What You Should Know About Using Massage Therapy for Trigger Points, According to Physical Therapists

Woke up with a tight knot in your neck? Suddenly feel a sore spot in your hamstring after a run? It might be a trigger point that’s setting off the pain you’re experiencing. And if your first thought is, I need a massage, you’re hardly alone. The relaxing, ahh-inducing effects of a massage are certainly alluring to treat targeted aches and pains. But keep this in mind: There actually isn’t much scientific proof that massage is the best way to work out these kinks.

In fact, massages are typically a short-term, feel-better remedy, not a long-term, get-better strategy. In other words, the relief you may feel usually doesn’t get to the bottom of what’s causing that tight knot in the first place. Movement, stretching, and exercise, plus staying hydrated and getting enough sleep should play a bigger role in your recovery because these daily activities improve your chances of more sustained relief. 

But that doesn’t mean you have to pass up on a massage entirely. Massage can still be incorporated into your recovery plan so long as it’s not the main or only solution you’re using to ease the pain. 

Here, we’ll cover what you should know about trigger point massage, a noninvasive therapy used by massage therapists, physical therapists, and chiropractors to spot-treat sore areas.

Sore Spots: Trigger Points Explained

Trigger points, which can feel hard or lumpy, are often referred to as knots. While it may feel like a knot, there’s no actual knot in your muscle. “A trigger point is believed to be a dime- to quarter-sized tight band of muscle tissue and surrounding fascia,” says Lori Walter, PT, DPT, a Hinge Health physical therapist. Trigger points aren’t usually associated with an injury, and they aren’t dangerous.

Instead of the entire muscle being affected, the trigger point is a localized area, but the pain can radiate to other parts of the body. For example, sore spots in the neck or shoulders may contribute to headaches or elbow pain. They can also cause stiffness and reduced range of motion.

“The neck, shoulders, lower back, and hips are common areas for trigger points,” says James Louie, a health coach at Hinge Health and a massage therapist. They can happen in any muscle, sometimes hurting only when pressed and other times producing more constant pain. 

What Causes Trigger Points?

Although most people have experienced a muscle knot at some point, there’s little scientific understanding of trigger points. Variations in how trigger points present is one of the reasons they are so hard to study. This has led to differing views on why they occur in the first place (some experts aren’t even sure trigger points are truly caused by tight muscles) and how to best treat the pain. 

One popular explanation for what causes trigger points involves the overuse of muscles, which can happen with repetitive activity like swinging a racket. But you don’t have to move for your muscles to be taxed. Sitting hunched over a computer for an extended period or sleeping in a certain position can also strain muscles, making them susceptible to these sore spots. Even stress can set up a muscle to develop a trigger point when muscles tighten.

So what should you do if you’re in pain and suspect it might be a trigger point? Even if the science on trigger points is not yet understood, massage can still be part of your recovery plan if it provides you with relief that helps you get moving, says Dr. Walter. In fact, an analysis of 60 studies showed that massage therapy helped people manage their pain better than people who received only sham or placebo treatments.

What Is Trigger Point Massage Therapy?

While there’s no research that one form of massage is better than another, a trigger point massage is a targeted therapy with the goal of releasing or diminishing sore areas. “It’s not your typical relaxation massage,” says Louie. During a trigger point massage, the practitioner applies direct pressure to a trigger point for 30 to 90 seconds to help release the tension. You may be asked to take deep breaths as they apply pressure. Once the pressure is released, the therapist will massage the area with long, light strokes to flush it out and aid in relaxation. The cycle repeats as often as needed on sore spots throughout the body.

“A skilled and knowledgeable massage therapist should check in with you constantly to make sure you can tolerate the intensity,” says Louie. “It can get pretty intense, but it shouldn’t go above what an acceptable level of pain is for you.”

After the massage, you may notice that some trigger points are more tender. As long as the soreness improves in about 24 hours, it’s normal. The trigger point pain should continue to improve over time.

“If a person's not feeling significant relief in two to three sessions, it’s time to reevaluate,” says Louie.

Trigger point massage may not be appropriate if you recently had surgery or an injury, have been sick, take blood thinners or cortisone treatments, or have osteoporosis, rheumatoid arthritis, advanced degenerative joint disease, blood clots/deep vein thrombosis, or advanced diabetes. Talk to your doctor if you have any of these conditions or other concerns before getting a trigger point massage. And always let your massage therapist or physical therapist know about any health problems you have.

Massage as an Adjunct to Movement

The right movement and stretching plan can ease and prevent trigger points, and adding massage to the equation can help. Here’s how massage can support your recovery:

• Reduced muscle tension: When muscles are tense, circulation decreases, reducing blood flow to the area. This means less oxygen and nutrients are coming in and fewer waste products are being removed, which can contribute to pain. Massage stretches and relaxes tense muscles, which, in turn, improves circulation.

• Improved mobility and flexibility: Trigger point contractions shorten a muscle. When those contractions aren’t released, it impairs your range of motion. Think of it like a rope:  The more knots in a rope, the shorter the rope becomes. Massage can help release stubborn contractions so you can move more freely.

• Reduced stress: A typical stress response is to tense up. Some people clench their jaws. Others hike up their shoulders. These sustained contractions can set the stage for trigger points. Massage doesn’t just help release these contractions; it may also help you feel more relaxed overall, so you tense up less throughout the day. Stress can also worsen pain. While a massage isn’t likely to alleviate your stress for good, it can be a valuable tool to help you manage stress more effectively.

At-Home Trigger Point Massage

If you’re feeling a knot after a long day, say, on the computer, you don’t have to wait to schedule an appointment for a massage. You can try self-massage to relieve the pain and tightness. Here’s how:

• Find the tight spot (it often feels like a marble) and apply pressure with your thumb or finger.

• Press firmly for 30 to 90 seconds, taking deep breaths.

• Repeat for three to five minutes.

For hard-to-reach spots, like in your back, you can lie on a tennis ball to apply pressure. Some people find that making circular motions as you apply pressure is helpful. Remember that any discomfort or pain as you press should not exceed a level that’s acceptable for you. A massage therapist or physical therapist can help you to locate trigger points and guide you in the most effective ways to perform self-massage.

And remember: “Massage therapy can help relieve or diminish the trigger point, but massage alone isn’t the answer,” says Louie. Massage is one tool in your toolkit that may help you manage pain along with regular movement, proper hydration, solid sleep, and good stress management. This way, you’ll address some of the underlying causes of trigger points.

PT Tip: Support Your Sleep

Constantly waking up with a crick in your neck or a knot in your back? To prevent trigger points from developing overnight, make sure your body is supported as you sleep.

If you wake in the middle of the night or morning with any discomfort, you might consider making a few sleeping adjustments. A pillow that supports the curve of your neck so it’s in line with your spine works well for many people. If you’re a side sleeper, you could try placing a pillow between your knees. If you sleep on your back, consider using a pillow under your legs to help you get a restful night of sleep. 

“Pillows can support muscles, so they aren’t working for the seven to eight hours that you’re in bed,” says Dr. Walter. “This can minimize the incidence of trigger points in the morning.”

How Hinge Health Can Help You 

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you. 

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. 

Additionally, you’ll have a personal care team to guide, support, and tailor our program to you. See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

1. Ingraham, P. (2021, April 29). Trigger Point Doubts. PainScience.com. https://www.painscience.com/articles/trigger-point-doubts.php

2. Ingraham, P. (2023, June 17). The Complete Guide to Trigger Points & Myofascial Pain. PainScience.com. https://www.painscience.com/tutorials/trigger-points.php

3. Bond, C. (2015, March 2). Massage and Trigger Points. American Massage Therapy Association. https://www.amtamassage.org/publications/massage-therapy-journal/massage-and-trigger-points/

4. Crawford, C., Boyd, C., Paat, C. F., Price, A., Xenakis, L., Yang, E., & Zhang, W. (2016). The Impact of Massage Therapy on Function in Pain Populations—A Systematic Review and Meta-Analysis of Randomized Controlled Trials: Part I, Patients Experiencing Pain in the General Population. Pain Medicine, 17(7), 1353–1375. doi:10.1093/pm/pnw099

5. Knots in Your Neck? How to Try a Trigger Point Massage to Release Them. (2019, April 4). Cleveland Clinic. https://health.clevelandclinic.org/knots-in-your-neck-how-to-try-a-trigger-point-massage-to-release-them/