SaveYourself.ca • Sensible advice for aches, pains & injuries
published 3/20/05, updated 5/26/10
Trigger points (TrPs), or muscle knots, are the world’s most common cause of aches and pains, and yet they are rarely diagnosed correctly. Having too many stubborn trigger points is called “myofascial pain syndrome” (MPS). The Perfect Spots series of articles highlights trigger points that are unusually common and yet relatively easy to treat yourself — the most satisfying and therapeutically significant places to apply pressure on the human body. For a complete, advanced tutorial that walks you through every possible self-treatment option for muscle pain, see Save Yourself from Trigger Points & Myofascial Pain Syndrome!
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. Area No. 11 belongs in this series even though it is not, strictly speaking, a single spot.
Many people suffer from what I call “brick back” — that is, their upper back feels like a brick, specifically between the shoulder blades. It is dense, rigid, and sometimes seemingly impervious to pressure, as though the spine is held so tightly by the muscles that it has been fused.
This condition is the work of the erector spinae muscle group. The erector spinae are the thick columns of muscle on either side of your spine. They often feel ropy and hard, and are a natural target for massage. Trigger points in the erector spinae are numerous, like a string full of knots, and they can be loud complainers. Unlike many of the other Perfect Spots, which are unfamiliar, people are often well aware that they have knots in the upper back: their only question is, “How do I get rid of them?” Even people who do not have obviously painful trigger points in this area will usually find that massage here feels especially good.
There is no definite, satisfying explanation for why these muscles accumulate so many nasty active and latent trigger points. Along with the shoulders, lower back, and hips, they just seem to be a favourite spot for stress and anxiety to express itself.
Evolution doesn’t care if we’re comfortable, as long as we survive.The cause may also be structural. Most people think that the spine is a marvel of biological engineering, and so it is — but it is engineered by natural selection for quadrupeds, not bipeds. We have the same basic spinal anatomy as every other vertebrate on Earth, but we are the only ones using it in an upright position on a daily basis. Bipedality has advantages that are so valuable that we’ve evolved that way even though it may be painful. Evolution doesn’t care if we’re comfortable, as long as we survive.
And, of course, stress and evolution aside, the upper back and shoulders both often suffer from common activities such as sitting, slouching and computer work!
Finding this area is easy, because it’s big and the landmarks are obvious. Start by finding the spine. Now move just to one side of the spine. There is a groove here between the spine and the bulky column of the erector spinae.
You will find sensitive knots at the bottom of the groove, on the inner edges of the erector spinae, and on top of them. This is true for the entire back, but the most useful area ranges from the base of the neck to about two thirds of the way down between the shoulder blades.
Like any of the other Perfect Spots, you can find a knot and press on it until the tension eases. However, because there are so many knots in these muscles, a couple of other approaches produce even more satisfying results.
The first is called “stripping,” in which you lubricate the skin and slide slowly and strongly along the length of the groove, using a thumb, fingertips, the heel of your hand, knuckles, or even an elbow. The amount of pressure you use depends completely on the person you are massaging. Keep it manageable! This technique will treat many trigger points instead of just one: more bang for your buck.
The erector spinae are often quite ropy, and sometimes feel surprisingly like guitar strings.Another way of treating several trigger points at once is called “strumming” or “frictions.” The erector spinae are often quite ropy, and sometimes feel surprisingly like guitar strings. Especially when this is the case, you can create a delicious sensation of release by rubbing back and forth (side to side) across the fibres with your fingertips. This does not require lubrication, as the skin moves with the fingers.
For the best results from strumming, carefully feel around in the groove between the spine and the bulkiest column of the erector spinae for a single clearly identifiable “string” of muscle. You may need to press quite firmly to do so. You can use the same technique quite broadly and lightly across the entire group, but it doesn’t feel nearly as dramatic as deep strumming of individual strands.
Heavenly! In my experience, strumming in the very uppermost part of the back is one of the most vivid sensations in all of massage. However, this combines both a location and a specific technique — which doesn’t affect everyone the same way. At its best, though, the sensation is deeply penetrating and people often speak of feeling it “in my chest.”
Nowhere is the idea of “good pain” or a “sweet ache” more obvious than it is here. While many trigger point releases have a satisfying quality, these muscles produce the gold standard of good pain by which all other good pains are judged. Only excessive pressure on the most unhappy backs will feel sharp or burning. Most people will experience a deep, spreading, warming ache.
While many trigger point releases have a satisfying quality, these muscles are the gold standard by which all others are judged.These muscles also often produce extravagant referred sensations. A wide variety are possible. Most commonly, feelings of (good) pain or pressure will spread down and outwards. The shoulders often respond, as do the chest and throat. With several trigger points being released at once, some people sometimes report a widespread feeling of being pleasantly paralyzed throughout the entire torso! The sensation may be “breathtaking,” which can be alarming if it’s too strong, or wonderful if the pressure is tolerable.
Although the arch of the foot (Spot No. 10) may be the best single spot for massage in the body, it is just a mere spot, and far from the core. By contrast, the summed effect of all the trigger points in this area is so potent and useful that I always request treatment for it every time I see a massage therapist myself.
Trigger point therapy isn’t too good to be true: it’s just ordinary good. It can relieve some pain cheaply and safely in many cases. The existence of trigger points is not controversial. 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.
The Perfect Spots are based on a decade of my own clinical experience, and on the research and writing of Drs. Janet Travell and David Simons, pioneers of myofascial pain syndrome research. They produced “the Big Red Books” (a massive pair of texts).
Trigger points are clinically significant, but unfortunately obscure. As Dr. Simons wrote, “Muscle is an orphan organ. No medical speciality claims it.”
Want to know more? This is the tip of the iceberg. There’s a whole book …
Just ordinary good. Trigger point therapy isn’t a miracle cure, but it is a valuable life skill. Practically anyone can benefit at least a little, and many will experience significant relief from stubborn aches and pains. The first several sections are free.
Just ordinary good. Trigger point therapy isn’t a miracle cure, but it is a valuable life skill. Practically anyone can benefit at least a little, and many will experience significant relief from stubborn aches and pains. The first several sections are free.
Under the back of the skull must be the single most popular massage target 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 the 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, 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, and it covers the sides of the jaw just behind the cheeks. It’s also the muscle that makes you clench your jaw and grind your teeth, unfortunately, and it may be the single most common location for trigger points (muscle knots) in the entire human body. 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 impossible, but massage is an option: although often shockingly sensitive, Perfect Spot No. 8 is often a contributing factor or complication of 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 |
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! Read more.
| for pain: in the bottom of the foot | related to: plantar fasciitis | muscle(s): arch muscles |
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 |