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  • Writer's pictureEquilibrium Pain Management Coaching & Massage Therapy

Trigger points - an explanation

This original article on trigger points appeared in one of my newsletters back in August 2014. I have updated the article and republished it here.

You may hear me talk about trigger points during your massage session and wonder what exactly these often painful spots are and why when one is pressed, you feel discomfort somewhere else. A trigger point is essentially an irritable spot in a tight band of muscle.

It is thought that the tight band is an area of muscle that remains contracted because of increased amounts of the neurotransmitter acetylcholine (ACh), which triggers muscle contraction. Continuous contraction causes restricted blood flow to the area. This means reduced supply of oxygen and nutrients to the muscle. Metabolic waste may build up in the muscle which can cause pain, increased tension, irritation, and muscle spasm. Trigger points can have pain or tenderness on and around the point itself but most distinctly, they cause referred pain to other areas quite distant from the muscle concerned. Pain can feel sharp, stinging or a deep ache. Other symptoms associated with trigger points include decreased range of movement of the muscle or group of muscles affected, muscle twitching around the area, localised sweating and changes in temperature in the surrounding tissue.

The development of trigger points can be related to factors such as poor posture e.g. as slumping in a chair or holding a phone between the ear and shoulder, prolonged bending and poor workstation set up. Repetitive overuse, bra straps that are too tight, muscle tensing due to stress, injury (e.g. whiplash), and even inactivity can also cause trigger points. Scarring from surgical procedures can also predispose tissue to the formation of trigger points.

If we look at trigger points (marked with an X in the diagram) located in the Upper Trapezius muscle, we can see that these can refer to the back of the head and neck, behind the ear and into the jaw and temples (shown by the solid and stippled red areas).

Addressing trigger points within your massage sessions can help to reduce pain, tension and weakness in muscles, increase range and of movement and improve muscle function and health. It is also important to address the cause of trigger points, so this may involve some modifications of posture, exercises to stretch and strengthen as well as looking at factors that may contribute to muscle tension associated with stress.


Alvarez, D. J., & Rockwell, P. G. (2002). Trigger points: diagnosis and management. American Family Physician, 65(4), 653-662. Retreived from

McPartland, J. M. (2004). Travell trigger points--molecular and osteopathic perspectives. J Am Osteopath Assoc, 104(6), 244-249. Retrieved from

MyoRehab. (2014). The triggerpoint & referred pain guide. Retrieved from

Simons, D. G., Travell, J. G., & Simons, L. S. (1999). Travell & Simons' myofascial pain and dysfunction: upper half of body (Vol. 1). Lippincott Williams & Wilkins.


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