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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