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.
Your masseter muscle is your primary chewing muscle — not the only one,1 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.2 It is an accomplice in many cases of bruxism (that’s Latin for “grinding your teeth”) and temporomandibular joint syndrome (a painful condition of the jaw joint), and probably other unexplained painful problems in the area — it will be either a contributing factor or a complication.
Not only does the masseter muscle probably harbour the most common trigger points in the human body, the masseter is also the strongest muscle in the human body (pound for pound), although many variables make this difficult to be sure of.4 Together with the temporalis muscle and a few other smaller muscles, most people can generate at least 150 pounds of force (lbf) between their teeth. For contrast, the world record for human bite strength is 975 lbf. 975!5 More than six times normal. A human shark!
Muscles might all seem similar, but it’s amazing how specialized they can be. The masseter gets extraordinary strength from a “multipennate” arrangement of fibres that’s like a complex feather — fibres converging diagonally on several internal tendons.6 This feathered arrangement favours torque over speed, making the masseter a very “low gear” muscle, slow but powerful and efficient, lots of chewing bang for your masseter buck. The physics details are a bit mind-bendy.7
It’s easy enough to imagine why this muscle might enjoy the occasional massage. Whose jaw isn’t a bit tense? But the masseter’s potential to wreak havoc — and its need for therapy — is often underestimated by everyone, both patients and professionals. (Although I’m pleased to see a surprisingly strong interest in the subject amongst dental specialists.) When irritated, masseter muscle knots can cause and/or aggravate several problems:
Headaches, of course — this makes strong intuitive sense to most people. There seems to be a pretty strong connection between tension headaches and jaw clenching. This is partly due to the temporalis muscle, which is reflexively massaged by everyone with a headache. But the masseter is often neglected, even though it is by far the more powerful jaw muscle. They really both need some attention — massaging above and below the cheekbone. I actually considered defining Spot No. 7 as the temple and the masseter.8
Earaches and toothaches — which are much less obvious. A masseter trigger point can radiate pain directly into a tooth. Travell and Simons quip, “This can lead to disastrous results for an innocent tooth.”9 I once suffered a dramatic case of a “toothache” that was completely relieved by a massage therapist the day before an emergency appointment with the dentist: a particularly vivid experience, which originally got me interested in trigger points.
Tinnitus (ringing in the ears) and dizziness. Both can be serious and complex problems, and are definitely not necessarily caused by masseter trigger points. There are many other potential contributing factors and causes of these conditions — but the masseter is one of the possible causes that should be considered.10
Bruxism, or grinding and cracking of molars.
Temporomandibular joint syndrome, which is a slow, painful failure of jaw joint function.
As you can see, masseter problems are not to be taken lightly.
Fortunately, it’s easy — really easy — to massage and soothe your own masseter muscle, which is what makes it such a particularly perfect Perfect Spot. It has both great needs and it’s unusually easy and satisfying to self-massage.
The masseter muscle “hangs” from the underside of the cheekbone on the side of the face. The bottom of the muscle attaches to a broad area on the side of the jawbone.
Perfect Spot No. 7 is conveniently located in a notch in the cheekbone, about one inch in front of your ears. The notch is on the underside of the cheekbone, it’s easy to find, and your thumb or fingertip will fit into it nicely, unless you have freakishly large hands. If you press firmly inward and upwards with your thumb in the cheekbone notch, you will usually be rewarded with a sweet ache.
The rest of the masseter muscle, however, tends to feel like not much, or unpleasantly tender. Although the entire muscle can be rubbed gently, most people will find that the Perfect Spot is definitely limited to the upper edge of the muscle.
Spot 7 is a sturdy piece of anatomy, so don’t be afraid to work steadily up to hard pressure — if that’s what you feel like you want. Either constant pressure or small, kneading circles are both appropriate. Since this spot is so tough, another good trick is to use a knuckle for extra pressure. A useful tool in this location is Pressure Positive’s Knobble productshow — it’s easy to lie down on your side and let the weight of your head apply a steady, firm pressure, with the tip fitting nicely into the cheekbone notch.
Does anyone go to the dentist anymore and not get a prescription for a mouth guard? Judging by the inevitable prescriptions, apparently everyone has some kind of jaw-clenching problem. I do not know if this is actually the case, and sometimes I feel suspicious that the problem is greatly over-diagnosed (because selling mouth appliances is probably profitable). Then again, many people (including my wife) have actual cracks in their molars from clenching so hard — and it’s kind of hard to argue that there isn’t a problem there!
This article is mostly about massaging Perfect Spot 7 in the masseter, but it’s obviously potentially extremely helpful for temporomandibular joint syndrome, bruxism, clenching, and grinding if you can also figure out how to relax your jaw. But this is not easy. A nice massage (or any other relaxing experience) is a helpful start, but it doesn’t do much for long.11 And simply willing yourself to stop clenching seems almost completely ineffective. Simply willing yourself to stop clenching seems to be almost completely ineffective I’ve known many people who have tried to get serious about reminding themselves to stop clenching, using egg timers and so on … with rather underwhelming results.
So what can you do? How can you possibly learn to clench less? Here are two ideas that I think work better than simply “trying hard” not to clench:
The Fake Drunk — Slur your speech as though you are so sleepy that you can hardly form words. You know that lovely feeling when you’re waking up slowly, in no hurry, and you’re conscious yet not even remotely ready to move or speak yet? That floaty, delicious feeling of happy paralysis? Of complete contentment to just lie there? Don’t just visualize that feeling, actually act like you feel that way, in your mouth. To get into the spirit of the thing, speak the words, “I’m so relaxed I can hardly talk,” and slur your words. Literally slur them. Slur them like your mouth is so relaxed you are having trouble making words! You will find that this is quick and effortless way to relax your jaw. It won’t necessarily last, but it is a most helpful way to quickly get back to the state you want.
I use this technique even when there are people around. I find that I can easily just mouth the words “I can hardly talk,” making no noise, and immediately access the sensory experience of jaw relaxation, with no one around me having a clue about what I’m up to.
The Long Surprise: Spend long periods of time with your jaw wide open. Hold your mouth open at least wide enough to fit a finger between your teeth for one full hour. Not just open, but open wide — as though you are really just shocked by something, continuously, for an hour. Every time during the hour that you catch yourself with your teeth together, simply calmly stretch your mouth open again. After an hour of this, clenching starts to feel abnormal, and you will find it much easier to keep your jaw relaxed for some time afterwards.
You may also find it helpful to actually prop your mouth open with something durable and spit-proof, such as a Lego block, or a small rubber ball. Most people will salivate too much to keep this up for an entire long session, but it can be a useful way to help you focus on the challenge for a few minutes at a time. Some people may find it practical for longer.
This intensive approach is generally a much more effective method of breaking the clenching habit than scattered self-reminders to “stop clenching,” which just never really take. If you are really determined, spend an hour a day holding your face like someone just stuck a needle in your keister. If you put in the time, you really can’t fail. I estimate that most people need 5–10 hours of practice in a week to put a good dent in a clenching habit. Of course, life is likely to regenerate the problem back sooner or later … but you will know what to do when that happens.
Good luck, and have fun with it.
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.
In 2007, these researchers found that “in 56% of patients with tinnitus and MTPs, the tinnitus could be modulated by applying digital compression of such points, mainly those of the masseter muscle.” And how many people with tinnitus had trigger points? Quite a few. The researchers found “a strong correlation between tinnitus and the presence of MTPs in head, neck and shoulder girdle.”BACK TO TEXT
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 (this page!)
|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 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|
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|
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|
I avoided adding Spot 14 to this series for many years, because it’s a little tricky to find. But precision is not required: although there is one specific spot that’s especially good, nearly anywhere just under the ridge of bone on the shoulder blade is worthwhile, and often a surprising key to pain and stiffness everywhere else in the shoulder… but especially all the way around on the other side, facing forward. Read more
|for pain: any part of the shoulder, and upper arm||related to: frozen shoulder, supraspinatus tendinitis||muscle(s): infraspinatus, teres minor|