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Treating Masseter Trigger Points - Dr. Jonathan Kuttner



Ischemic Compression Technique


Masseter trigger points are significant contributors to headaches

A forward-head posture places the mandible in a position that puts the masseter under undue stress.

Antagonist muscles, such as the geniohyoid, omohyoid, and digastric, can all become spastic as a result of overtraining of the abdominal muscles using poor technique.

This in turn may inhibit the masseter, with resulting trigger point formation to provide stiffness or tension within the muscle.

Changes in associated suboccipital muscles lead to changes in homeostasis of the head and face muscles.

A change in the positioning of the temporomandibular joint will also affect the position of the cervical spine.

Correct alignment of the temporomandibular joint requires treatment of the masseter and pterygoids at the local level, with attention to core efficiency at the global level.

The masseter is a complex muscle, and pain is referred into the eyebrow, maxilla, mandible (anterior), and upper and lower molar teeth.

Any person with a toothache will rightly go to a dentist.

With no obvious pathology presenting, it is in the patient’s best interests to rule out the possibility of referred pain from trigger points being at the root of the pain.

Other related sensations include hypersensitivity to pressure and temperature changes (e.g. during flights).

Pain and changes in sensations can also refer into the temporomandibular joint and inner ear.

Remember also that masseter trigger points are significant contributors to headaches.


Masseter Trigger Points

Masseter - Common Trigger Point Sites



Zygomatic process of maxilla. Medial and inferior surfaces of zygomatic arch.


Angle of ramus of mandible. Coronoid process of mandible.


Closes jaw. Clenches teeth. Assists in side to side movement of mandible.
Antagonist: platysma.


Trigeminal V nerve (mandibular division).

Basic Functional Movement

Chewing food.

Referred Pain Patterns

Superficial: eyebrow, maxilla, and mandible (anterior). Upper and lower molar teeth.
Deep: ear and TMJ.


Trismus (severely restricted jaw), TMJ pain, tension/stress headache, ear pain, ipsilateral tinnitus, dental pain, bruxism, sinusitis pain, puffiness under the eyes (often present in singers).


Chewing gum, tooth grinding/ bruxism, prolonged dental work, stress, emotional tension, head- forward postures.

Differential Diagnosis

TMJ pain/syndrome. Tinnitus. Trismus.


Ipsilateral temporalis, medial pterygoid, contralateral masseter, SCM.

Trigger Point Treatment Techniques

Compression YES
Muscle Energy Techniques YES
Positional Release YES
Dry Needling YES


Bite Plates/Occlusal Splints

Opinion varies as to efficacy, type, and duration of use of occlusal devices. An evidence base suggests they can be beneficial.

Breathing and Stress Control Techniques

Stress, tension, and poor breathing mechanics can be a factor. Autogenic and breathing methods might be worth exploring for some.


Head forward or upper crossover patterns can be treated by a range of manual and trigger point therapists.


Stop tooth grinding (bite plates). Work posture (telephone). Posture of head–neck–tongue. Stop chewing gum/ice/nails.

Self Help

Use pincer grip, placing thumb inside the mouth.



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We are honored to have received the 2017 "Excellence in Education" Award from the National Association of Myofascial Trigger Point Therapists.

Since 1999 Niel Asher Education has won numerous awards for education and in particular for education and services provided in the field of trigger point therapy.

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Niel Asher Healthcare course instructors have won a host of prestigious awards including 2 lifetime achievement honorees - Stuart Hinds, Lifetime Achievement Honoree, AAMT, 2015, and Dr. Jonathan Kuttner, MD, Lifetime Achievement Honoree, NAMTPT, 2014.

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This trigger point therapy blog is intended to be used for information purposes only and is not intended to be used for medical diagnosis or treatment or to substitute for a medical diagnosis and/or treatment rendered or prescribed by a physician or competent healthcare professional. This information is designed as educational material, but should not be taken as a recommendation for treatment of any particular person or patient. Always consult your physician if you think you need treatment or if you feel unwell. 





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