Trigger points in muscle tissue are a real but poorly understood phenomenon, and it is hard to predict how they will respond to different stresses and therapies. Sometimes they seem to defy all logic.

published 04/25/09, updated 9/15/09

Three Muscle Knots That Broke The Rules

Three examples of myofascial trigger points that responded to therapeutic methods that don’t normally work

by Paul Ingraham, Vancouver, Canada MORE
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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.

I try to emphasize to my clients and readers that no one knows exactly what makes myofascial trigger points (muscle knots) go away. There is no proven therapy. We don’t understand why muscle forms trigger points in the first place, so we can hardly have a reliable science-based treatment for them. The best we can do is experiment with therapeutic approaches, starting with the safest and cheapest things that often seem to help.

For instance, a heating pad rarely works any miracles on painful muscle tension — but the majority of people report that heat helps, it’s cheap, and I’ve never heard of a negative experience with heating aching muscles. Therefore, odds favour heat as a worthwhile self-treatment approach.

But sometimes trigger points break the rules!

Here are three examples that highlight just how surprising muscle knot behaviour can be. In each case, trigger points seemed to respond to a therapeutic approach that I would not normally expect to work (if not the opposite). In each example, I had good confidence that trigger points were the origin of the problem, and that there were no obvious confusing factors.

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1. Hard running helps a gluteal trigger point

Generally speaking, over-exertion seems to be a risk factor for trigger points — it’s more likely to make it worse. I have countless stories of workouts gone bad. In this recent case, a patient with severe gluteal pain, unable to talk without a limp, did not respond to basic trigger point therapy. Frustrated, he decided to “push through” the pain, running hard. The pain was almost unbearable for the first few minutes, but then over the space of only a few more minutes it eased, completely disappeared, and did not return. Why did this trigger point “like” the muscle being used aggressively? I don’t know, but clearly it did.

1. Brutally intense neck stretching eases a muscle knot

Strong stretching is a well-known risk factor for trigger points — in fact, many people get their first experience of severe trigger point pain from over-stretching in a yoga class, or from resting with a muscle in an uncomfortably elongated position. The effect of stretching on muscle pain is known to be unpredictable, but this was an exceptional case: a client with severe chronic neck pain, on her own initiative, stretched her neck as hard as she could. She described it as “brutal — I pulled as hard as I could. I was almost crying it was so painful. But I had nothing to lose.” Somewhat miraculously, her pain eased and never returned. Please don’t try this! The chances of a good result are significantly out-weighed by the risks.

1. Beating on an arm trigger point solves an old tennis elbow problem

Some time ago, a workaholic desk jockey with severe chronic arm and wrist pain craved strong pressure in a massage treatment. He kept encouraging me to press harder: “It just feels like I want you to beat the hell out of it!” We had already tried and failed to have much effect on the situation with a progression of increasingly strong pressures in past appointments, so I decided it was safe to indulge him. We talked about the risks — I might actually injure him — and he was fine with it. So I gave him what must be the strongest treatment I’ve ever given anyone: massive, grinding elbow pressure in the forearm musculature, pretty much all my weight and all my leverage. He got better instantly. He was grinning ear-to-ear by the end of the appointment, and has never had any significant arm pain again since then.

Each of these cases involved a “therapy” that was risky and could have made things much worse — in each case, the trigger point responded beautifully. It’s unlikely that anything else was wrong, because most other problems are even less likely to respond positively to these treatments.