Myofascial Trigger Points 101


By Mai Vu, Physical Therapist

Often, we hear people complain about pesky “knots” in their necks, shoulders, or backs. Not only can these knots be a nuisance, but they can also cause pain, limit range of motion, and have a negative impact on daily activities. A muscle “knot” is a commonly used lay term; health care professionals often refer to these knots as trigger points.

What is a trigger point?
Trigger points are nodules that can form within tight bands of muscle. They can also be located in tendons, ligaments, skin, joint capsules, and scar tissue. When pressed, they often produce local pain or referred pain (pain elsewhere in the body).

Why do trigger points form?
There are a number of aggravating factors such as muscle overload, stress, trauma, infections and other diseases, and unhealthy lifestyle choices.

Types of trigger points
Active – actively refers pain (locally or to another part of the body)
Latent – the trigger point is present, but does not actively cause pain; however, it may elicit pain when pressed
Key – activates other trigger points
Satellite – has been activated by a key trigger point

According to Travell and Simons’ Myofascial Pain and Dysfunction: The Trigger Point Manual:

  • Around 75% of pain clinic patients have a trigger point as the sole source of their pain
  • The following conditions are often diagnosed (incorrectly) when trigger points are the true cause of pain: carpal tunnel syndrome, bursitis, tendinitis, angina pectoris, sciatic symptoms, along with many other pain problems
  • Arthritis is often cited as the cause for pain even though pain is not always concomitant with arthritis. The real culprit may be a trigger point, normally activated by a certain activity involving the muscles used in the motion, by chronically poor posture, poor body mechanics, repetitive motion, structural deficiencies such as a lower limb length inequality or an asymmetrical pelvis, or nutritional deficiencies.

How are trigger points treated?
Treatments can include one or more of the following: massage/trigger point release, mechanical vibration, ultrasound, electric stimulation, stretching, muscle energy techniques (MET), proprioceptive neuromuscular facilitation (PNF), and either injections with a local anesthetic or “dry needling”. Eliminating the aggravating factor is also important in keeping trigger points at bay.


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