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.
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 pain), and probably other unexplained painful problems in the area — it will be either a contributing factor or a complication.
The masseter muscle is strong (and special)
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 “low gear” muscle, slow but powerful and efficient, lots of chewing bang for your masseter buck. Lots of torque. The physics details are a bit mind-bendy.6
Why is the masseter muscle a Perfect Spot for massage?
A little muscle rubbing and stretching probably eases pain and stiffness at least a little,7 and it’s easy to imagine why this muscle might enjoy that: 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 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 cause and/or complicate several problems:
Tension headaches, of course — this makes strong intuitive sense to most people. There seems to be a clear link between tension headaches and jaw muscle tension.8 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.9
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.”10 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 themselves, they are probably involved and need to be considered.11
Bruxism, or grinding and cracking of molars, with many early warning signs of wear and tear.12
Temporomandibular joint syndrome (TMJS) is a slow-motion failure of jaw joint function, mostly pain and/or limited movement, strongly linked to habitual clenching and grinding (bruxism). TMJS can be minor or awful, and is one of the classic chronic pain syndromes that lacks an obvious cause. The worst cases interfere with eating and sleeping, often involve ear aches and ringing as well
How do you massage the masseter muscle?
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 product show — 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.
For more general tips about how to work on your own knots, see Basic Self-Massage Tips for Myofascial Trigger Points.
Don’t neglect your neck
Everything’s connected, and the neck and the jaw have a strong 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.13 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…
Learning to relax your jaw
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.14 I feel suspicious that they may be over-prescribed, because selling mouth appliances is probably profitable. It’s unclear that it works, and it could even do some harm.15
Then again, many people (including my wife) have actual cracks in their molars from clenching so hard, so clearly some people do actually need to protect their teeth. So it’s complicated.
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.16 And simply willing yourself to stop clenching seems 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.
Jaw relaxation trick #1: The Fake Drunk
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.
Jaw relaxation trick #2: The Long Surprise
Now, don’t move. (Unless it hurts. Heck, don’t do anything that hurts!)
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.
When massage and relaxation aren’t enough: management of nastier jaw pain
As with most kinds of 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 dysfunctional sensitization.17 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.
- Eat like you have no teeth, or fragile ones. Purge hard and chewy foods from your diet. Become a huge fan of smoothies. Make your jaw’s job as easy as possible for as long as necessary. When you do chew firmer things, favour usage of the back molars: they have better leverage.18
- Your teeth should never be in contact unless eating! Contact at any other time is a stressful habit to be unlearned (which may be slow and difficult). You should also avoid opening your jaw widely (which is usually much easier to avoid).
- Consciously return your jaw to neutral resting position as often as possible: teeth slightly apart, with the tongue on the roof of the mouth just behind your front teeth (the position used to say the letter “N”).19 For a while, use a timer to remind yourself of this frequently throughout the day. When you start to ignore that — and you will! — get creative with other reminder methods.
- Beware of extreme or awkward neck or jaw positions, and/or applying pressure to the jaw. Sleeping on your stomach is the classic example. Use a firm pillow between your knees to help prevent yourself from rolling onto your front. Leaning your jaw on your hand is another common one.
- Soothe the jaw as often and as well as you can, with either ice or heat: whatever feels most pleasant to you at any given time. Conservative use of painkillers20 can be a perfectly good temporary crutch, and Voltaren gel can be especially useful in this location.
- Spend some time each day practicing painless, gentle jaw movements: sets of slight opening and closing and side-to-side movements, a few times a day. Make these movements as easy and subtle as required to ensure that they are painless. The idea is teach your brain that movement is safe and dandy. These are “mobilizations,” but unusually tiny ones. With the jaw it is necessary to be particularly delicate — so much so that you might feel like you’re almost doing nothing at all. That’s okay, as long as there is movement and it doesn’t hurt.
- All of the above might still fail if you have severe chronic anxiety or insomnia. Addressing big life problems like a job you hate, or a bad marriage, can be critical in the long run: see Pain Relief from Personal Growth. I look at this in the most general way in Vulnerability to Chronic Pain: Chronic pain often has more to do with general biological vulnerabilities than specific tissue problems.
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.
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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.
What’s new in this article?
2017 — Added citation to Webb et al regarding massage efficacy.
2015 — Added new section, “Don’t neglect your neck.”
2015 — Added new section, “When massage and relaxation aren’t enough: management of nastier jaw pain.”
2005 — Publication.
- The other major one is the temporalis muscle, which covers more of the side of the head than most people realize: the entire temple, of course, but quite a bit more above and behind that.
- Travell J, Simons D, Simons L. Myofascial Pain and Dysfunction: The Trigger Point Manual. 2nd ed. Lippincott, Williams & Wilkins; 1999. p330. Several studies are discussed that conclude that myofascial trigger points in the superficial masseter muscle are either the most common, or the second most common, of all the trigger points studied. It’s a hard thing to nail down for sure, but it seems clear that it’s an extremely prominent “Perfect Spot!”
- The tongue is also popularly claimed to be the most powerful muscle, but that’s really hard to substantiate. The tongue isn’t one muscle, but a muscle group, and it can’t apply force in a way that can be compared meaningfully to other muscles. How, exactly, do you test tongue strength? Tongue push-ups?
- According to the 1992 Guinness Book of Records, in 1986 Richard Hofmann of Lake City, Florida achieved a bite strength of 442 kbf (975 lbf) for two seconds.
- “Pennate” just means “like a feather,” with diagonal fibres converging on a line — a tendon. In a “multi” pennate muscle, there are multiple and dividing central tendons. The result is a complex, densely packed feathering of fibres. There are only a few multipennate muscles in the body, like the deltoid on the shoulder, and most of the small muscles in the hands and feet. But the masseter is the king of “pennatedness.”
- Pennate muscle power is a winch: powerful but slow, and you need more cable to pull shorter distances. Pennate muscles exploit the pulley effect by pulling on the sides of tendons that run all the way through the muscle, converging on them at angles. Imagine a tug-of-war team with ropes tied to the main rope — you could have at least twice as many pullers! More fibres pulling on a tendon means that pennate muscles are found in the “tight spaces” in the body where power is needed without a lot of mass. In contrast, muscles with parallel fibres, like the biceps, pull directly on their target bone, and so they can pull faster and farther, but they are also weaker pound-for-pound and take up a lot of room. If you converted pennated muscles to a parallel fibre structure, they would have to be roughly twice as big! Imagine doubling the size of your masseters. Chipmunk!
- Webb TR, Rajendran D. Myofascial techniques: What are their effects on joint range of motion and pain? A systematic review and meta-analysis of randomised controlled trials. J Bodyw Mov Ther. 2016 Jul;20(3):682–99. PubMed #27634094 ❐
A review of nine studies of dubious quality of “myofascial technique” — rubbing and stretching basically — for joint pain and stiffness. Although all the studies showed improved range of motion and reduced pain, most clearly for the jaw, the authors of this review think that there are “a number of threats that challenge the statistical inferences underpinning these findings.” Translation: they think the studies they reviewed are of poor quality and that their conclusions cannot be trusted (garbage in, garbage out). Obviously the science is incomplete, but there are some reasons for optimism here (and it’s not exactly a huge claim that some rubbing and stretching might help a painful, stiff joint).
- Gonçalves DA, Bigal ME, Jales LC, Camparis CM, Speciali JG. Headache and symptoms of temporomandibular disorder: an epidemiological study. Headache. 2010 Feb;50(2):231–41. PubMed #19751369 ❐
This epidemiological study found temporomandibular joint dysfunction is more common in tension and chronic daily headache patients, and especially migraine headache sufferers, than in the general population. This is such a well-documented link that this is the only reference I have for it.
- I decided against it because the two halves of the spot are so different in character. The temporalis is much thinner, massage there needs to be generally more delicate and superficial, and it feels more like massage of the surface of the head than the jaw. Only about a centimetre away, just on the other side of the cheekbone, the top of the masseter is sturdy and thick, and tolerates strong pressure which feels more much more penetrating and much more relevant to jaw tension.
- Travell J, Simons D, Simons L. Myofascial Pain and Dysfunction: The Trigger Point Manual. 2nd ed. Lippincott, Williams & Wilkins; 1999. p339
- Rocha CA, Sanchez TG. Myofascial trigger points: another way of modulating tinnitus. Prog Brain Res. 2007;166:209–214. PubMed #17956784 ❐
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.”
- For instance, a dental x-ray may show signs of calcification in molar interiors. My dentist pointed this out to me in early 2015, after years of warning me that there were more superficial signs of bruxism. Seeing the trouble on an x-ray finally got my attention.
- Fernández-de-Las-Peñas C, Galán-Del-Río F, Alonso-Blanco C, et al. Referred pain from muscle trigger points in the masticatory and neck-shoulder musculature in women with temporomandibular disoders. J Pain. 2010 Dec;11(12):1295–304. PubMed #20494623 ❐
- The actual prevalance of bruxism is probably no more than 30% of the population, though some sources cite much higher figures. A large percentage are probably unaware of it.
- Bereznicki T, Barry E, Wilson NH. Unintended changes to the occlusion following the provision of night guards. Br Dent J. 2018 10;225(8):715–722. PubMed #30361571 ❐
- This is one of the classic problems with massage. Although massage does appear to be quite helpful for some people, some of the time, the results are a bit underwhelming on average — and the benefits are notoriously brief. This is discussed in much more detail in both my advanced trigger points tutorial, and also my general massage review, Does Massage Therapy Work?
- Pain itself often modifies the way the central nervous system works, so that a patient actually becomes more sensitive and gets more pain with less provocation. This is called “central sensitization.” (And there’s peripheral sensitization too.) Sensitized patients are not only more sensitive to things that should hurt, but also to ordinary touch and pressure as well. Their pain also “echoes,” fading more slowly than in other people. See Sensitization in Chronic Pain: Pain itself can change how pain works, resulting in more pain with less provocation.
- Using your front chompers takes more strength, because they are further from the joint — from the fulcrum. So avoid things like biting into apples with your front teeth, which takes a lot of biting power with the worst leverage.
- When lying down, the tongue can fall back and down a bit: holding it on the roof of the mouth would take tension.
- Don’t get chronic with any painkiller, even the ordinary ones, and don’t exceed dosage recommendations, especially for acetaminophen/paracetamol (Tylenol, Panadol, etc), and beware of indigestion with ibuprofen (Advil, Midol, etc).
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
- Massage Therapy for Shin Splints — Perfect Spot No. 3, in the tibialis anterior muscle of the shin
- 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
- Spot No. 7 is this page.
- 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