EXCERPT This page is a simplified excerpt from a much more detailed tutorial about trigger points.
Muscle knots or “trigger points” are small patches of super-contracted muscle fibres that cause aching and stiffness. They can affect performance of the whole muscle, spread pain to adjacent areas, and even cause other trigger points. They seem to be a major and often unsuspected factor in common pain problems like low back pain and neck pain. And most minor ones are treatable — self-treatable.
You can often get even more relief from self-massage than you can get from a massage therapist. Professional help can be nice — probably essential now and then — but it can also be extremely cost-effective to learn to save yourself from trigger points. It is a safe, cheap, and reasonable approach to self-help for common pain.moreWhen choosing treatments, please be wary of Quackery Red Flags: treatments that may be dangerous, dubious, and distracting (costly or time-consuming). No pain treatment is perfect, but does it at least make sense? Is it safe? Cheap? Reasonably convenient?
Self-massage for trigger point massage mostly passes these tests, but it’s not perfect. There is controversy and scientific uncertainty about trigger points. The phenomenon of sensitive spots on the body is undeniable … but their nature remains somewhat puzzling, and the imagery of a “contracted spot” could just be wrong. See Trigger Point Doubts.
This article does not get into the science and the phenomenon of trigger points — it only introduces the basic principles of treating trigger points with self-massage. If you haven’t heard of trigger points before, you might want to look at my huge trigger point tutorial first.
Most trigger point pain can be relieved with a surprisingly small amount of simple self-massage with your own thumbs, or with some cheap tools. Although trigger points can certainly be weird and stubborn, most are simply painful spots in muscles that are usually fairly easy to find and get rid of with a just little rubbing.
Dr. Janet Travell wrote that “almost any [physical] intervention” can relieve a trigger point. And self-massage is usually the simplest, cheapest, and most effective intervention. How can so little be so effective? How can such a minor treatment work?
One possibility is that the sensitivity is an entirely neurological phenomenon, and virtually any “disturbance” changes the equation. A trigger point may not even be a muscle problem, technically speaking.
Or, if we consider trigger points to be “tight spots,” the vicious cycle taking place inside a lesser trigger point may not be especially difficult to disrupt. The knot may not be all that tightly contracted in the first place. The accumulation of metabolic wastes could be relatively small compared to a severe trigger point, and probably fairly easy to “squish” out with gentle pressure. The dysfunction is not usually particularly entrenched, and fairly likely to change in response to minor stimuli. Adhesions (the tissue getting stuck) are just not a factor in trigger points that haven’t been around for long.
Finally, isolated trigger points are generally much easier to manage — neurologically simpler. So if the problem is pretty well confined to an area, there’s a better chance of dealing with it.
For an easy case, literally just a few moments of gentle rubbing can be enough.quick case studyTrue story. One morning an office worker developed increasingly sharp stabbing pains in his lower back. Because the pains were sharp and pinchy, he thought they were kind of scary. He tried to stay calm and got up regularly to wiggle around and stretch, but the pains just kept coming back. He decided to try massage with a tennis ball. Although the pain didn’t seem particularly muscular, pressure on the low back muscles felt terrific — a deep, “sweet” ache. He massaged for just a couple of minutes, and didn’t expect results. And yet, to his amazement, the sharp pains had simply vanished, and they stayed gone: from alarming and rapidly worsening sharp pains to nothing at all in just a couple minutes. For slightly more difficult cases, a day or two of applying small but frequent doses of rubbing will usually do the trick. An “investment” of about a half dozen miniature treatments per day, each about 20–30 kneading strokes, can reduce the pain of the vast majority of trigger points.
Here are a bunch more specific tips …
Rub with what? Rub the trigger point with your fingertips, thumbs, fist, elbow … whatever feels easiest and most comfortable to you. Simple tools are really handy for spots that are harder to reach. And I don’t mean specialized massaging tools — just a tennis ball, or other handy household objects.
Rub in what way? For simplicity, either simply press on the trigger point directly and hold for a while (10–100 seconds), or apply small kneading strokes, either circular or back and forth, and don’t worry about the direction of the muscle fibres. Really, anything goes. But, if you happen to know the direction of the muscle fibres — sometimes it’s obvious — then stroke parallel to the fibres as though you are trying to elongate them, because it might be more effective.
Rub how hard? This matters much more. Because massage is a “conversation with your nervous system,” you want it to have the right tone. The intensity of the treatment should be Goldilocks just-right: strong enough to satisfy, but easy to live with. On a scale of 10 — where 1 is painless and 10 is intolerable — please aim for the 4–7 range, and err on the side of gentle at first.
What should it feel like? Pressure on a muscle knot should generally be clear and strong and satisfying; it should have a relieving, welcome quality. This is “good pain.” Massage is a conversation with your nervous system. So you want it to have the right tone. Friendly and helpful! Not shouty and rude.If you are wincing or gritting your teeth, you probably need to be more gentle. You need to be able to relax. See the next section for more information about how trigger point massage should feel.
What if it backfires? It probably won’t, especially if the pressure is reasonable. But if you experience any negative reaction in the hours after treatment, simply ease up. In basic therapy, you can always count on tissue adapting to stronger pressures over the course of a few days of regular treatment. If they don’t, either the problem isn’t really trigger points, or they are worse trigger points than you thought!
Rub where? For basic self-treatment, you can trust your instincts: rub where it hurts! Do explore for sensitive spots, but you can limit your exploration to a fairly small area of muscle tissue around the “epicentre” of your symptoms. So, for instance, if the top of your shoulder aches, search for trigger points mainly in the top of your shoulder. You will not necessarily be able to feel a bump or “knot” in your muscle, so don’t worry too much about that.
What if the trigger point is not where the pain is? As you learned earlier in the tutorial, trigger points may generate symptoms that aren’t where the trigger point is! What’s a beginner to do? Don’t worry about it too much. Remember, this is basic trigger point treatment. Bear in mind the possibility of confusing referred pain, but don’t worry about it unless basic therapy is failing.
Rub how much? Massage each suspected trigger point for about 30 seconds. This is actually enough for many trigger points — especially if you think that you have several that all need attention! Five minutes is roughly the maximum that any trigger point will need at one time, but there is not really any limit — if rubbing the trigger point continues to feel good, you should certainly feel free to keep going.
Rub how often? As long as you aren’t experiencing any negative reactions, you should massage a key trigger point at least once per day, and as often as a half dozen times per day.
The goal of self-massage for trigger points is to achieve a “release.” What is trigger point “release” and what does it feel like? How do you measure success?
Release is a vague term. It is more poetry than anything else: it has no specific scientific definition. It means “the trigger point goes away.” Maybe it refers to the literal relaxation of the tightly contracted sarcomeres that the trigger point may be made of.
Unfortunately, a release may not be obvious. In fact, perhaps the tissue even remains a bit “polluted” with waste metabolites even after a successful release. Release might actually involve (or even require) some damage to the tissue of the muscle knots — that is one theory. This means that the area could still be sensitive even if you’ve succeeded.
For beginners, don’t worry about the details: trust that you probably achieved a release, or a partial release, and then wait for the trigger point to calm down. Over the next several hours, if you were successful, you will notice a distinct reduction in symptoms — mission accomplished. (Often success is most obvious the next morning.)If you released a trigger point, you will notice a distinct reduction in symptoms over the next several hours — mission accomplished.
Good pain? With easy trigger points, successful release is typically associated with “good pain” — that clear, strong, and satisfying sensation that is somehow both painful and relieving. It is positive in the same sense that throwing up is positive: it’s not exactly pleasant, and yet your body “knows” that it needs and wants the pressure. Usually, if you feel “good pain,” a trigger point release is likely.
On the other hand, if you are wincing or gritting your teeth, you probably need to be more gentle. Ease and comfort is an important component of successful treatment. If you can’t massage the trigger point without wincing, either you’re being too brutal on yourself, or the trigger point is simply too severe. Sometimes a trigger point will feel nasty and hot and burning and still release anyway. But often such a rotten trigger point will need more persistent or advanced treatment.
I am a science writer, former massage therapist, and assistant editor of Science-Based Medicine. I have had my share of injuries and pain challenges as a runner and ultimate player. My wife and I live in downtown Vancouver, Canada. See my full bio and qualifications, or my blog, Writerly. You might run into me on Facebook and Google, but mostly Twitter.