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What Is Trigger Point Therapy (And Why Does It Hurt So Good)?
You know that spot in your shoulder that always feels like it has a knot? The one that makes you wince when someone presses on it but also makes you say "right there, don't stop"? That's a trigger point, and trigger point therapy is designed to release it.
If you've been dealing with persistent muscle tension, referral pain, or areas that feel tight no matter how much you stretch, trigger points are likely part of the problem. Understanding what they are and how trigger point therapy works can help you get more out of your massage sessions and finally find relief from stubborn muscle pain.
What Exactly Is a Trigger Point?
A trigger point is a hyperirritable spot in a taut band of muscle tissue. Think of it as a small area of muscle that's stuck in a contracted state, creating a knot or nodule you can often feel under the skin.
Trigger points form when muscle fibers can't fully relax after contracting. This can happen from overuse, injury, poor posture, repetitive movements, or sustained muscle tension. When a section of muscle stays partially contracted, it becomes ischemic, meaning blood flow to that area decreases. Without adequate blood flow, the tissue can't get the oxygen and nutrients it needs or clear out metabolic waste products. This creates a self-perpetuating cycle where the trigger point becomes increasingly irritable and painful.
What makes trigger points particularly frustrating is that they often cause pain in areas other than where the trigger point is located. This is called referral pain. For example, a trigger point in your upper trapezius muscle can cause pain that radiates up into your head, creating tension headaches. A trigger point in your gluteus medius can refer pain down your leg, mimicking sciatica.
This referral pattern is why people often spend months treating the wrong area. They're focusing on where it hurts instead of where the actual problem is located.
The Role of Fascia
Trigger points don't exist in isolation. They're embedded within your fascia, the connective tissue that wraps around every muscle, organ, bone, nerve, and blood vessel in your body. Fascia is like a continuous web throughout your entire body, connecting everything to everything else.
When muscles develop chronic tension or trigger points, the surrounding fascia also becomes restricted and tight. This fascial restriction can pull on distant areas, creating compensation patterns and spreading dysfunction beyond the original trigger point location.
This is why effective trigger point therapy often includes fascial release techniques like muscle scraping (gua sha) or myofascial release. Addressing both the trigger point and the surrounding fascial restrictions provides more complete and lasting relief.
What Happens During Trigger Point Therapy
Trigger point therapy is different from general relaxation massage. It's focused, specific work that requires your active participation for best results.
Tissue Preparation: The session begins with warming up the tissue using broader, gentler strokes. This increases circulation, prepares the muscles for deeper work, and helps me identify where trigger points are located. You might feel some tender areas during this phase, which guides me to the spots that need focused attention.
Assessment: As I work, I'm feeling for areas of tension, restriction, and those characteristic nodules that indicate trigger points. I'm also paying attention to your feedback about where you feel discomfort or referral pain, which helps me locate the source of your symptoms.
Focused Pressure: Once I've identified a trigger point, I apply sustained pressure directly to the spot. This isn't just pressing hard randomly. I'm using very specific pressure at a precise location, typically holding for anywhere from 10 to 60 seconds depending on how the tissue responds.
During this hold, you'll likely feel discomfort. It might be tender, achy, or intense. Sometimes you'll feel sensations radiating into other areas (that's the referral pattern). The discomfort should be significant enough that you feel something is happening, but never so intense that you're bracing or holding your breath.
Your Role: While I'm applying pressure, your job is to breathe deeply and consciously try to relax the muscle. I know this sounds counterintuitive when something uncomfortable is happening, but muscle guarding interferes with trigger point release. Deep breathing activates your parasympathetic nervous system, which helps the muscle let go.
If at any point the pressure becomes too much, speak up immediately. This isn't a "no pain, no gain" situation. If you're tensing up because the pressure is too intense, the trigger point won't release effectively. I can adjust to a lighter pressure that allows you to stay relaxed, which actually produces better results.
Release and Integration: After holding pressure on a trigger point, I'll often use softer strokes to help the tissue integrate the release and flush out metabolic waste products that have accumulated in that area. You might feel the muscle suddenly soften or the pain decrease noticeably. Sometimes you'll feel warmth or tingling as circulation returns to the area.
Why Communication Is Critical
Open dialogue during trigger point therapy isn't just nice to have, it's essential for effectiveness. I need to know what you're feeling so I can work at the right depth and adjust my approach based on how your tissue is responding.
Tell me if the pressure is too much, too little, or if you're feeling referral pain in unexpected areas. Describe the sensations you're experiencing. This feedback helps me work more precisely and get better results in less time.
After 12 years of doing this work, I can tell you that the clients who see the fastest improvement are the ones who communicate clearly during sessions. Don't try to tough it out or assume I know what you're feeling. Your feedback makes the treatment more effective.
What Trigger Point Therapy Can Help With
Trigger point therapy is particularly effective for:
Chronic tension headaches and migraines: Trigger points in the neck, shoulders, and base of the skull are common culprits behind persistent headaches.
Neck and shoulder pain: Especially from desk work, where sustained postures create trigger points in the upper traps, levator scapulae, and suboccipitals.
Low back pain: Trigger points in the quadratus lumborum, erector spinae, and gluteal muscles often underlie chronic low back discomfort.
Limited range of motion: Trigger points restrict movement and create the feeling of being "tight" even after stretching. Releasing them often immediately improves flexibility.
Referral pain patterns: When you have pain in one area but the source is elsewhere, trigger point therapy can identify and treat the actual cause.
Poor posture compensation: Trigger points contribute to postural dysfunction, and releasing them makes it easier to maintain proper alignment.
Sports-related muscle tension: Repetitive athletic movements create predictable trigger point patterns that interfere with performance and recovery.
What to Expect After Treatment
Immediately after trigger point therapy, you might feel soreness similar to post-workout muscle soreness. This is normal and typically resolves within 24 to 48 hours. The soreness comes from the metabolic waste products being flushed out and the tissue adjusting to its new, more relaxed state.
Drink plenty of water after your session to help flush out toxins and support tissue recovery. Gentle movement and stretching can help reduce post-treatment soreness, but avoid intense exercise for 24 hours to let your body integrate the work.
Many people notice immediate improvement in range of motion and pain reduction after trigger point therapy. However, trigger points that have been present for months or years may require multiple sessions to fully resolve. Each session builds on the previous one, progressively releasing layers of restriction.
Trigger Point Therapy vs. "Deep Tissue" Massage
People often confuse trigger point therapy with deep tissue massage, but they're different approaches. Deep tissue massage uses sustained pressure on broader areas to release chronic muscle tension and fascial restrictions. It's less focused on specific points and more about addressing overall patterns of tension.
Trigger point therapy is highly specific, targeting individual trigger points with precise pressure. A session might include both approaches, using broader deep tissue techniques to prepare the tissue and then focusing on specific trigger points that are causing symptoms.
Neither approach should be painful to the point of causing you to tense up or hold your breath. If your massage therapist believes that "more pain equals better results," find a different therapist. Effective trigger point work requires appropriate pressure that allows your nervous system to relax, not intense pain that causes you to guard.
Combining Trigger Point Therapy With Other Techniques
In my practice, I rarely use trigger point therapy in isolation. I combine it with other modalities that address different aspects of muscle dysfunction:
Gua sha (muscle scraping): Releases fascial restrictions around trigger points and improves tissue quality.
Cupping therapy: Creates decompression that helps release trigger points and increases blood flow to ischemic tissue.
AcuDetox: Calms the nervous system before trigger point work, making it easier for your body to release chronic holding patterns.
Corrective exercises: Addresses the postural or movement patterns that created the trigger points in the first place, preventing them from immediately reforming.
This integrated approach treats trigger points within the larger context of your body's patterns, which leads to more lasting results than just treating isolated tender spots.
When to Consider Trigger Point Therapy
Trigger point therapy might be right for you if:
You have areas of persistent muscle tension that don't respond to stretching
You experience referral pain where the source isn't clear
You get frequent tension headaches or migraines
You have limited range of motion that feels like muscle tightness
Previous massage has helped temporarily but the tension keeps returning
You have chronic pain from postural stress or repetitive movements
If you're dealing with any of these issues, trigger point therapy combined with fascial release and corrective exercises can help identify and resolve the underlying muscle dysfunction causing your symptoms.
Ready to finally release those stubborn knots? Let's identify what's really causing your tension and create a treatment plan that addresses the root cause.
Kim Schemahorn, LMT, PRC, AAT
About the Author
I'm a licensed massage therapist with 12 years of experience treating chronic pain and sports injuries. I specialize in therapeutic massage and sports massage, integrating advanced techniques like gua sha muscle scraping, cupping therapy, and corrective exercises to address the root causes of pain and dysfunction.
As an Auricular Acu-Technician (AAT) credentialed through POCA, I'm trained in the 5-Needle Protocol (AcuDetox), an evidence-based ear acupuncture treatment recognized by SAMHSA for addressing trauma, pain, toxic stress, and nervous system regulation. I'm also a certified Pain Reprocessing Coach, which allows me to integrate nervous system retraining directly into treatment sessions for clients dealing with chronic pain.
My approach combines manual therapy with pain neuroscience education and nervous system regulation to help clients achieve lasting relief, not just temporary symptom management. Whether you're an athlete recovering from injury or someone who's been living with chronic pain for years, I'm here to help you understand what's happening in your body and find a path forward.
Ready to get started? Schedule your session or join my 1st Wednesday community group to learn more about treating chronic pain.
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