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Understanding Trigger Points: A Massage Therapist’s Guide to Location, Application, and Techniques

As a massage therapist, mastering the art of working with trigger points can elevate the effectiveness of your treatments, providing your clients with lasting relief from pain, discomfort, and muscle tension. Trigger points, often described as “muscle knots,” are hyperirritable spots within a muscle or its fascia. These points can cause localized or referred pain, and they often persist despite regular stretching and exercise. Understanding their location, how to address them, and how to interpret the body’s responses can make a significant difference in your practice.

What Are Trigger Points?

Trigger points are small, tight areas within a muscle that can cause pain both at the site and in other areas of the body. They are often the result of muscle overuse, poor posture, injury, stress, or prolonged inactivity. There are two primary types of trigger points:

• Active trigger points: These are painful on their own and can radiate pain to other parts of the body. They are often tender to the touch and can restrict movement.

• Latent trigger points: These don’t necessarily cause pain unless they are pressed, but they can limit the range of motion and can be activated into active points.

Trigger points can refer pain to distant areas. For example, a trigger point in the upper trapezius might cause a headache, or a knot in the quadratus lumborum could lead to lower back pain. Recognizing these patterns is critical to effective treatment.

Where to Find Trigger Points

Trigger points can appear in nearly any muscle, but some areas are more prone to them due to their function, location, or the amount of tension they typically hold. Common places to find trigger points include:

1. Neck and Shoulders: The upper trapezius, levator scapulae, and sternocleidomastoid (SCM) are often sources of tightness and discomfort. Trigger points here can lead to neck stiffness, headaches, or radiating pain along the arm.

2. Upper Back: The rhomboids, infraspinatus, and the subscapularis are key areas. These trigger points are frequently associated with postural issues, especially when clients have rounded shoulders or sit at desks for long periods.

3. Lower Back: The quadratus lumborum, erector spinae, and gluteus medius are commonly affected. Trigger points here may contribute to low back pain, sciatica, and hip discomfort.

4. Arms and Hands: The forearms, biceps, and triceps can develop trigger points that radiate pain to the wrist or hand. In particular, tennis elbow and carpal tunnel syndrome are often exacerbated by muscle dysfunction in these areas.

5. Legs and Hips: The piriformis, hamstrings, quadriceps, and calf muscles are common locations for trigger points. These can cause symptoms like sciatica, hip pain, or difficulty with movement in the lower extremities.

How to Use Trigger Points in Your Massage Practice

Knowing how to locate and treat trigger points effectively requires both an understanding of anatomy and a sensitivity to your client’s body. Here’s how to incorporate trigger point therapy into your massage practice:

Locate the Trigger Point:

• Palpation: Gently press along the muscle to feel for tight, tender areas. When you find a trigger point, the muscle will feel bumpy, tense, or rope-like.

• Referral Patterns: Pay attention to where your client reports pain. The muscle knot may refer pain to other parts of the body, so learning common referral patterns will guide you to the correct muscle.

Apply Pressure:

• Direct Pressure: Once you locate a trigger point, apply gentle but firm pressure. The pressure should be enough to elicit a sensation of discomfort, but not so intense that it causes pain or discomfort for the client.

• Sustained Pressure: Hold the pressure on the point for 20-30 seconds to allow the muscle to release. This will often trigger a release of tension and increase blood flow to the area.

• Release and Reassess: After holding the pressure, release slowly and reassess the muscle. Often, you will feel a noticeable reduction in tightness, or the knot may have softened.

Stretch and Mobilize:

• After addressing a trigger point, incorporating gentle stretching and mobilization can help lengthen the muscle and prevent the trigger point from reforming. For example, after working on the trapezius, a gentle neck stretch can be beneficial.

• For chronic or stubborn trigger points, it might be helpful to combine manual techniques with stretching to facilitate greater muscle relaxation.

Use Different Techniques:

• Effleurage and Petrissage: After releasing a trigger point, lighter techniques like effleurage or petrissage can help distribute the increased blood flow and promote relaxation in the surrounding tissues.

• Myofascial Release: In cases where trigger points are tied to fascial restrictions, using myofascial release techniques may be effective in restoring mobility and decreasing pain.

• Dry Needling: If you’re trained and licensed to do so, dry needling can be an effective technique for releasing trigger points by inserting a thin needle directly into the knot.

Provide Client Education: 

Educate your clients about how they can manage trigger points outside of the massage room. Stretching, posture correction, and proper hydration can all contribute to long-term relief. Advise them on avoiding activities that strain the affected area and encourage them to incorporate self-care techniques like foam rolling.

How to Understand Trigger Points

As a therapist, it’s important to understand that trigger points are not just localized muscle issues, but part of a broader musculoskeletal dysfunction. Here are key insights to deepen your understanding of trigger points:

1. Chronic Tension: Repeated muscle contractions due to stress, poor posture, or overuse lead to the formation of trigger points. Over time, this can alter muscle function and contribute to chronic pain syndromes.

2. Central Sensitization: When trigger points are not addressed, they can contribute to central sensitization—a condition where the nervous system becomes more sensitive to pain signals, making the entire body more prone to pain.

3. Integrated Treatment: Trigger point therapy works best when integrated with an overall treatment plan. It should not only target the affected muscle but also address underlying issues like posture, movement dysfunction, and muscle imbalances.

4. Client Feedback: Always communicate with your client during treatment. Ask them to rate their pain level or describe what they feel as you work through each trigger point. This feedback can guide your technique, ensuring that you’re applying the right amount of pressure and that your client is comfortable.

Conclusion

Trigger point therapy is an essential skill for any massage therapist who wants to help clients alleviate chronic pain, reduce muscle tightness, and improve their overall quality of life. By knowing where to find trigger points, how to apply pressure effectively, and how to understand their underlying causes, you can create a more targeted and therapeutic massage experience. Remember, patience and practice are key. Over time, your ability to locate, treat, and understand trigger points will become an invaluable tool in your therapeutic repertoire.

Article by Jeppe Tengbjerg (CEO & Founder International Massage Association)

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Have you seen what our particpants have to say?

May AuMay Au
09:57 20 Oct 24
It is a great honor to receive the NMC Overall Winner Award 2024, and I am truly grateful to have Jeppe present it to me. His experience and skills are admired globally, and he is not only highly knowledgeable but also generous and supportive. I feel fortunate to learn from him and I hope we can all continue working together in the massage field to achieve great things. Thank you so much, Jeppe!
Sami StressadeSami Stressade
10:45 20 Sep 24
The International Massage World Championships (IMA) in Copenhagen was an extraordinary experience. It provided a unique platform to compete with the best massage therapists in the world and learn advanced techniques at the highest level.The professional exchange, the valuable feedback from the jury and the inspiring atmosphere have significantly expanded my skills. An absolute recommendation for anyone who wants to perfect their art and make international connections.A special thank you goes to Jeppe Tengbjerg, founder and CEO of the International Massage Association and organizer of the World Championships in Massage. Without his vision and commitment, this outstanding event would not have been possible.
Amanda J M.Amanda J M.
03:52 18 Sep 24
Thank you very much for the lessons that IMA has shared with the public... this knowledge will forever be useful for me to grow even more.. hugs and kisses 💆‍♂️🌎🕊🙏😇
semenuk-t Tanyasemenuk-t Tanya
14:45 25 Aug 24
Very interesting, informative. A colossal experience. Exchange of skills and techniques. Friendly atmosphere....❤️❤️❤️It is worth taking part in order to grow and become better.
I have attended the IMA World massage Champs since 2017, it’s a must in the June calendar each year. Go visit or compete!! Copenhagen is a great City break aswell.
Tereze BelkovaTereze Belkova
19:06 24 Apr 24
An excellent school where you can not only learn different massage techniques, but also improve your skills. A place that brings together massage professionals from all over the world by organising the World Massage Championships in Denmark.
Michael PedersenMichael Pedersen
21:24 05 Mar 24
Huge praise for holding dm in massage 2024.Warm atmosphere, good energy and super well organised.A school that is passionate about giving students the best possible education.Can only warmly recommend the school.
Carsten AnderslundCarsten Anderslund
20:12 05 Mar 24
Carl NewburyCarl Newbury
11:28 29 Feb 24
I have been attending Jeppe's events in Copenhagen since 2017. The World Championship in Massage is the highlight of my year networking with massage therapists from all over the World. Well Done Jeppe
Victoria BilousovaVictoria Bilousova
12:54 07 Feb 24
Thank you so much for an amazing World Massage Championship organized in a high level! A lot of new friends and inspiration I found there😇
It was with great pleasure to teach at your school in Denmark, I experienced a good atmosfeer, an interesting class and you as host/teacher mr. Jeppe Tengbjerg.Also thank you for the colaboration to teach at my school in Lelystad the Netherlands last year, it is of great interest to learn from each other and I welcome you again, this year in september 2024.SoeReiMas Courses & CoachingLelystad the Netherlands
Chutima HälgChutima Hälg
00:47 07 Feb 24
I recently had the pleasure of attending a massage seminar jointly organized by IMA Academy and Chiida Academy, and I must say it was a truly enriching experience. The seminar, led by a professional instructor, was a perfect blend of theory and practice, offering valuable insights into the art of massage therapy. The theoretical aspects covered were comprehensive and informative, providing a solid foundation of knowledge for all participants. From anatomy and physiology to various massage techniques and their applications, every aspect was explained with clarity and depth. It was evident that the instructor was not only knowledgeable but also passionate about imparting their expertise to the students. What truly stood out about this seminar was the emphasis on hands-on practice. Participants were given ample opportunities to apply the theoretical concepts they had learned in a supportive and nurturing environment. The instructor's guidance and feedback were invaluable in honing our skills and techniques. Moreover, I was impressed by the caring attitude and thoughtfulness shown towards the students throughout the seminar. From providing necessary materials to addressing individual queries and concerns, the organizers ensured that everyone felt valued and supported. I would like to extend my gratitude to Mr. Jeppe Tengbjerg for his exceptional leadership in making this seminar a resounding success. His expertise, patience, and genuine dedication to the art of massage therapy were truly inspiring.In conclusion, the collaborative effort between IMA Academy and Chiida Academy in presenting this massage seminar was commendable. It was a rewarding experience that left me feeling empowered and equipped with valuable knowledge and skills. I highly recommend it to anyone seeking to deepen their understanding of massage therapy or embark on a career in this field.
Corpore VitalCorpore Vital
16:13 06 Feb 24
Professionalism and education at the highest level. The students are very attentive and involved in the way the information is conveyed and because there is a lot of practice, the course becomes even more exciting. Congratulations for the interactive way in which you transmit the information.
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