Trigger Point Therapy for Muscle Knots: What You Need to Know

trigger point therapy

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Maybe you’ve had lingering back pain from an old injury or mysteriously persistent headaches but haven’t found relief no matter how many doctors, treatments, or medicines you try. Chronic problems like these can be physically and emotionally taxing. But trigger point therapy might deliver the results you’ve been looking for. Read on to hear what experts have to say about targeting your muscles with trigger point therapy to ease chronic pain and other conditions.

Meet the Expert

  • Christopher Hicks, MD, clinical associate of orthopedic surgery and rehabilitation medicine at University of Chicago, is a board-certified orthopedist who specializes in non-operative sports medicine. 
  • Mary Biancalana, MS, CMTPT, LMT, is a certified myofascial trigger point therapist in Chicago and has been treating chronic and acute pain for more than 20 years.
  • Jen Liu, CMTPT, LMT, is a certified trigger point therapist in Chicago who treats patients’ trigger points and their underlying causes.


What Is Trigger Point Therapy?

Muscles are made up of cells called muscle fibers. Healthy muscle fibers are long and flexible, says Liu, allowing your muscles to expand and contract so you can do things like bend your knee or nod your head. But sometimes they shorten as an adaptation to how you use or hold your body, forming a tight band called a trigger point. Pain-causing chemicals can collect in that spot, says Liu. Altogether, this can cause pain, tightness, weakness, or physical limitations. 

We can all get them when we do something our muscles aren’t accustomed to, says Biancalana. This can be anything from overtraining to injury to a change in posture from your new work-from-home setup. Those pesky knots in your back or neck? They’re probably trigger points.

“Trigger points can feel like a micro–charley horse,” says Hicks. “This taut band in a part of the muscle tissue can cut off blood vessels. That blocks blood and nutrients from getting to the area to help it heal. On top of that, trigger points can irritate nerves in that muscle. These nerves lead to different areas in the body, so that can cause pain in areas outside of the trigger point itself.”

Enter trigger point therapy, a treatment where you release those knots by pressing on them. “It’s reeducating your muscles to learn how to be in a normal state,” says Liu.

The Benefits


Trigger point therapy can treat a swath of chronic and acute conditions, including injuries, chronic pain disorders like fibromyalgia, nerve pain like sciatica, bone conditions like plantar fasciitis, and more. While there’s not much conclusive research pointing to why exactly it works, there is some evidence to suggest that it relieves pain, like headaches. And despite ongoing research, says Liu, patients consistently report good results.

Trigger point therapy might also clear up some seemingly unrelated aches and pains. These are often downstream effects of undealt-with trigger points, says Liu, like digestive issues, vertigo, ringing in the ears, or frequent headaches.

Here’s how you can benefit from trigger point therapy, according to these practitioners:

  • Eliminates tight bands in your muscles called trigger points
  • Reduces muscle and nerve pain 
  • Relieves discomfort from chronic pain conditions
  • Promotes blood flow to the affected area to stimulate the body’s natural healing process

The Drawbacks

Trigger point therapy doesn’t work for everyone. And it can be uncomfortable to have pressure applied to sensitive areas in your muscle. Since it releases pain-causing chemicals into the bloodstream, you may feel lethargic for a day or two after therapy while your body processes those substances, says Liu. You also might feel soreness in the areas that were treated, she notes, which you can relieve with a hot compress.

Trigger Point Therapy vs. Acupuncture 


Some forms of trigger point therapy use needles to relieve knots in your muscle fibers. “Introducing the needle into a tight muscle for a few seconds causes the electrical signal within the muscle to spontaneously contract,” says Hicks. “And once it contracts, the muscle can relax to promote healing.” 


There are two kinds of trigger point injections: wet and dry needling. Wet needling uses a local numbing medication like lidocaine to help prevent soreness around the needle stick. Dry needling is the same thing but without the anesthetic.


Acupuncture likewise uses needles to target areas of the body that may be contributing to pain elsewhere. But the approaches are different. Acupuncture is a type of Chinese medicine that treats various ailments by balancing your energy flow, called chi, through needles in the skin. Trigger point therapy uses pressure to eliminate knots in your muscle, and doesn’t always require needles.

How to Prepare for a Trigger Point Therapy Session


Drink lots of water, says Liu. She recommends patients drink four cups of water before a treatment. And if you’re someone who never drinks enough, she suggests starting to hydrate days before the appointment. This helps your body better process any toxins released from trigger points during therapy. 

You should also wear something comfortable and easy to move around in, notes Biancalana. “These sessions are active and dynamic,” she says. “It’s participatory and built on a dialogue where you’re always giving feedback about your discomfort level and function.”

What to Expect at Trigger Point Therapy

You can expect your first session to cover a lot of ground over the course of a few hours, says Liu. Your therapist will dive into your medical history and symptoms to get a comprehensive picture of your health, lifestyle, and pain. Patients often experience symptoms that they don’t realize are related to trigger points, says Liu, and a therapist will use those clues to zero in on the muscles to treat. 

You’ll have a number of physical exams, says Biancalana, like checking your posture and range of motion, so that your therapist can observe how you move and where there may be some muscle irregularities. You’ll also have what’s called a structural assessment. It’s an exam to see if you have any natural features that predispose you to certain trigger points, like having one leg that’s shorter than the other. That way your therapist can address underlying anatomical factors that might contribute to your discomfort. Some practitioners may also give a neurological exam, like testing your reflexes or your response to sensations on the skin, to see if your pain is related to nerves. 

After that, it’s time for the main event. You might stay seated or lay down on a bed depending on the muscles of focus. Your therapist will feel your muscles to find the characteristic tight ropy bands of trigger points, says Liu. Then they’ll press and hold the trigger point to release it. She likens it to squeezing a lemon: “The more you press and stretch it, the more ‘juices’ will come out.”

Don’t be surprised if your practitioner targets muscles seemingly disconnected from your pain. “We don’t treat where it hurts. We treat why it hurts there,” says Biancalana. “That’s because 80 percent of trigger points create pain in places distant from where the trigger point is located.” For instance, says Liu, a trigger point in your neck may shorten the muscles connected to your shoulder, thereby decreasing range of motion and causing pain in that area.

Aftercare


Therapy doesn’t stop at the end of the session. “I often give my patients homework,” says Liu. “We’ll address the things that need to change to relieve and prevent trigger points, like your sleeping position or posture.”


You might also use tools at home to keep trigger points at bay, says Biancalana, like rolling out your impacted muscle with a tennis ball or applying a self-massager to the affected area. 

At-Home vs. In-Office Trigger Point Therapy

Hicks recommends starting with in-office therapy to get professional evaluation and treatment for your condition. An expert’s eye can help identify and address underlying causes of pain, like posture or bone structure. 

Your practitioner can also teach you how to target your trigger points at home so you can manage persistent knots yourself. “Trigger points can come back pretty quickly if they’ve been there for a while since the muscle is trained to stay short. It’s muscle memory,” says Liu.  

At-home therapy is an effective and inexpensive way to maintain the health of your muscles long-term. Where and how often you administer treatment to yourself depends on your condition, but your practitioner can teach you how to do it and help you decide what combination of in-office and at-home sessions is best for you. 

The Cost

Prices vary based on where you’re getting treated, how many sessions you need and your insurance (though it often isn’t covered). At her clinic, Liu says patients can expect to pay $260 for their first two-hour evaluation and treatment, and then $180 for each hour-and-a-half-long session thereafter. You may also want to shell out for self-care tools or corrective devices needed to support your treatment, like pillows to aid your posture. Check in with your therapist about cost before you get started.

The Takeaway


If you’re looking for a new way to relieve your pain without the need for medication, try trigger point therapy. Learning how to ease your discomfort at home (at the direction and discretion of your practitioner) can be a game-changer during the pandemic, when frequent clinic visits may not be an option. 


“It’s a great way to reduce pain and restore full function in the muscles,” says Biancalana. “Patients participate in the treatment, which gives them empowerment over their problem.”


To find a board-certified therapist near you, check out the National Association of Myofascial Trigger Point Therapists’ directory.