A clear, balanced exploration for massage therapists, manual therapists, and movement professionals

Trigger point therapy is something almost every manual therapist has encountered. Many of us learned about it in school, refined it in clinic, and have felt its clinical impact in the treatment room more times than we can count. But for as widespread as trigger point therapy has become — from elite sport settings to everyday pain management — it continues to spark debate. The question “Do trigger points really exist?” is still being asked, not only by practitioners outside our world, but even within it.

For massage therapists, manual therapists, and rehabilitation professionals, this topic matters. It matters because the concept of a trigger point influences how we assess muscle pain, how we choose treatment strategies, and how we communicate with clients about their pain. It also affects how we interpret research, how we integrate manual techniques with exercise and movement prescription, and how confidently we apply our skills.

In this article, we’ll explore the evidence, the clinical experience, and the evolving understanding of trigger points. We’ll acknowledge the science, respect the skepticism, and most importantly, ground our discussion in practical insight that can help you become a more thoughtful, effective therapist.

Understanding What a Trigger Point Is

When manual therapists talk about trigger points, we are referring to hyperirritable spots within a taut band of skeletal muscle or fascia. These spots are often tender to palpation, may feel like firm nodules or small nodular bands, and are associated with pain that can be local or referred to other areas. When pressed, some trigger points can elicit a characteristic response known as a local twitch response, where the muscle fiber under the palpating force visibly contracts.

If we take a quick look at how the concept has been described in medical literature, trigger points are defined as small, focal regions within muscle tissue that produce pain or sensitivity — not just where they are pressed, but often in spots that seem unrelated or distant from the point itself. This is part of what solidifies their relevance in clinical work: the familiar pattern where a trigger point in one muscle produces a pain pattern somewhere else entirely.

The term “trigger point” itself was popularised by pioneers in the field, and over decades many therapists have learned to recognise them by feel and clinical pattern. This practical recognition is real in clinical terms — even while scientists continue to investigate exactly what the underlying structures are.

The Evidence Base: Research Studies and Imaging

Critics sometimes argue that trigger points are conceptual rather than anatomical — that is, they say there isn’t a discrete structure that can be consistently visualised like a torn ligament or a herniated disc. But research has shown measurable changes in muscles where trigger points are present.

Early work by Dr. Janet Travell in the mid-20th century helped establish the idea that trigger points can produce measurable electrical activity. Dr. Travell discovered that trigger points “generate and receive” tiny electrical currents, and that this activity could be detected with electromyography (EMG). In resting muscle, electrical activity is usually silent. However, within a trigger point region — where a small segment of muscle fibers is held in chronic contracture — small spikes of electrical potential can be detected, indicating abnormal contractile behavior even at rest.

Later studies supported this phenomenon, demonstrating that when trigger points are needled with a monopolar EMG needle, they often show a local twitch response — a high-amplitude electrical discharge indicative of a neurological reflex in muscle fibers. Imaging studies, including MRI and high-resolution ultrasound, have also identified changes in muscle regions consistent with trigger point concepts: these include localized hypoechoic regions and altered tissue structure within muscle fibers.

Research using microdialysis — where tiny tubes sample the chemical environment in tissue — has shown that trigger point regions often contain higher levels of inflammatory mediators, lower pH (indicating acidosis), and signs of localized ischemia (poor blood flow). These biochemical signatures align with clinical sensations: muscles that are stuck in a state of contraction, suffering from reduced oxygen and accumulated waste products, can generate pain, stiffness, and restricted movement.

While these studies do not entirely explain every aspect of trigger point behavior (for example, questions remain about exactly how needling creates relief and why a twitch response is painful), the accumulation of evidence strongly supports that trigger points are not imaginary. They are physiologically distinguishable and clinically relevant phenomena.

Local twitch response (LTR) in a rabbit tender spot. LTRs are elicited only when the needle is placed accurately within the trigger spot. (Adapted from: Hong 1996.)

The Skeptics and Why Science Debates Them

Despite the evidence, some researchers continue to question whether trigger points are a valid scientific construct. Common criticisms include the lack of a universally agreed diagnostic standard, variable reliability between clinicians when locating trigger points, and inconsistent imaging findings in some studies.

In science, disagreement is normal. Not all phenomena are perfectly consistent across all research modalities — especially in areas involving the complex interplay between nervous system reflexes, muscle tissue, and pain perception. The presence of some debate in the literature does not invalidate professional observation or practical efficacy. Rather it highlights that trigger point science, like many areas of clinical practice, is evolving.

The important thing for clinicians is to understand both sides: to appreciate that the science continues to develop while also recognising that clinical hands-on results and patient responses provide valuable insight. Many treatments that are now widely accepted in clinical practice — including joint mobilisation and soft tissue techniques — were once subject to similar debate.

Clinical Relevance: What Trigger Points Mean in Practice

So what does it mean for you as a therapist? If trigger points are real — supported by measurable electrical activity, imaging, and biochemical markers — then including trigger point assessment and treatment in your toolkit can enhance your clinical outcomes.

Trigger points are often associated with muscle pain, restricted range of motion, and altered movement patterns. They can be both active (producing pain without pressure) and latent (painful only when palpated). Active trigger points can mimic other conditions — for example, pain from a trigger point in the trapezius may feel like a tension headache, and trigger points in the gluteal muscles can produce pain that resembles sciatica. Understanding this referral pattern helps you assess more accurately and treat more effectively.

Locating trigger points usually involves palpation along the muscle belly while looking for taut bands and areas of tenderness that reproduce familiar pain patterns. Advanced clinicians also use dynamic assessment, finding points that snap or twitch under precise stimulation. This sensitivity to tissue response is one of the hallmarks of skilled manual therapy.

Treatment Strategies: Beyond “Knots” and Quick Fixes

A common misconception among laypeople — and sometimes even among newer therapists — is that trigger points are simply “muscle knots” that can be “felt and unknotted” with deep pressure. This oversimplifies a more complex clinical reality.

Trigger points are not just tangled fibers that can be untwisted. They represent a localized region of altered neuromuscular function where muscle fibers are held in a contracted state. Effective treatment requires more than brute force. The best approaches consider both the neurological and mechanical aspects of muscle function.

Manual therapy options include sustained pressure, ischemic compression, muscle energy techniques, myofascial release, and assisted range of motion. Dry needling — though sometimes controversial — is another approach that directly interacts with the localized contracture and can elicit a twitch response that helps reset the reflex loop. Other supportive strategies include soft tissue mobilisation, stretching, and movement re-education to restore normal muscle length and function.

An intelligent treatment plan will also address contributing factors: postural habits, movement patterns, ergonomic stress, and repetitive movement behaviors. Trigger points rarely appear in isolation; they develop as part of a larger pattern of neuromuscular tension and compensation.

Integrating Trigger Point Work with Broader Clinical Goals

Rather than seeing trigger point therapy as an isolated technique, it’s helpful to view it as one part of a comprehensive approach to musculoskeletal health. Trigger points can contribute to pain and dysfunction, but they often coexist with other issues: joint stiffness, postural imbalance, nerve irritation, and movement pattern disruptions.

When you integrate trigger point therapy into your practice, you’re enhancing your ability to address both symptom and cause. For example, a client with chronic low back pain may have trigger points in the lumbar extensors, gluteal muscles, and hip flexors. Treating those trigger points can alleviate local pain and improve range of motion, but long-term benefit also comes from strengthening weak muscle groups, correcting postural imbalances, and retraining movement patterns that perpetuate the trigger point activity.

A thoughtful therapist uses trigger point work to support bigger goals: facilitating more fluid movement, reducing compensatory strain, and improving functional outcomes in daily activities or athletic performance.

3D imaging of trigger points. A mechanically-scanned 3D probe (3D9-3v) was used for 3D imaging in a subject with a latent trapezius trigger point. The MTrP is clearly identified (arrows) in all three planes as well as in a multi-slice view.

Ref: Novel Applications of Ultrasound Technology to Visualize and Characterize Myofascial Trigger Points and Surrounding Soft Tissue, 2010, Jay P. Shah (et al) 

Why Trigger Points Still Matter for Manual Therapists

Trigger point therapy is not outdated theory. It remains a powerful and relevant part of manual therapy because it bridges the subjective experience of pain with observable, tactile findings in muscle tissue. For many clients, finding and treating trigger points can be the difference between persistent discomfort and meaningful relief.

As research continues to evolve, our understanding deepens. Imaging techniques, biochemical analysis, and neurophysiological studies continue to support that trigger points are more than just an idea — they are a clinically observable phenomenon that responds to manual intervention.

Whether you are a massage therapist refining your palpation skills, a physical therapist integrating dry needling, a chiropractor addressing muscular imbalance, or a rehabilitation professional working on complex pain patterns, trigger point therapy offers a valuable dimension to your clinical work.

Concluding Thoughts: Science, Skill, and Sensitivity

In the end, the question “Do trigger points really exist?” does not have to be a divide between science and clinical practice. The evidence to date supports that trigger points are a real, measurable, and treatable component of musculoskeletal pain. At the same time, the model remains a dynamic, evolving construct — open to refinement as research progresses.

What matters most for you as a clinician is how you use that knowledge in practice. Recognise that trigger points are part of the broader neuromuscular ecosystem; appreciate the subtleties of referral patterns and muscle behavior; and apply your manual skills with both precision and context. Treating trigger points is not about brute force, but about understanding tissue response, nervous system behavior, and the patterns that underlie pain.

Trigger point therapy is grounded in decades of clinical experience and supported by a growing evidence base. Viewed through this lens, trigger points are not a myth, nor are they magic. They are a nuanced, real phenomenon — and understanding them more fully will make you a more effective and confident practitioner.