What Are Trigger Points and How Can PT Help?

A trigger point is a taut band of skeletal muscle inside a muscle group. Trigger points are tender to the touch and can refer pain to distant parts of the body. You may have regional, persistent pain resulting in a decreased range of motion in the affected muscles.

Trigger point therapy is a soft-tissue treatment that helps release tense, painful knots in your muscles and fascia (web of connective tissue). Components of trigger point therapy may include sustained pressure, posture and movement correction, electrical stimulation, dry needling, and massage.

Hand massaging hamstring
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What Are Trigger Points?

Trigger points feel like little marbles or knots just under your skin. When pressing on trigger points, many people feel no pain or discomfort. Sometimes, trigger points become very sensitive, and some people feel significant pain in areas where they have trigger points.

Have you ever had a Charlie horse in a muscle? If so, then you know how this feels: the entire muscle goes into a painful spasm, and the only thing that seems to help is to gently elongate and stretch the muscle. Now, think of trigger points as tiny Charlie horses in your muscle. These pesky points don't cause that entire muscle to spasm, just a very small portion of it. But if you have enough trigger points, you may start to feel intense pain and experience limited muscle mobility.

Passive and Active Trigger Points

There are two types of trigger points: active and passive.

Passive trigger points simply hurt at their exact location. If you have a painful muscle knot in your hamstring and someone presses on it, the pain will be felt right where the pressure is on the knot.

An active trigger point refers to pain to another part of the body. If someone presses on an active trigger point in your shoulder, you may feel pain in your shoulder along with symptoms in your chest or arm.

Regardless of the type of trigger point you have, you may benefit from physical therapy to help manage your problem.

The Science of Trigger Points

Research indicates that no one really knows what the exact tissue is that makes you feel trigger points. It is also unknown why some people feel pain when touching muscle knots and some people do not.

Today's science cannot explain why some trigger points hurt and some trigger points are simply muscle knots. It is theorized that trigger points become so tense that the limit blood flow to muscle tissue.

This creates a metabolic crisis in the muscle tissue; there are pain and tightness which requires oxygen and nutrients to help heal, but those nutrients are unable to get to the muscle due to decreased circulation because of the tightness. The pain-decreased circulation-pain cycle begins, and this cycle can be difficult to interrupt.

Where Do People Get Trigger Points?

Trigger points and muscle knots can occur anywhere in your body. Wherever there is muscle tissue, there may be a small area of tissue tension. This could be a trigger point. Areas in the body where trigger points are more commonly found may include:

  • Your upper trapezius muscles on either side of your neck just above your shoulders
  • Your quadratus lumborum muscles of your low back
  • Your hamstrings
  • Your calf muscles
  • Along your iliotibial band

You can get trigger points anywhere in your body, and if they occur excessively, you may experience chronic pain and myofascial pain syndrome.

Myofascial Pain Syndrome and Trigger Points

Imagine having a small cut on your finger. One cut, one finger. It may hurt a bit, especially if something bumps the tiny cut or if you move your finger in just the right way. But the cut is nothing serious, and it is merely a temporary nuisance.

Now imagine your entire hand and all your fingers have tiny cuts on them. These cuts are so numerous that they hurt, and hurt badly. And since the cuts are so numerous, every motion (and some resting positions) causes pain. This is myofascial pain syndrome. You have so many tiny muscle and fascial trigger points that your body's muscles are constantly in a painful state.

Myofascial pain syndrome can be difficult to treat; the pain is so widespread that it can be difficult to know where to start treatment.

What Is Trigger Point Therapy?

Trigger point therapy is performed by a PT putting and holding pressure on your trigger points. This temporarily cuts off circulation to the tissue, which raises levels of a chemical in the tissues called nitric oxide. Nitric oxide signals your body to open up microcapillaries (extremely small blood vessels), thus increasing blood flow to help break up the trigger point and end the pain-spasm-pain cycle.

Another technique called myofascial release may also be helpful for your muscle knots and trigger points. Myofascial release is a type of massage thought to help properly align the fascia surrounding your muscles. This can help improve circulation and normal movement of your muscles.

Other treatments for trigger points include:

Treatment Goals

The goal of physical therapy for trigger points generally is not to eliminate your trigger points. Rather, you should focus on learning strategies to help manage painful trigger points. 

Physical therapy for can help you manage your pain and help determine the underlying body mechanics that may be making your muscle knots painful.

At Home Trigger Point Therapy

One of the best things you can do for your trigger points is to learn to self-manage your condition. This may include performing self-massage trigger point techniques. These may include:

  • Using a Back-Nobber to press into your trigger points
  • Rolling over a tennis ball to press into your trigger points
  • Foam rolling over your muscles to help smooth out fascial tissue

Research indicates that there is not one single best treatment for muscle knots. One thing is for certain-engaging in an active treatment program of postural correction and exercise is superior to passive treatments for trigger points.Check-in with your physical therapist for a complete evaluation of your condition to learn about self-care strategies to manage your trigger points.

A Word From Verywell

If you are dealing with painful muscle knots and trigger points, first, don't panic. Trigger points are benign and pose no significant danger to you or your health. They simply cause pain which may limit your normal mobility.

To manage your painful muscle knots, check-in with your healthcare provider to ensure that there is no underlying sinister cause of your pain. Ask about physical therapy to help treat your trigger points, and start engaging in an active treatment program to make a positive difference with your trigger points. By learning strategies to self-manage your pain, you can be in control of your condition.

Frequently Asked Questions

  • Are trigger points the same as muscle knots?

    Yes, trigger points are a taut band of skeletal muscle that feels like a marble under the skin. Trigger points are frequently referred to as knots.

  • Do trigger points hurt?

    Yes, but not always. Trigger points are typically very sensitive to the touch and can refer pain to other parts of the body. Having several trigger points can result in widespread aches and pains sometimes referred to as myofascial pain syndrome.

  • How does trigger point therapy work?

    Trigger point therapy involves applying direct pressure to trigger points. This temporarily cuts off circulation to the tissue causing a build-up of nitric oxide in the tissue. Nitric oxide signals microcapillaries to open, increasing blood flow to break up the muscle knot.

  • Does trigger point therapy hurt?

    Yes, trigger point therapy can be painful, but only while pressure is being applied to the tender area. The temporary pain of trigger point therapy can help to relieve ongoing pain and muscle spasms.

    You may not feel immediate relief from a session but should feel the improvement the day after. It may take several sessions to fully resolve a trigger point. After each session, be sure to drink lots of water to help flush waste material from your muscles.

5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Jafri MS. Mechanisms of myofascial pain. Int Sch Res Notices. 2014. doi:10.1155/2014/523924

  2. Celik D, Mutlu EK. Clinical implication of latent myofascial trigger point. Curr Pain Headache Rep. 2013;17(8):353. doi:10.1007/s11916-013-0353-8

  3. Desai MJ, Saini V, Saini S. Myofascial pain syndrome: a treatment review. Pain Ther. 2013;2(1):21-36. doi:10.1007/s40122-013-0006-y

  4.  Shah JP, Thaker N, Heimur J, Aredo JV, Sikdar S, Gerber L. Myofascial trigger points then and now: a historical and scientific perspective. PM R. 2015;7(7):746-761. doi:10.1016/j.pmrj.2015.01.024

  5. Bron, C., de Gast, A., Dommerholt, J. et al. Treatment of myofascial trigger points in patients with chronic shoulder pain: a randomized, controlled trialBMC Med 9, 8 (2011) doi:10.1186/1741-7015-9-8

Additional Reading
  • Oh, Sejun, et al. “Effect of Myofascial Trigger Point Therapy with an Inflatable Ball in Elderlies with Chronic Non-Specific Low Back Pain.” Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 1, June 2018, pp. 119–126., doi:10.3233/bmr-169696.

By Laura Inverarity, DO
 Laura Inverarity, PT, DO, is a current board-certified anesthesiologist and former physical therapist.