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Tennis Ball Massage for Myofascial Trigger Points

Some creative tips on using a tennis ball (and other tools) to self-massage myofascial trigger points

updated (first published 2004)
by Paul Ingraham, Vancouver, Canadabio
I am a science writer and a former Registered Massage Therapist with a decade of experience treating tough pain cases. I was the Assistant Editor of ScienceBasedMedicine.org for several years. I’ve written hundreds of articles and several books, and I’m known for readable but heavily referenced analysis, with a touch of sass. I am a runner and ultimate player. • more about memore about PainScience.com
Photograph of a bright yellow tennis ball, isolated on white. Tennis balls are effective self-massage tools.

Ah, the humble tennis ball

Best buddy to the common muscle knot!

“My orthopedic surgeon didn’t know about using tennis balls for massage! He asked what helped my back pain, and I told him I always lie on a tennis ball. He looked at me like he was going to refer me to a psychiatrist! How can an orthopedic surgeon not know about the tennis ball thing? Doesn’t everyone know about the tennis ball thing?”

~ a massage therapy client

Unfortunately, no: not everyone knows about the tennis ball thing. But it is a time-honoured simple self-treatment for chronic muscle aches and pains, running a close second to “the hot bath thing.”

A tennis ball is just a particularly cheap, handy, portable self-massage tool that you can use on suspected “knots” in your muscles. It’s like a tiny little foam roller.

In this basic article, I serve up (•sad trombone•) some fun tips on how to use a tennis ball — and similar tools — to relieve “knots” in your muscles, or at least to try without the expense of a massage therapist. (They’re lovely, but they ain’t cheap, and it can be a challenge to find a good one.)

What’s the point? The biology of tennis ball massage

Muscle “knots” are sore, aching spots of uncertain nature best known as “trigger points.”1 Having too many severe, chronic trigger points is myofascial pain syndrome, a rather vague label for chronic widespread pain that is presumed to involve primarily muscle pain (as opposed to neuropathy, arthritic joints, say). The idea of MPS also overlaps quite a bit with fibromyalgia. But even healthy people have occasional flare-ups of this kind of discomfort.

In theory, knots are soothed by pressure and rubbing, and it’s often much easier to do that with a tennis ball than your thumbs and fingers.

How to do it: tennis ball massage technique basics

The basic idea of tennis ball massage, or any massage with any kind of ball, is to apply specific pressure to a stiff or aching spot in a muscle by trapping it between your body and something else: usually the floor, sometimes a wall, or another body part (or a few other creative options like the back of the couch, the bottom of the bathtub, and so on). The point is to use the ball to reach spots that you simply can’t get to with your hands, and every other kind of tool massage is a variation on this theme.

It is in fact exactly like foam rolling,2 but less trendy and more precise. Both have their strengths, but if I could only have one, I’d definitely choose the tennis ball for its accuracy and versatility.

Tennis ball massage is usually the most useful in the muscles of the back and the hips: places where you can actually lie down on the tennis ball, pinching it between your body and the floor or wall. Many other locations are awkward (especially for beginners), and you may find it difficult or impossible to apply pressure effectively.

The specific goal of tennis ball massage: “release”

The goal of tennis ball massage is to achieve a “release” by applying just the right amount of pressure: enough to do some good, but not enough to irritate your nervous system. (Although it’s quite safe, massage is not harmless.3) The sensation should be clear and strong and satisfying, what we call “good pain.”

If you are wincing or gritting your teeth, please be more gentle with yourself. You need to be able to relax.

Once you have adjusted yourself to achieve the right pressure, relax as much as possible and wait for the sensation to fade to about eighty percent of the original intensity. This is the “release”: a change in the physiological state of the tissues, or a “melting” of the knot, and/or just a sensory change, relief, a subjective experience of it easing. This can take anywhere from ten seconds to a few minutes. I’ll briefly introduce the (messy) biology of this below.

Where to apply your tennis ball

Tennis ball massage is usually the most useful in the muscles of the back and the hips: places where you can actually lie down on the tennis ball, pinching it between your body and the floor or wall. Many other locations are awkward (especially for beginners), and you may find it difficult or impossible to apply pressure effectively.

Lie down on a tennis ball, placing it in approximately the right location. You do not have to be precise. “Explore” by moving slowly and gently, until you’ve got just the right spot.

See the “Perfect Spots” series of articles for several recommended starting places for massage.

Tips and tricks for longer lasting trigger point release

Trigger point massage often provides only temporary relief. Here are some basic tips and tricks to help make it last as long as possible:

For more help with technique, see Basic Self-Massage Tips for Myofascial Trigger Points.

Does it have to be a tennis ball? Not hardly! Other massage tools for trigger point release …

Lacrosse balls are less common and much firmer, but they have a great rubbery texture that makes them easy to work with, and less prone to slipping. Squash balls are also nice and “sticky,” but much smaller and more precise.

A simple selection of balls — I have had a “bucket o’ balls” around for many years now — gives great bang for your buck, and anyone who has a tough muscle pain problem should have one. Most of the balls in a good bucket o’ balls can be purchased in one trip to a sporting goods store and a pet store. A bucket o’ balls and a bit of practice is like having 50% of a good massage therapist on call for the rest of your life, for the tiniest fraction of the cost of therapy. A ball certainly can’t do it all, but it’s a good start and an incredible value!

Your dog’s “ball” might be useful: a Kong dog toy, with it’s pyramidal shape and a hardness that varies depending on how you use it, can be much better than a tennis ball for some areas.

The Kong dog toy is an amazingly good self-massage tool!

The Kong dog toy is an amazingly good self-massage tool!

There are, of course, countless simple commercial self-massage tools: balls of every description, sticks and widgets, rollers and thumpers, wooden thumbs, and on and on.

Even rocks can make good self-massage tools!

Even rocks can make good self-massage tools!

I even know a therapist who collects smooth river rocks — seriously —and gives them away to patients as self-massage tools. It’s a nice idea. Although hard as rock, too hard for many patients, they’re just right for certain self-massage challenges. For instance, they might be ideal for firm “scraping” of the muscles of the forearm — a muscle group which can really take a beating in some people.

Squash balls are softer and smaller than tennis balls, which makes them ideal for massaging some hard-to-reach spots, like the back of the shoulder.

Squash balls are softer & smaller than tennis balls, which makes them ideal for massaging some hard-to-reach spots, like the back of the shoulder.

Many of these tools are handy and fun, but one of the most important idea’s in this article is that you really don’t need to go out of your way to buy anything special: most people already have a tennis ball around, and it really is one of the most versatile self-massage tools in the world.

The guidelines in this article for self-treatment apply more or less regardless of what tool you use.

Why tennis balls might help trigger points (the extremely oversimplified science)

A knot or trigger point is a tiny spasm … maybe. It’s just a theory. The nerve that controls the muscle may be firing too quickly, and the tissue is full of (irritating) waste molecules produced by the “revving” tissue. Or it could be something else altogether. It’s all quite controversial,4 and pain is surprisingly mysterious.5

It’s also a scientific unknown if applying pressure is actually an effective treatment for trigger points.6 It may be more of a sensory distraction than an actual “cure.” Or it may have a biological effect on the trigger point. Two common ideas are that the pressure creates a small, local stretch that resolves the spasm just like stretching to relieve a larger spasm, and/or the pressure literally squeezes stagnant tissue fluids out of the area.

Regardless, trying to untie muscle knots certainly feels good, and many people seem to experience profound relief from focused massage pressure. Just like stretching, it’s therapeutic value is unclear, but it can definitely feel fantastic, like scratching an itch. Pleasant massage is its own reward, and just-right pressure on trigger points is one of the main things that makes massage pleasant.

Importantly, it’s also very cheap and safe to experiment with tennis ball massage (as long as you don’t get carried away pressing on vulnerable anatomy).


About Paul Ingraham

Headshot of Paul Ingraham, short hair, neat beard, suit jacket.

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.

Related Reading

Drawing of a thumb pressing downwards on a myofascial trigger point.

This article is excerpted from PainScience.com’s huge, advanced myofascial pain syndrome tutorial, which goes into vastly more detail: not just more about tennis ball and other tools for self-massage, but every other kind of treatment for trigger points you can imagine, how to troubleshoot every kind of treatment challenge: mistakes that beginners tend to make, how to deal with unusually stubborn trigger points, what to do for trigger points that are ‘stuck’ with adhesions and contractures, and explanations for why stretching sometimes works really well for trigger points and sometimes not at all, and much, much more. See:

Other (much shorter) relevant articles …

What’s new in this article?

OctoberAdded a little more and clearer information about the biology of tennis ball massage. This article is really supposed to KISS, but even here there should be a high quality basic summary of the science. Some organizational improvements. Added reading recommendations.

2016Significant upgrade: added a half dozen footnotes to the article (this one had none previously), mostly the chatty kind, mostly about foam rolling, massage safety and efficacy, and assorted bits of trigger point science.

2016Added suggestions about other kinds of balls that are suitable for self-massage. General editing. Modernization of information about trigger points.

2004Publication.

Notes

  1. Muscle knots — myofascial “trigger points” — are a factor in most of the world’s aches and pains. Their biology is still mostly mysterious: conventional wisdom says they are tiny spasms, but they might also be a more pure neurological problem. Regardless, they can cause strong pain that often spreads in confusing patterns, and they grow like weeds around other painful problems and injuries, making them quite interesting and tricky. Although they are well known to many specialists and researchers, most doctors and therapists know little about them, so misdiagnosis is epidemic. BACK TO TEXT
  2. Foam rolling in particular is often faddishly associated with fascial release. Sheets and wrappings of connective tissue called fascia are considered an exciting frontier in massage therapy. Supposedly fascia can get tight and needs to be “released.” However, key examples of research either fail to support fascial therapy or actually undermine it — for instance, fascia is too tough to actually change. Fascia enthusiasm seems to be a fad. (More about fascia.) Foam rolling is fine if you like the feeling, but the widespread idea that the point of it is manipulate fascia is nonsense. Trigger points aren’t exactly on solid scientific ground either, but in my opinion they are a far better reason for massaging. BACK TO TEXT
  3. Massage is safe, but nothing’s perfect. “Deep tissue” massage causes most of the trouble: sometimes it causes minor new injuries or aggravates old ones. Soreness and malaise are common, which is probably caused by mild muscle injury (not ‘detoxification’). It can especially traumatize people with chronic pain. Serious injuries are extremely rare. For more information, see Massage Therapy Side Effects: What could possibly go wrong with massage? The risks and side effects of massage therapy are usually mild, but “deep tissue” massage can cause trouble. BACK TO TEXT
  4. 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.)

    BACK TO TEXT
  5. Modern pain science shows that pain is an unpredictable sensation thoroughly tuned by the brain and not as closely related to tissue trouble as most people assume. So can we think pain away? Probably not, but we may be able to influence it. For more information, see Pain is Weird: Pain science reveals a volatile, misleading sensation that is often more than just a symptom, and sometimes worse than whatever started it. BACK TO TEXT
  6. As far as I know — and I’ve been studying this stuff for a long time now — massage for trigger points has never come anywhere close to being properly scientifically tested. Although there’s plenty of research that is mildly encouraging, it clearly falls well short of proof. All I’ve really got is my professional experience (hardly reliable) and speculation. Full disclosure! BACK TO TEXT