SaveYourself.ca helps you solve pain problems

published 10/07/07

Massage Therapy for Low Back Pain (Again)

Perfect Spot No. 13, The Most Classic Low Back Pain Trigger Point

by Paul Ingraham, Vancouver, Canada MORE

Credentials and qualifications

I am a writer and retired Registered Massage Therapist (unusually well-trained for a massage therapist, a 3000-hour program). I’m almost done with a Bachelor of Health Sciences degree. I am a peer reviewer for The Natural Standard, and a copyeditor for Science-Based Medicine. My most important qualification is more than a decade of workaholic post-graduate study, clinical experience, and constant conversations with readers from around the world, including many experts who have provided countless suggestions and criticisms.

For more information, see: Who Am I to Say? More information about my qualifications, credentials and professional experiences for my readers and customers.


Trigger points (muscle knots) are the world’s most common cause of aches and pains. The Perfect Spots series of articles teaches you how to self massage the most satisfying and therapeutically significant places on the human body to apply pressure. Each Perfect Spot article focuses on a specific location. 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!

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 that parallel the spine.

Important Note

This article is best for people with a minor low back pain problem. If you are having more serious or chronic back pain, please start with:
Save Yourself from Low Back Pain!

How do you find Perfect Spot No. 13?

Perfect Spot No. 13 is easy to find. Think of the “pit” of your low back. The bottom of the back. As far down as you can go, right next to the spine, without actually crossing over into the pelvis. It is the lowest possible spot next the spine that can still be called the back.

As you learned reading about Perfect Spot No. 12 (gluteus maximus), “low back pain” isn’t necessarily in the low back. It can range anywhere from the hips to lower thoracic vertebrae, or from the very center of the back right on the spine all the way out to the tips of the ribs.

Perfect Spot No. 13 is very close the geographic center of the range of low back pain: right in the very “bottom corner” of the low back, between the back dimples.

If you press on the meaty column of muscle found on either side of the spine — called the lumbar paraspinal muscles or the erector spinae muscle group — and follow it downwards, you will find that the last place where it feels thick and meaty is between the low back dimple and the spine. Go any lower and the muscle feels thinner as it peters out and starts to turn into tendon over the surface of the sacrum.

Perfect Spot No. 13 is usually right beside the dimple, in the lowest thick portion of the paraspinals. However, it may also be slightly higher, or slightly lower in the thinner tissue over the sacrum.

What does Perfect Spot No. 13 feel like?

Only in the most acute back pain does Perfect Spot No. 13 feel sharp. In the vast majority of people, this spot feels like a deep, deep, deep dull ache that closely resembles — or feels highly relevant too — any back pain or stiffness that you may have.

One of the reasons that I’ve nominated this trigger point to be a “perfect spot” is that, properly located and treated, it so reliably feels like scratching an itch — one of the best examples of that feeling to be found anywhere in the body.

Confusion with Perfect Spot No. 12

You may have noted that Perfect Spots 12 and 13 are extremely close to each other, one on each side of the “divide,” one in the low back, one in the gluteals.

Generally speaking, someone who craves relief from one of them will also crave relief from the other — the “butt-back connection.” However, one of them will also typically dominate, feeling more like the epicentre of pain and/or stiffness in the region. The only way to find out is to experiment and check both.

How do you treat Perfect Spot No. 13?

Start with thumbs — but this is deep muscle tissue, and often you (and your patient) are going to want to graduate to elbow. It’s an easy spot to press on with the elbow, and many people absolutely require a good portion of your body weight delivered in this way in order to get relief.

Sometimes pressure is best applied straight downwards onto the back muscles here. But for many people, the trigger point is better treated with a pressure that is direct partly downwards, and partly on an angle towards the spine. In some cases, you may even find that the best relief comes from attack the spot directly from the side, pressing horizontally into the very side of the muscle group, straight towards the spine.

The further you move around to the side, the more you generally have to navigate upwards (towards the head) a smidgen, which actually puts your point of contact above the low back dimple, as opposed to between the dimple and the spine. This is okay. Perfect Spot No. 13 is in there somewhere in that lowest section of lumbar paraspinal muscle, and you should feel free to experiment with many angles. Anything within a couple square inches down there counts as being Spot No. 13.


All The Perfect Spots for Trigger Point Massage

Choose your
perfect spot!

Or, for general information and advanced tips about trigger point therapy, see Save Yourself from Trigger Points!

and …


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Is trigger point therapy too good to be true?

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.”