral epicondylitis), golfer’s elbow (medial epicondylitis), thoracic outlet syndrome, and several more||muscle(s): extensor muscles of the forearm, mobile wad (brachioradialis, extensor carpi radialis longus and brevis), extensor digitorum, extensor carpi ulnaris|
When you have back pain, buttock pain, hip pain, or leg pain, much or even all of your trouble may well be caused by trigger points in the obscure gluteus medius and minimus muscles, a pair of pizza-slice shaped muscles a little forward of your hip pocket. Other muscles in the region are usually involved as well, such as the gluteus maximus, piriformis, and the lumbar paraspinal muscles. However, the gluteus medius and minimus are a bit special: their contribution to pain in this area is particularly significant, and yet people who have buttock and leg pain rarely suspect that much of it is coming from muscle knots so high and far out on the side of the hip. (Click/tap heading to read more.)
|for pain: in the low back, hip, buttocks (especially immediately under the buttocks), side of the thigh, hamstrings||related to: sciatica, trochanteric bursitis, low back pain||muscle(s): gluteus medius and minimus|
Your masseter muscle is your primary chewing muscle — not the only one, but the main one — and it covers the sides of the jaw just behind the cheeks. It’s also the main muscle that clenches your jaw and grinds your teeth, unfortunately, and it’s one of the most common locations for trigger points in the human body. It is probably an accomplice in most cases of bruxism (that’s Latin for “grinding your teeth”) and temporomandibular joint syndrome (jaw joint pain), plus other unexplained painful problems in the area. (Click/tap heading to read more.)
|for pain: in the side of the face, jaw, teeth (rarely)||related to: bruxism, headache, jaw clenching, TMJ syndrome, toothache, tinnitus||muscle(s): masseter|
A lot of quadriceps aching, stiffness and fatigue emanates from an epicentre of “knotted” muscle in the lower third of the thigh, in the vastus lateralis, a huge muscle — one of your biggest — that dominates the lateral part of the leg. Stretching it is effectively impossible, but massage is an option: although often shockingly sensitive, Perfect Spot No. 8 can also be quite satisfying. It also often complicates or contributes to other problems in the area, especially runner’s knee (iliotibial band syndrome). (Click/tap heading to read more.)
|for pain: in the lower half of the thigh, knee||related to: iliotibial band syndrome, patellofemoral pain syndrome||muscle(s): quadriceps (vastus lateralis, vastus intermedius, vastus medialis, rectus femoris)|
The “pecs” are popular: of 700+ muscles, the pectoralis major is one of just a dozen or so that most people can name and point to. It also harbours one of the most commonly-encountered and significant trigger points in the human body, and can produce pain much like a heart attack in both quality and intensity. (Click/tap heading to read more.)
|for pain: anywhere in the chest, upper arm||related to: “heart attack,” respiratory dysfunction||muscle(s): pectoralis major|
The tenth of the Perfect Spots is one of the most popular of the lot, and right under your feet — literally. It lies in the center of the arch muscles of the foot. This is one of the Perfect Spots that everyone knows about. No massage is complete without a foot massage! (Click/tap heading to read more.)
|for pain: in the bottom of the foot||related to: plantar fasciitis||muscle(s): arch muscles|
This “spot” is too large to really be called a “spot” — it’s more of an area. The thick columns of muscle beside the spine are routinely littered with muscle knots from top to bottom. Nevertheless, there is one section of the group where massage is particularly appreciated: from the thick muscle at the base of the neck, down through the region between the shoulder blades, tapering off around their lower tips. There is no doubt that this part of a back massage feels even better than the rest — even the low back, despite its own quite perfect spots, cannot compete. (Click/tap heading to read more.)
|for pain: anywhere in the upper back, mainly between the shoulder blades||related to: scoliosis||muscle(s): erector spinae muscle group|
At the top of the gluteal muscles lies a Perfect Spot among Perfect Spots: a sneaky but trouble-making brute of a TrP that commonly forms in the roots of the gluteus maximus muscle, just below the pit of the low back, but experienced as low back pain. This is the kind of spot that the Perfect Spots concept is really all about — not only does it tend to produce a profound and sweet ache when massaged, but the extent of the pain that spreads out around it is almost always a surprise. (Click/tap heading to read more.)
|for pain: in the lower back, buttocks, hip, hamstrings||related to: low back pain, sciatica, sacroiliac joint dysfunction||muscle(s): gluteus maximus|
Some of the Perfect Spots are perfect because they are “surprising” — they aren’t where you thought they’d be, and it’s delightful to discover the real source of pain. Others are perfect because they are exactly where you expect them to be — and what a relief it is to be able to treat them. Perfect Spot No. 13 is perhaps the ultimate, the quintessential “right where I thought it was” trigger point: right at the very bottom of the thick columns of muscle, in the “pit” of the low back. (Click/tap heading to read more.)
|for pain: in the low back, buttocks, hamstrings||related to: low back pain, sciatica, sacroiliac joint dysfunction||muscle(s): erector spinae muscle group at L5|
I avoided adding Spot 14 to this series for many years, because it’s a little tricky to find. But precision is not required: although there is one specific spot that’s especially good, nearly anywhere just under the ridge of bone on the shoulder blade is worthwhile, and often a surprising key to pain and stiffness everywhere else in the shoulder… but especially all the way around on the other side, facing forward. (Click/tap heading to read more.)
|for pain: any part of the shoulder, and upper arm||related to: frozen shoulder, supraspinatus tendinitis||muscle(s): infraspinatus, teres minor|