What Are Trigger Points and How Can PT Help?

Painful shoulder conditions may need physical therapy to help return to normal.
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A trigger point describes a taut band of skeletal muscle located within a larger muscle group. Trigger points are tender to the touch and can refer pain to distant parts of the body. Patients may have regional, persistent pain resulting in a decreased range of motion in the affected muscles. Massage, spray and stretch, and injections are a few techniques to decrease trigger point pain.

What Are Trigger Points?

Trigger points feel like little marbles or knots just under your skin. When pressing on trigger points, many people feel no pain or discomfort. Sometimes, trigger points become very sensitive, and some people feel significant pain in areas where they have trigger points.

Have you ever had a Charlie horse in a muscle? If so, then you know how this feels: the entire muscle goes into a painful spasm, and the only thing that seems to help is to gently elongate and stretch the muscle. Now, think of trigger points as tiny Charlie horses in your muscle. These pesky points don't cause that entire muscle to spasm, just a very small portion of it. But if you have enough trigger points, you may start to feel intense pain and experience limited muscle mobility.

Where Do People Get Trigger Points?

Trigger points and muscle knots can occur anywhere in your body. Wherever there is muscle tissue, there may be a small area of tissue tension. This could be a trigger point. Areas in the body where trigger points are more commonly found may include:

  • Your upper trapezius muscles on either side of your neck just above your shoulders
  • Your quadratus lumborum muscles of your low back
  • Your hamstrings
  • Your calf muscles
  • Along your iliotibial band

You can get trigger points anywhere in your body, and if they occur excessively, you may experience chronic pain and myofascial pain syndrome.

Myofascial Pain Syndrome and Trigger Points

Imaging having a small cut on your finger. One cut, one finger. It may hurt a bit, especially if something bumps the tiny cut or if you move your finger in just the right way. But the cut is nothing serious, and it is merely a temporary nuisance.

Now imagine your entire hand and all your fingers have tiny cuts on them. These cuts are so numerous that they hurt, and hurt badly. And since the cuts are so numerous, every motion (and some resting positions) causes pain. This is myofascial pain syndrome. You have so many tiny muscle and fascial trigger points that your body's muscles are constantly in a painful state.

Myofascial pain syndrome can be difficult to treat; the pain is so widespread and so mysterious that it can be difficult to know where to start treatment.

Does Science Support Trigger Points and Trigger Point Therapy?

Research indicates that no one really knows what the exact tissue is that makes you feel trigger points. It is also unknown why some people feel pain when touching muscle knots and some people do not.

Today's science cannot explain why some trigger points hurt and some trigger points are simply muscle knots. It is theorized that trigger points, the tight bands of muscle and fascia tissue, become so tense that the limit blood flow to muscle tissue. This creates a metabolic crisis in the muscle tissue; there is pain and tightness which requires oxygen and nutrients to help heal, but those nutrients are unable to get to the muscle due to decreased circulation because of the tightness. The pain-decreased circulation-pain cycle begins, and this cycle can be difficult to interrupt.

Active and Passive Trigger Points

There are two types of trigger points that physical therapists treat: active and passive trigger points. Passive trigger points simply hurt at their exact location. If you have a painful muscle knot in your hamstring and someone presses on it, the pain will be felt right where the pressure is on the knot.

An active trigger point refers pain to another part of the body. If someone presses on an active trigger point in your shoulder, you may feel pain in your shoulder along with symptoms in your chest or arm.

Regardless of the type of trigger point you have or the fact that we do not fully understand what is happening when trigger points form, you may benefit from physical therapy to help manage your problem.

How Can Physical Therapy Help?

If you seek out care from a physical therapist for trigger point therapy, do not go with the goal of eliminating your trigger points. Rather, focus on learning strategies to help manage painful trigger points. Physical therapy for muscle knots can help you manage your pain and help determine the underlying body mechanics that may be making your muscle knots painful.

There are many different physical therapy treatments for trigger points. These may include:

Myofascial release techniques and trigger point therapy may be helpful for your muscle knots and trigger points. Myofascial release is thought to help properly align the fascia surrounding your muscles. This can help improve circulation and normal movement of your muscles.

Trigger point therapy is performed by having your PT press and hold on top of the trigger points in your muscles. This temporarily cuts off circulation to the tissue. This cutting off of circulation increases a chemical called nitric oxide in the tissue. Nitric oxide signals your body to open up microcapillaries, thus bringing in more blood flow and breaking the pain-spasm-pain cycle.

At Home Trigger Point Therapy

One of the best things you can do for your trigger points is to learn to self-manage your condition. This may include performing self-massage trigger point techniques. These may include:

  • Using a Back-Nobber to press into your trigger points
  • Rolling over a tennis ball to press into your trigger points
  • Foam rolling over your muscles to help smooth out fascial tissue

Research indicates that there is not one single best treatment for muscle knots. One thing is for certain-engaging in an active treatment program of postural correction and exercise is superior to passive treatments for trigger points. Check in with your physical therapist for a complete evaluation of your condition to learn about self-care strategies to manage your trigger points.

A Word From Verywell

If you are dealing with painful muscle knots and trigger points, first, don't panic. Trigger points are benign and pose no significant danger to you or your health. They simply cause pain which may limit your normal mobility.

To manage your painful muscle knots, check in with your doctor to ensure that there is no underlying sinister cause of your pain. Ask about physical therapy to help treat your trigger points, and start engaging in an active treatment program to make a positive difference with your trigger points. By learning strategies to self-manage your pain, you can be in control of your condition.

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Article Sources
  • Oh, Sejun, et al. “Effect of Myofascial Trigger Point Therapy with an Inflatable Ball in Elderlies with Chronic Non-Specific Low Back Pain.” Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 1, June 2018, pp. 119–126., doi:10.3233/bmr-169696.