Trigger Point Therapy

Trigger point therapy is an effective technique used by both massage therapists and physiotherapists to relieve muscular pain and tension. It targets specific areas of muscle that have become tight and sensitive, known as “trigger points.” At our clinic, we use trigger point therapy as part of a holistic approach to managing pain, restoring movement, and supporting recovery from injury.

Trigger points are small, tight knots that develop within a taut band of skeletal muscle, often as a result of overuse, injury, or chronic stress. They result in sustained muscle contractions that reduce circulation and the clearance of metabolic by-products. This leads to a build-up of substances such as CGRP (calcitonin gene-related peptide), Substance P, and bradykinin, which contribute to localised inflammation and pain. Prolonged exposure to trigger points may lead to central sensitisation, a process involved in many cases of chronic pain, or myofascial pain syndromes.

Trigger points can be tender to touch and may refer pain to other parts of the body. For example, a trigger point in the upper shoulder may cause pain that radiates up the neck and into the head, contributing to tension headaches. This is common in administration type workers who spend the majority of their day at their desk. Other times trigger points can develope to protect a joint, such as in the neck following a whiplash type injury.

There are two types of trigger points:

• Active Trigger Points: Cause pain even at rest and may refer pain to other areas.
• Latent Trigger Points: Do not cause constant pain but can restrict movement and become painful when touched or activated.

Trigger points can form in any muscle but are commonly found in the neck, shoulders, back, hips, and calves.

Trigger point therapy involves applying targeted pressure to the affected muscle tissue to release tension and reduce pain. This pressure interrupts the cycle of muscle spasm and pain, encourages blood flow, and helps the muscle return to a normal resting state. Techniques may include:

• Ischemic compression of the trigger point
• Myofascial release
• Deep tissue massage
• Cross fibre frictions
• Active Release Therapy

• Some physiotherapists also use dry needling or acupuncture to help deactivate trigger points; in this approach, very thin needles are inserted directly into the muscle knot to release tension and reduce pain.

When a practitioner or individual applies pressure to a trigger point, they target a specific spot within the muscle that feels tight, tender, or knotted. This isn’t just random pressing—it’s a deliberate, sustained force applied directly to the hyperirritable area within a taut band of muscle fibers. Here’s a more detailed breakdown of how this process works:

Mechanical Disruption of Contracted Fibers: A trigger point forms when a small group of muscle fibers becomes stuck in a contracted state, often due to overuse, injury, or stress. These fibers don’t relax like the surrounding muscle tissue, creating that characteristic “knot.” When pressure is applied—typically for 30 seconds to a couple of minutes—it physically compresses these shortened fibers. This compression fatigues the contracted area, forcing it to let go of its tension.

Interrupting Local Nerve Signals: The sustained pressure also affects the nervous system locally. Trigger points are often hypersensitive because the nerves controlling those muscle fibers are overstimulated, leading to a constant release of acetylechlorine, which causes the muscles to stay locked in contraction. By pressing on the point, you overload these nerve signals. This can temporarily block the communication between the muscle and the nervous system, a bit like hitting a reset button. Once the pressure is released, the muscle often “forgets” to stay contracted, allowing it to relax. A similar mechnism is used in dry-needling.

Pain Threshold and Adaptation: Initially, pressing on a trigger point can hurt because it’s already irritated. Practitioners often aim for a level of pressure that’s intense but tolerable—sometimes described as a 7 out of 10 on the pain scale. As the pressure is held, the discomfort typically decreases. This happens because the muscle adapts to the stimulus, and the nerve endings become less reactive over time. The reduction in pain during the hold is a sign that the trigger point is starting to release.

Ischemic Compression Mechanism: One common technique within this step is called ischemic compression, where the pressure temporarily restricts blood flow to the trigger point. This might sound counterintuitive since blood flow helps healing, but the brief ischemia (lack of oxygen) stresses the muscle tissue just enough to trigger a relaxation response. When the pressure is released, blood rushes back in (a process called reactive hyperemia), which further aids in flushing out waste and reducing tension. It’s like wringing out a sponge to get rid of dirty water before letting it soak up fresh water.

Precision and Technique: The effectiveness of the pressure depends on finding the exact spot. A skilled practitioner palpates the muscle to locate the taut band and the most tender point within it—often a small, pea-sized nodule. They might adjust the angle or depth of pressure based on feedback from the muscle (like a twitch response) or the person’s reaction. For self-therapy, tools like foam rollers, massage balls, or even fingertips can be used, though it’s trickier to target and maintain consistent pressure.

This process helps:

• Improve range of motion
• Reduce pain and discomfort
• Break the cycle of muscle guarding
• Enhance overall muscular performance

Trigger point therapy rarely stands alone. At our clinic, it is often integrated with other hands-on techniques and treatment modalities. These may include:

• Remedial massage: To address broader muscle tension and improve circulation
• Physiotherapy: To mobilise stiff joints, use acupuncture or dry needling, strengthen weak muscles with Pilates or Clinical Rehabilitation contributing to the trigger points.

By combining therapies, we can treat both the symptoms (pain and stiffness) and the underlying issues (postural imbalance, movement restriction, or muscle weakness).

A typical session will begin with an assessment of your posture, movement patterns, and areas of discomfort. Your remedial therapist will locate trigger points by palpating muscles for tight bands or nodules. Once identified, firm but controlled pressure is applied using the fingers, thumbs, knuckles, or elbows.

You may feel:

• Local tenderness or pressure
• Referred pain (pain felt in another area)
• A release or twitch response in the muscle

While some discomfort is normal during the treatment, it should never be intolerable. Most clients feel a sense of release and increased mobility afterward. Mild soreness may follow, similar to post-exercise soreness, and typically resolves within 24–48 hours.

Trigger point therapy is supported by clinical studies and commonly used in pain management. According to Physiopedia, trigger points are a major contributor to musculoskeletal pain and are commonly treated through manual therapy. The American Massage Therapy Association also recognises trigger point therapy as an effective part of a broader therapeutic approach to soft tissue dysfunction.

If you’re experiencing stubborn muscle pain, headaches, or movement restriction, trigger point therapy may be just what you need. Book an appointment with one of our qualified physiotherapists or massage therapists and experience targeted relief through expert hands-on care.