Understanding Muscle Trigger Points: A Patient Guide to Trigger Point Pain, Treatment, & Recovery
What is a Trigger Point (TrP)?
A trigger point, or myofascial trigger point, is simply a knot in a muscle or myofascial unit. Trigger points are quite common and are hyper-irritable spots within and between tight muscle(s) and supporting fascia. When pressed – or sometimes when at rest – trigger points can produce a local or referred pain (pain felt in another area of the body), tenderness, and restricted movement. There are two types of trigger points – latent, and active trigger points.
Latent Trigger Points
Latent trigger points do not produce a referral pattern. They only produce pain when pressed on. They can still limit range of motion and produce muscle weakness even without pain present.
Active Trigger Points
Active trigger points cause pain at rest or with movement. Additionally, there is a strong chance you have or may notice a dull ache, burning sensation, or deep pressure within the area of the trigger point with a referral pattern into another area. Active trigger points are known for their referral patterns. An active trigger point is an exaggerated and ticked-off form of a latent trigger point.
3-Step Progression to Knots and Pain
You can think about “knots” in a 3-step progression. First, there is simple tension in a muscle that produces no pain. This can often be thought of as ropey muscles. Tension in muscles can be a good thing. However, like all things, there is a healthy amount and an unhealthy amount. Second, the knot becomes a latent trigger point, which when unresolved, can then elevate into the third step – an active trigger point.
3-Level Complexity to Trigger Points
When treating trigger points, there is also a 3-level complexity to work through. There are local trigger points, regional trigger points, and global trigger points. Just like the 3-step progression of a knot, this 3-level complexity becomes more problematic the further it progresses from a local trigger point to a global trigger point.
Local Trigger Points
Local trigger points are the simplest to understand and treat. Local trigger points are typically latent trigger points that produce a local pain – local problem produces local pain.
Regional Trigger Points
Regional trigger points get a little bit stickier. A regional trigger point is typically an active trigger point that produces a referral pain. Regional triggers points are what we in the clinic treat the most. An easy example is a hip trigger point that produces a referral pattern into the knee; nothing is wrong with the knee. However, the hip needs to be treated to take the referral pain away in the knee.
Global Trigger Points
Global trigger points are the rarest and can be problematic to treat. Global trigger points are when several latent and/or active trigger points along a myofascial chain produce pain in one or multiple areas. When present, the primary trigger point may be significantly far away from the area of pain.
Common Locations for Trigger Points:
Neck, upper trapezius, shoulders, mid-back, lower back, glutes, calves, and jaw muscles — though trigger points can occur in virtually any skeletal muscle.
What Causes Trigger Points?
- Repetitive overuse (e.g., painting, gym)
- Sustained prolonged postures (e.g., desk job)
- Acute muscle overload (e.g., lifting heavy weights)
- Sudden Trauma (e.g., whiplash, falls, auto accidents)
- Poor sleep, chronic stress, or nutritional deficiencies
- Muscle deconditioning (e.g., not being active)
- Prolonged immobilization (e.g., post-surgery, postural bracing/splinting)
- Joint dysfunction(s) altering movement mechanics and muscular tension
Treatments That Work Best
Research supports a multimodal approach – combining many therapies into a single model. This is what ICT Muscle & Joint Clinic does! Often there is a need for various services including hands-on therapies in the office in addition to supporting exercises and stretches, which you can perform at home. Homework is just as important as in-office care. Research supports the idea that a multimodal approach achieves a faster, and longer-lasting result than any single treatment or intervention alone.
The Most Evidence-Based Options:
Ischemic Compression – A therapist applies sustained, gradually increasing pressure directly to the trigger point until the tissue releases. It is highly effective for immediate pain reduction and improved range of motion. This often produces intense pain at first, but then quickly subsides.
Dry Needling - A thin needle, used in acupuncture as well, is inserted into the trigger point. This produces a local twitch response that often feels like a quick shock of electricity. This shock-like sensation occurs quickly enough that people do not respond negatively to this symptom. There is strong evidence in support of dry needling for reducing pain and restoring muscle function.
Soft Tissue Mobilizations & Massage
Scraping Tool Techniques
- There are many “techniques” with the use of a rounded blade applied to the skin. At the core of them all the principles are the same. Apply pressure through a tool while moving it along an adhesion (aka knot).
Active Release Techniques (A.R.T.)
- This can be thought of as a specific massage targeting restrictions. A practitioner will shorten a muscle, apply pressure through their hand(s), and then stretch the tissue in a specific way to length the tension.
Therapeutic Exercises & Stretching
Targeted lengthening of restricted tissue(s) and progressive strengthening of the area(s) which are needed to support the painful area during the problematic task(s). This helps to address the underlying postural and biomechanical contributors – essential for preventing reoccurrences.
Electrical Stimulation (TENS / IFC)
Electrical Stimulation helps to reduce pain and inflammation while fatiguing trigger points. E-stim is often paired best with manual techniques rather than being used in isolation.
Shockwave Therapy
Shockwave Therapy uses burst sound waves to help reduce adhesions while restoring blood flow to the targeted area. This can be painful while performing, but the intensity is taken to the patient’s tolerance level of pain.
Postural & Ergonomic Correction
Identifying and modifying the activities, postures, or movements that perpetuate your trigger points (i.e., workstation, sleeping posture, lifting mechanics, running mechanics, etc.). This too is vital for long-term success.
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· Tip: Consistent daily self-care between clinic visits dramatically helps recovery! |
What to Expect During Recovery
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Timeline |
What You May Experience |
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First 24-hrs |
Potential for some post-treatment soreness is normal. Follow green light, yellow light, red light rules. |
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Weeks 1-2 |
Gradual reduction in resting pain with the position and/or movements that have been problematic. Some days throughout the week will feel better than others – which is normal. |
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Weeks 3-6 |
Significant pain relief and performance improvement with uncomplicated cases. Remember the 3-step progress and 3-level complexity. |
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Weeks 6-12 |
Long-standing or complex trigger points may require a longer-term program. At this point, visits are spread further apart with focus geared towards at-home maintenance exercises/stretches. |
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Ongoing Maintenance |
For various factors – sports performance, structural damage, and desires – some individuals may need periodic check-ins. |
Normal Treatment Recovery Expectations
- Temporary increase in local soreness – ideally 24-hours or less
- A “hurts so good” sensation during manual techniques
- Feeling of warmth, heaviness, or fatigue in the treated area for 1-2 days
- Potential for light bruising
There are many links within this blog, especially the services, that can better help explain further details.
