This is a list of all pages on PainScience.com about so-called “trigger points” — and there are quite a few of them! “Trigger points” is the most popular modern name for sensitive spots associated with aching and stiffness, which seem to be a cause, complication, and/or symptom of many other painful problems.
Long ago, in the early 2000s, this website was much more focused on massage and other hands-on therapy for painful problems. These days, the salamander site is becoming a more general website about the science of pain — but trigger points remains a major sub-topic. I have written one huge book about them, and many articles.
My writing about trigger points is weird: it is both skeptical and enthusiastic. I appreciate trigger point therapy, and I have extensive personal and professional experience with sore spots. But I also think that the trigger point therapy "industry" is a pseudoscientific dumpster fire. This balance is a striking contrast with most other writing on this topic, which is evangelical and promotional, and only examines the science is to fill in a few blanks (post hoc rationalization). I think that we still just flat-out do not understand what trigger points actually are or how to treat them effectively and consistently — and the point of studying the science is to try to understand, not just prop up pet theories.
That perspective just isn’t available anywhere else that I know of.
~ Paul Ingraham, PainScience publisher
The Big Three are a self-help primer, a huge book, and an in-depth critical analysis:
- Basic Self-Massage Tips for Myofascial Trigger Points — Learn how to massage your own trigger points (muscle knots) The primary primer: a short but highly polished summary of self-treatment of trigger points. This is the “cheat sheet” for patients.
- The Complete Guide to Trigger Points & Myofascial Pain. The e-book: an extremely comprehensive guide, a 210,000-word monster. Many sub-topics are covered only in the book (e.g. dry needling). This book is intended both for keen patients and healthcare professionals who really want to wrap their heads around the topic. It’s major claim to fame is that it seems to be the only book about trigger points in existence that both takes the idea seriously and also seriously criticizes it, prioritizing science over hype.
- Trigger Point Doubts. Do muscle knots “exist”? Explore the controversies about the existence and nature of so-called trigger points and myofascial pain syndrome. Skepticism about trigger points is absolutely justified, because the science is embarrassingly incomplete, and trigger point therapists routinely talk like they know ten times more about this than anyone possibly can. So what do we actually know? This is one of the dorkiest deep dives on the domain.
Other articles directly about trigger points, roughly in order of importance:
- Trigger Points on Trial — A summary of the public and academic debate about the legitimacy of the idea of trigger points. It summarizes and reviews a key 2014 paper, Quintner et al., and the reactions from other experts.
- The Trigger Point Identity Crisis — The biological evidence that a trigger point is a lesion in muscle tissue — Takes a “just the facts” approach to the biological evidence that a trigger point is a lesion in muscle.
- Review of The Trigger Point Therapy Workbook — A popular book that promises too much and ignores recent science and controversies, which alienates many physicians and sets patients up for disappointment.
- Micro Muscles and the Dance of the Sarcomeres — A mental picture of muscle knot physiology helps to explain four familiar features of muscle pain.
- Tennis Ball Massage for Myofascial Trigger Points — Some creative tips on using a tennis ball (and other tools) to self-massage myofascial trigger points.
- The Bath Trick for Trigger Point Release — A clever way of combining self-treatment techniques to self-treat your trigger points (muscle knots).
- Back Pain & Trigger Points — A quick introduction to the role of trigger points and massage therapy in back pain.
- Toxic Muscle Knots — Research suggests myofascial trigger points may be quagmires of irritating molecules.
- Hypermobility and Ehlers-Danlos syndrome — In patients with persistent and widespread muscle pain.
The “Perfect Spots” Series
The 14 Perfect Spots are trigger points that are common and yet fairly easy to self-treat with massage — the most satisfying amd useful places to apply pressure to muscle.
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||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 and thoracic vertebrae gives way to the relative instability of the lumbar spine. It 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, the erector spinae. (Click/tap heading to read more.)
|for pain: anywhere in the low back, tailbone, lower buttock, abdomen, groin, side of the hip||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||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||muscle(s): 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 more inevitable trigger points in the body: Perfect Spot No. 5. It is constantly provoked both by computer usage today, and more often by the use of a pen in simpler times — and by the occasional tennis match, then and now, or maybe crocheting. (Click/tap heading to read more.)
|for pain: in the elbow, arm, wrist, and hand||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||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)||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||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||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||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 often 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||muscle(s): erector spinae muscle group|
At the top of the buttocks lies a Perfect Spot for massage: a sneaky but trouble-making brute of a trigger point that commonly forms in the roots of the gluteus maximus muscle. It’s below the lowest part of the low back, but it often feels like low back pain. This is the kind of spot that the Perfect Spots series is all about: not only does it tend to produce a profound, sweet ache when massaged, but the extent of the pain that spreads out around it is almost always a surprise. It feels like a key to much more than expected. (Click/tap heading to read more.)
|for pain: in the lower back, buttocks, hip, hamstrings||muscle(s): gluteus maximus|
Some of the Perfect Spots are perfect because they are “surprising” — it’s delightful to find a place to massage that feels highly relevant your pain in an unexpected location. 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 example of a trigger point that is usually “right where I thought the problem was”: in the “pit” of the low back, at the bottom of the thick columns of back muscle beside the spine. (Click/tap heading to read more.)
|for pain: in the low back, buttocks, hamstrings||muscle(s): erector spinae muscle group at L5|
I avoided adding Spot 14 to this series for many years, because it’s a bit tricky to find. But precision is not required: although there is one specific spot that’s especially good, nearly anywhere 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, 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||muscle(s): infraspinatus, teres minor|