Sensible advice for aches, pains & injuries

Back Pain & Trigger Points

A quick introduction to the role of trigger points in back pain

updated (first published 2008)
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 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
Illustration of a man with back pain, presumably, slightly stooped over, with four signs sticking out of his back. The signs have green biohazard symbols on them, indicating the presence of toxic tissue or trigger points at those locations

Trigger points are probably a much greater factor in back pain than most doctors and therapists realize.

Low back pain is usually attributed to “structural” factors such as:

But these kinds of problems are amazingly minor factors in back pain (as they are everywhere else1). In fact, most acute and chronic back pain is probably caused by myofascial trigger points — the humble muscle knot.

Many health care professionals are under-informed on this topic, and underestimate the severity of muscle pain. But trigger point pain can be as nasty as any injury, and more persistent than most. It can be as painful as a muscle strain or a joint sprain, and more persistent.

Of course there are many possible causes of back pain,2 and some cases of back pain have nothing to do with trigger points — at least at first. But regardless of how back pain begins, trigger points routinely become a factor as time passes. They are a common complicating factor, cropping up as a reaction to other problems, and even persisting and causing pain to continue long after the original problem has resolved — out of the frying pan, into the trigger point fire.

What’s a muscle knot?

The science is half baked and controversial,3 but the best evidence available so far suggests that trigger points are tiny spasms: a patch of clenched, exhausted, and highly irritable muscle tissue.

Of all possible causes of back pain, trigger points are also relatively treatable. Although lacking any proven treatment method, trigger points often seem to yield to heating, massage, and light exercise like mobilizations, stretching, and endurance training… all of which makes them an ideal target for safe, cheap “presumptive treatment.”

Treat yourself as if you have trigger points, and you might well relieve some or all of the pain. If you fail, at least you won’t hurt yourself or your wallet trying.

The “special” relationship between trigger points and back pain

Trigger points tend to grow in certain anatomical regions better than others. The muscles of the low back and hips are probably the most fertile ground in the body for this phenomenon (competing with the upper shoulders for first place). There are many theories about why this might be the case: it may be related to posture and a sedentary lifestyle, or psychological factors like being unusually nervous about back pain, or variations in muscle metabolism in different areas.

Whatever the reason, the result is that there are a few “perfect spots” in and near the low back — classic trigger point locations, often very relieving to massage, and helpful for back pain:

Further reading

This website features two advanced tutorials on both back pain and trigger points. This page is just a tiny primer focussing on the relationship These are both extremely detailed:

There are also dozens of useful shorter articles, on a wide variety of issues relates to back pain, muscle, and trigger points:

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 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.


  1. “Structuralism” is the excessive focus on causes of pain like crookedness and biomechanical problems. It’s an old and inadequate view of how pain works, but it persists because it offers comforting, marketable simplicity that is the mainstay of entire styles of therapy. For more information, see Your Back Is Not Out of Alignment: Debunking the obsession with alignment, posture, and other biomechanical bogeymen as major causes of pain. BACK TO TEXT
  2. PS Ingraham. When to Worry About Low Back Pain: And when not to! What’s bark and what’s bite? 4095 words. BACK TO TEXT
  3. PS Ingraham. Trigger Point Doubts: A thorough review of the problems with the science of “muscle knots” and myofascial pain syndrome. 11016 words. BACK TO TEXT