Trigger Points Explained: Finding and Treating Muscle Knots

If you've ever pressed on a tight spot in a muscle and felt pain radiate to a seemingly unrelated area, you've encountered a trigger point. These myofascial phenomena—commonly called "muscle knots"—are a primary target for percussion therapy and one of the main reasons people turn to massage guns for relief.

Understanding trigger points—what they are, why they form, and how to treat them effectively—can dramatically improve your results with percussion therapy. This guide provides a comprehensive look at these troublesome spots and how to address them.

What Exactly Is a Trigger Point?

A trigger point is a hyperirritable spot within a taut band of skeletal muscle. It's essentially a small patch of muscle fibres that have become stuck in a contracted state. When pressed, these points are painful locally and often produce pain in a different location—a phenomenon called "referred pain."

The term was first systematically described by Dr. Janet Travell in the 1940s, and her work remains foundational to myofascial therapy today. Trigger points are not the same as tender points (found in conditions like fibromyalgia) or acupuncture points, though they sometimes overlap.

Active vs Latent Trigger Points

• Active trigger points: Cause constant pain, whether at rest or during movement. They produce referred pain patterns when compressed and can restrict range of motion.
• Latent trigger points: Only painful when pressed directly. They may not cause symptoms until activated by stress, overuse, or other factors. Most people have numerous latent trigger points.

Why Do Trigger Points Form?

Trigger points develop for various reasons, often related to muscle stress and metabolic issues:

Common Causes

• Muscle overload: Acute overload from lifting something heavy, or chronic overload from repetitive activities
• Sustained postures: Holding muscles in shortened or lengthened positions for extended periods (desk work, sleeping positions)
• Direct trauma: Injuries that damage muscle tissue
• Muscle imbalances: When some muscles are tight and others are weak, compensation patterns develop
• Stress and tension: Psychological stress manifests as physical muscle tension
• Nutritional deficiencies: Particularly B vitamins, iron, and vitamin D
• Dehydration: Chronic mild dehydration affects muscle function
• Lack of movement: Sedentary lifestyle allows trigger points to develop and persist

The Energy Crisis Theory

The leading theory for why trigger points form involves an energy crisis at the cellular level. When muscle fibres become overloaded, they may not receive adequate blood flow, leading to reduced oxygen and nutrient delivery. Without sufficient ATP (cellular energy), the muscle fibres can't release from their contracted state, creating the palpable "knot."

This explains why improved blood flow—one of the primary effects of percussion therapy—can help release trigger points.

Common Trigger Point Locations

While trigger points can develop in any muscle, certain locations are particularly common, especially for office workers and athletes:

Upper Trapezius

The most common trigger point location. Found in the muscle running from the shoulder to the neck. Often causes headaches, neck pain, and facial pain.

Levator Scapulae

Located at the side of the neck where it meets the shoulder blade. Causes stiff neck and shoulder pain. Often described as a "crick" in the neck.

Infraspinatus

One of the rotator cuff muscles on the shoulder blade. Causes deep shoulder pain and can mimic rotator cuff injury symptoms.

Quadratus Lumborum

Deep muscle of the lower back. A common source of chronic low back pain and can cause hip and buttock pain.

Piriformis

Deep in the buttock. Can compress the sciatic nerve and cause pain radiating down the leg (piriformis syndrome).

Gluteus Medius

On the side of the hip. Causes low back pain and hip pain, often mistaken for other conditions.

Finding Trigger Points

What to Feel For

• Taut band: A rope-like tension in the muscle, harder than surrounding tissue
• Nodule: A palpable "lump" or "knot" within the taut band
• Local tenderness: Pain when the spot is pressed
• Referred pain: Pressing the point causes pain elsewhere
• Jump sign: Pressing causes an involuntary reaction (flinching, pulling away)
• Local twitch response: The muscle may briefly spasm when the trigger point is stimulated

Self-Exploration Technique

1. Use your fingertips to palpate the muscle slowly and systematically
2. Apply moderate pressure—enough to feel the underlying tissue
3. Feel for areas that are harder or more taut than surrounding tissue
4. When you find a suspicious spot, press and hold for 5-10 seconds
5. Note if the spot is tender and if it produces pain elsewhere
6. Compare both sides of the body—asymmetry often indicates trigger points

Treating Trigger Points with Percussion Therapy

Massage guns are particularly effective for trigger point treatment because they combine sustained pressure with rapid oscillation, addressing both the mechanical and metabolic aspects of trigger points.

The Treatment Protocol

1. Locate the trigger point using the palpation technique described above
2. Select the right attachment: The bullet/cone head is ideal for pinpoint pressure; the ball head works for larger areas
3. Start with low speed to acclimate the tissue
4. Apply moderate pressure directly over the trigger point
5. Hold for 15-30 seconds, no longer—you should feel the tension release
6. Move to surrounding tissue using broader strokes
7. Return to the trigger point for another 15-30 second treatment if needed
8. Finish with sweeping movements across the entire muscle

Signs of Successful Treatment

• Noticeable reduction in local tenderness
• Decreased or eliminated referred pain
• Improved range of motion
• Softening of the taut band
• General feeling of relaxation in the area

What If It Doesn't Release?

Some trigger points are stubborn and won't release with a single treatment. Try:

• Multiple shorter sessions rather than one long session
• Applying heat before treatment
• Gentle stretching of the affected muscle after treatment
• Staying well-hydrated
• Addressing perpetuating factors (posture, stress, nutritional issues)
• Seeking professional treatment if self-care isn't working

Treating Common Trigger Point Patterns

Tension Headaches from Upper Trapezius

1. Locate trigger points in the upper trap (top of shoulder, near neck)
2. Use ball attachment at low speed
3. Treat each trigger point for 20-30 seconds
4. Work along the entire muscle from shoulder to base of skull
5. Also treat the suboccipital muscles at the base of the skull (very gently)

Low Back Pain from Quadratus Lumborum

1. The QL is located between the lower rib and hip, beside the spine
2. Use ball attachment at medium speed
3. Work the area while avoiding direct pressure on the spine
4. Treat trigger points for 15-20 seconds each
5. Include the gluteal muscles in your treatment

Shoulder Pain from Infraspinatus

1. Locate the infraspinatus on the shoulder blade, below the spine of the scapula
2. Use ball attachment at low to medium speed
3. Cover the entire muscle, pausing on tender spots
4. Also treat the supraspinatus above the spine of the scapula
5. Reach as best you can or ask someone to assist

Prevention: Keeping Trigger Points at Bay

Treatment is important, but prevention is better. To minimise trigger point development:

• Move regularly: Avoid staying in any position for extended periods
• Address posture: Proper ergonomics reduce chronic muscle stress
• Stay hydrated: Adequate water intake supports muscle function
• Manage stress: Psychological tension becomes physical tension
• Maintain conditioning: Strong, flexible muscles are less prone to trigger points
• Regular maintenance: Brief, daily percussion therapy sessions help prevent trigger point development
• Address imbalances: Strengthen weak muscles, stretch tight ones

When to Seek Professional Help

While self-treatment with a massage gun is effective for many trigger points, some situations warrant professional evaluation:

• Chronic pain that doesn't respond to self-treatment
• Trigger points that keep returning despite addressing perpetuating factors
• Symptoms that could indicate something other than trigger points (numbness, weakness, radiating pain)
• Trigger points in areas that are difficult to self-treat effectively
• When you want a thorough assessment and treatment plan

Physiotherapists, massage therapists, and other bodywork professionals can provide manual trigger point therapy, dry needling, and other treatments that complement your home care routine.

Understanding trigger points transforms your approach to percussion therapy. Instead of randomly running the massage gun over muscles, you can target the specific spots causing your pain, address referred pain patterns, and achieve better results. Combined with preventive measures, this knowledge empowers you to manage muscle pain effectively and maintain comfortable, functional muscles throughout your life.