Trigger points (TrPs), or muscle knots, are a common cause of stubborn and strange aches and pains, and yet they are under-diagnosed. The 13 Perfect Spots are trigger points that are common and yet fairly easy to massage yourself — the most satisfying and useful places to apply pressure to muscle. For tough cases, see the advanced treatment guide.
If you have — or think you may have — plantar fasciitis, you may prefer to start with this article instead: Save Yourself from Plantar Fasciitis!
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!
It isn't difficult to understand why the arch muscles of the foot would harbour a Perfect Spot for massage. They are, after all, the hardest working muscles in the human body. Our feet absorb an incredible amount of punishment, yet usually feel no worse than just stiff and tired. Injury here is common, but not nearly as common as you might expect.
The arch of the foot is a fascinating structure. The arch is like a bow without an arrow, and its curved shape is created by a “string” of muscles and elastic connective tissues. Every time you take a step, your weight pushes down on the arch. It doesn’t collapse because of an artful combination of bone shape, springy ligaments, long “stirrupt” tendons from leg muscles … and the arch muscles. The arch muscles of the foot itself don’t actually “kick in” until you reach quite heavy loads: about 400 pounds.1 Although that sounds like quite a lot, loading may spike that high in an average person with every step. We don’t have muscles there for nothing, of course! (The biggest arch supporter is probably the tibialis posterior, deep in the calf.2 And the tibialis anterior is another one — and it also has a perfect spot for massage, no. 3). Still, the forces on all of these structures are relentless and often very large — no wonder they get exhausted!
When these support mechanisms fail, the connective tissue in the arch may start to degenerate and fray — a kind of tendonits called plantar fasciitis. However, many people just develop really significant muscle knots in the arch, and in other arch supporting muscles.
There is another reason why this spot is significant. The skin of the feet has a disproportionate number of nerve endings, like the face and the hands, yet the feet are generally abused or at least neglected. Therefore the sensations of foot massage seem particularly rich and diverse in contrast to the usual stomp, stomp, stomp of their daily stimulus.
Not only is this probably the most perfect of all Perfect Spots, but it is also perfectly easy to find: it is exactly in the center of the bottom of the foot, halfway between the heel and the ball, and halfway between the inside and outside edges (perhaps slightly closer to the inside).
The arch muscles generally feel best when pressed on an angle, for example towards the outside of the foot. But this is a minor point: any angle will do!
You will know it when you feel it! Having massaged thousands of people and thousands of feet, I can tell you without hesitation that the center of the arch muscles is a popular, “feel good” spot. It usually produces a clear, sweet ache with mild to moderate thumb pressure only.
Note that despite its popularity, Perfect Spot No. 10 usually does not cause any referred sensation — that’s the satisfying, spreading ache that is often associated with other significant trigger points. Don't take the lack of referred sensation to mean that what you're doing isn't working!
All massage feels better when someone else does it, but this is especially true of foot massage. Although it is easy to massage your own foot (and highly recommended if you have no other choice), receiving a foot massage is one of life’s truly delicious experiences, the apple pie à la mode of touch.
Some believe that there is yet another reason why foot massage feels so good: there may be neurological and/or energetic connections between each part of the sole of the foot and every other region and system of the body. This is called reflexology. Reflexologists claim that foot massage can have a therapeutic effect on any part of the human body.
This claim is extraordinary, and “extraordinary claims require extraordinary evidence” (Carl Sagan, Broca’s Brain, 1972). I have certainly never seen nor heard of such evidence, although (to quote another old chestnut of skepticism) “absence of evidence is not evidence of absence.” The phenomenon may exist, whether there is clear evidence for it or not. However, it is most likely that the profound sensations of foot massage simply gave someone the idea that foot massage was unusually important.
I have no trouble with the general idea of therapeutically significant connections between body parts, or even with the particular idea that massaging the foot could affect organs and systems. That is plausible.
I doubt, however, that the average colourful reflexology “map” is 100% accurate — at least, not compared to the average textbook anatomy diagram. If the connections exist at all, they are probably subtle, and there is probably significant natural variation between individuals. Only a study of a large number of carefully compared observations by several extremely skilled and knowledgeable practitioners could hope to confirm that stimulating a certain tiny spot on the foot has a therapeutic effect on a certain organ — and even then it wouldn’t necessarily be true of every person.
My own personal experience with reflexology is that it feels as good as any other foot massage, but no better, and has no apparent additional therapeutic effect. Still, a foot massage is always a pleasant experience in and of itself.
Trigger point therapy isn’t too good to be true: it’s just ordinary good. It can probably relieve some pain cheaply and safely in many cases. Good bang for buck, and little risk. In the world of pain treatments, that’s a good mix.
But pain is difficult and complex, no treatment is perfect, and there is legitimate controversy about the science of trigger points. The phenomenon of sensitive spots on the body is undeniable … but their nature remains somewhat puzzling, and the classic image of a tightly “contracted patch” of muscle could just be wrong. On the one hand, you can measure their electrical activity, take samples of their highly acidic tissue chemistry, and now a new MRI-like technology can now show them as well. On the other hand, some of that may be wrong, and all of it could essentially just be “side effects” of a more basic problem. No one really knows.
What we do know is that people hurt. Muscle pain is clinically significant, but medically obscure. As Dr. David Simons wrote, “Muscle is an orphan organ. No medical speciality claims it.” Many patients can benefit from educating themselves.
The Perfect Spots are based on a decade of my own clinical experience as a massage therapist, and years of extensive science journalism on the topic. Want to know more? This is the tip of the iceberg. I’ve written a whole book about it …
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. 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||related to: headache, neck pain, migraine||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 gives way to the relative instability of the lumbar spine. Muscle tends to bunch up around this joint between the last of the thoracic vertebrae and the first of the lumbar. The sweet spot 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. Read more.
|for pain: anywhere in the low back, tailbone, lower buttock, abdomen, groin, side of the hip||related to: low back pain, herniated disc||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. Read more.
|for pain: in the shin, top of the foot, and the big toe||related to: shin splints, drop foot, anterior compartment syndrome, medial tibial stress syndrome||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. 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||related to: thoracic outlet syndrome, lump in the throat, hoarseness, TMJ syndrome||muscle(s): the 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 most inevitable myofascial TrPs in modern civilization: Perfect Spot No. 5. It is constantly and greatly aggravated both by computer usage today and by the use of a pen in simpler times — and by the occasional tennis match, then and now. Read more.
|for pain: in the elbow, arm, wrist, and hand||related to: carpal tunnel syndrome, tennis elbow (lateral epicondylitis), golfer’s elbow (medial epicondylitis), thoracic outlet syndrome, and several more||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. Read more.
|for pain: in the low back, hip, buttocks (especially immediately under the buttocks), side of the thigh, hamstrings||related to: sciatica, trochanteric bursitis, low back pain||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 entire human body. It is probably an accomplice in most cases of bruxism (that’s latin for “grinding your teeth”) and temporomandibular joint syndrome (a painful condition of the jaw joint), plus other unexplained painful problems in the area. Read more.
|for pain: in the side of the face, jaw, teeth (rarely)||related to: bruxism, headache, jaw clenching, TMJ syndrome, toothache, tinnitus||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’s also often complicates or contributes to other problems in the area, especially runner’s knee (iliotibial band syndrome). Read more.
|for pain: in the lower half of the thigh, knee||related to: iliotibial band syndrome, patellofemoral pain syndrome||muscle(s): quadriceps (vastus lateralis, vastus lateralis, vastus medialis, rectus femoris)|
The “pecs” are popular muscles. Of the 700+ muscles in the human body, the pectoralis major is one of the dozen or so that most people can name and point to. It also harbours one of the most commonly-encountered and significant — yet little known — trigger points in the human body, and can produce pain much like a heart attack in both quality and intensity. Read more.
|for pain: anywhere in the chest, upper arm||related to: “heart attack,” respiratory dysfunction||muscle(s): pectoralis major|
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 routinely 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. Read more.
|for pain: anywhere in the upper back, mainly between the shoulder blades||related to: scoliosis||muscle(s): erector spinae muscle group|
At the top of the gluteal muscles lies a Perfect Spot among Perfect Spots: a sneaky but trouble-making brute of a TrP that commonly forms in the roots of the gluteus maximus muscle, just below the pit of the low back, but experienced as low back pain. This is the kind of spot that the Perfect Spots concept is really all about — not only does it tend to produce a profound and sweet ache when massaged, but the extent of the pain that spreads out around it is almost always a surprise. Read more.
|for pain: in the lower back, buttocks, hip, hamstrings||related to: low back pain, sciatica, sacroiliac joint dysfunction||muscle(s): gluteus maximus|
Some of the Perfect Spots are perfect because they are “surprising” — they aren’t where you thought they’d be, and it’s delightful to discover the real source of pain. 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 “right where I thought it was” trigger point: right at the very bottom of the thick columns of muscle, in the “pit” of the low back. Read more.
|for pain: in the low back, buttocks, hamstrings||related to: low back pain, sciatica, sacroiliac joint dysfunction||muscle(s): erector spinae muscle group at L5|