Are Trigger Points Real? — A Massage Therapist’s Deep Dive Into Trigger Point Therapy

Hey there — I’m glad you're here. I’ve been a massage therapist for over two decades, and one question I hear (in one form or another) more than any other is: “Are trigger points real — or just a myth?”

It’s a deceptively simple question, and the short answer is: Yes, trigger points are real — but there’s nuance. Understanding them well, applying therapy intelligently, and respecting both science and experience is what separates a “trigger point believer” from a true practitioner. In this blog, I’ll walk you through my perspective (shaped by years of hands-on work, anatomy, reading, and teaching), and share a balanced, science-informed but experiential take on trigger point therapy.

What Is a Trigger Point?

To start, let’s define our terms so we’re on the same page. In the massage world, a “trigger point” (often abbreviated “TP”) typically refers to a hyperirritable spot in skeletal muscle (or its fascia) that is painful when compressed, and which may produce referred pain, local twitch responses, or other sensory phenomena.

Some useful characteristics often associated with trigger points:

• A tender nodule or band in a taut muscle fiber

• Pain that’s reproduced when you press that spot

• Referral patterns (i.e. pressing here can cause pain elsewhere)

• Sometimes, a “jump sign” or local twitch when you press or snap over it

Trigger point therapy, then, is the body of manual (or assisted) techniques to assess, locate, and resolve these hyperirritable spots, generally by applying sustained pressure, strokes, ischemic compression, etc.

But — that definition, though broadly accepted in massage and manual therapy circles, does not tell the whole story. For many years, the scientific literature debated whether trigger points exist in the way therapists believe, whether they can be reliably detected, and how (or even whether) manual interventions truly “resolve” them.

The Skeptics, the Science, and the Nuance

If you go digging in medical research or pain science literature, you’ll find more than a few papers casting doubt on trigger points. Some of the criticisms or challenges include:

• Lack of consistent diagnostic criteria — different studies use different definitions for what counts as a trigger point.

• Reliability issues — inter-rater reliability (i.e. agreement between different examiners) is often low.

• Placebo / non-specific effects — some question whether apparent relief is due to non-specific effects (e.g. expectation, pressure, tissue warming) rather than “fixing a trigger point.”

• Anatomical ambiguity — it’s hard under imaging or histology to see a “trigger point nodule” consistently.

So the science is not settled. But here’s where experience and nuance come in: science doesn’t have all the answers yet, but therapists who work with trigger point therapy daily see patterns, responses, and consistent results that give credence to the concept — if handled intelligently.

From my vantage point, I see trigger points as a useful model — a useful working hypothesis. They may represent a constellation of microstructural changes (e.g. motor endplate dysfunction, increased metabolic stress, local ischemia, neurogenic sensitization) rather than a neatly bounded “hot dot” you can photograph. But that doesn’t mean they’re worthless. Over time, skilled palpation, consistent responses, and clinical feedback convince me they are real in practice.

What Happens Biologically?

Let’s get a bit more technical — but not so much that you glaze over. Consider what may be happening in a trigger point (all of this is plausible, though some are hypotheses):

1. Sustained micro-contraction / motor endplate dysfunction
   At the site of the trigger point, some sarcomeres may remain in a contracted state due to excessive acetylcholine release or impaired reuptake. That sustained contraction compresses local blood vessels and lymphatics.

2. Local ischemia / hypoxia
   Because the contracted fibers constrict capillaries and perhaps compress venules, local blood flow drops. This leads to a buildup of metabolic waste (e.g. lactic acid, bradykinin) and a drop in oxygen. This chemical milieu sensitizes nociceptors (pain sensors).

3. Neurogenic sensitization
   The chemical milieu (e.g. substance P, CGRP) and low-grade inflammation sensitize local nerve endings. This means a stimulus that would not normally cause severe pain now does.

4. Referred pain, central sensitization
   The sensitized area may generate referred pain via the nervous system, contributing to what patients feel “away” from the actual trigger point. Over time, this process might contribute to central sensitization (the nervous system increasing its gain), making nearby tissues more reactive.

5. Spreading irritability
   One further notion is that a trigger point can “recruit” neighboring motor units or fascial planes; the area of dysfunction may grow if left untreated.

So, in sum: a trigger point is not a static “ball” but rather a dynamic zone of altered physiology — partly mechanical, partly biochemical, partly neurological.

Why Many Therapists Believe (From Experience)

You might wonder: “If the science isn’t definitive, why do seasoned therapists still swear by trigger point work?” Here’s why I (and many colleagues) consider it central to our craft:

• Consistent palpatory feedback
  Over years, one learns to sense subtle differences: a little “grittiness,” a denser band, that little gasp from a client. Trigger points feel different than surrounding tissue in many cases.

• Predictable referral patterns
  Over time, you’ll see that pressing certain spots in the upper trapezius often reproduces a headache. Pressing a spot in the glute med may refer down the leg. These patterns develop consistency across many clients.

• Good response
  When you treat a suspected trigger point (with care, patience, and correct technique), many clients report reduced pain, greater range of motion, or diminished symptoms. That clinical feedback is powerful.

• Integration with other modalities
  Trigger point work often enhances the effect of other modalities (stretching, strengthening, movement therapy). It’s not the only tool — but it can unlock a “stuck door” so things move better.

• Teaching and transferability
  I’ve taught many therapists (through workshops, mentorship, online courses) who began skeptical — and later saw clear differences in their results when they adopted principled TP work. That’s compelling.

So yes — we lean heavily on clinical intuition, pattern recognition, and repeated feedback loops between therapist and client.

Common Misunderstandings & Pitfalls

Because trigger point therapy is so popular, many misunderstandings or poor adaptations have spread. Let me warn you — these are traps that less-experienced therapists often fall into.

Mistake #1: Treating trigger points as “magic bullets”

Some say, “I just work the trigger point and everything is gone.” That’s naive. Trigger points are seldom the only factor in pain. Often there are biomechanical imbalances, postural habits, kinetic chain issues, movement patterns, neural restrictions, etc. Using trigger point work as one tool (not the only one) is wiser.

Mistake #2: Over-aggressiveness / too much pressure

Many novices think “the deeper, the better.” But overly aggressive pressure can actually irritate tissues, provoke guarding, or worsen sensitization. Or cause bruising or soreness next day that hinders the healing process. In sensitive or chronically painful clients, gentle, graded pressure and respect for client feedback is crucial.

Mistake #3: Relying solely on charts and maps

Trigger point charts (with colored referral patterns) are helpful guides. But real humans are individual. Don’t be rigidly bound to “this trigger must refer here.” Use the maps, but always check with palpation, client feedback, and exploration.

Mistake #4: Poor palpation skills

Trigger point palpation is a craft. If your palpation is clumsy, superficial, or inconsistent, you’ll mis-locate or misinterpret. Many therapists under-train palpation (i.e. just learn a technique but not feel deeply). Take time — years — to refine it.

Mistake #5: Ignoring the nervous system, biomechanics, or movement

Trigger points sometimes exist because of repetitive postures, joint restrictions, or neural tension. If you don’t correct contributing factors (e.g. scapular mechanics, thoracic mobility, neural glides), you may be chasing symptoms. You need a systems view

My Approach: A Step-By-Step Framework

Below is a rough framework I use when assessing and treating trigger points. Some of these steps are intuitive and honed by practice; others are more “textbook.” I share it so you can adapt or test in your own practice.

1. Intake & history

Before even touching the body, I ask:

• Onset and evolution of symptoms

• What aggravates / relieves

• Posture, work habits, hobbies, repetitive movements

• Previous treatments, imaging, surgeries

• Sleep, stress, general health

This helps me hypothesize likely trigger point sites and contributing structures.

2. Global screening & movement testing

I have the client move, stretch, flex, rotate. That gives me clues: where is range limited? Where is movement painful or restricted? What muscles feel “off” or tight? I may use orthopedic or neural tension tests too.

3. Regional palpation and comparison

I begin by feeling gross tissue tone, comparing left vs. right, superficial vs. deep. Then I narrow in on taut bands or nodules, applying gentle perpendicular pressure to see where sensitivity, referral, or twitch occurs. I use the client’s feedback (“Is that hurting?”) to guide me.

4. Provocation & confirmation

Once I locate a suspected hotspot, I press more carefully, trying to see if pain is reproduced or referred. Sometimes, I’ll do a small pinch-and-release to elicit a twitch. If the spot lights up the symptom, I have greater confidence. But I remain open to adjusting or abandoning hypotheses.

5. Treatment (manual techniques)

Here are some of the techniques I use:

• Ischemic compression: apply steady pressure (e.g. 10–30 seconds or more), gradually increasing intensity if tolerated

• Slow strokes / stripping: along the length of the muscle, often crossing the band

• Micro-mobilization / small oscillations: fine rocking or small directional pushes

• Instrumentation-assisted (tools, wooden tools): sometimes using tools to increase precision or reduce therapist fatigue

• Stretch + hold: after decompressing, gently stretch the muscle

• Loaded active movement (if client is able): have the client contract or move the muscle gently to help “reset” it

During the treatment, I constantly check in verbally and palpatorily: is pressure tolerable? Has the tissue changed? What feedback is the client giving?

6. Post-treatment strategies

After the trigger point is more pliable (or less irritable), I may prescribe:

• Gentle home stretching or “trigger point self-release” (if safe)

• Movement corrections, ergonomic advice

• Strengthening of antagonists or stabilizers

• Neural glides or joint mobilizations if needed

• Reassessment in subsequent sessions

7. Recheck & progression

In the next session (or even later in the same session), I always re-palpate the area to see whether the sensitivity has reduced, whether the referral changed, or whether new spots have emerged. Over time, I map the “terrain” of that client’s trigger point landscape.

When Trigger Points Get Stubborn

Sometimes a trigger point refuses to relent. These “stubborn” trigger points demand extra care. Here are some reasons they persist — and what I do:

• High sensitization — the nervous system is “primed” so that even small stimuli generate pain

• Poor vascular delivery — perhaps due to compression, scar, or posture

• Multiple overlapping dysfunctions — maybe a joint restriction or nerve entrapment is perpetuating tension

• Chronicity & central sensitization — over time, the pain gets “wired in” more deeply

In these cases, I may:

• Scale back pressure (go gentler, longer)

• Use more frequent but shorter sessions

• Use modalities to reduce neural sensitivity (heat, cold, gentle vibration)

• Work “around” the spot (proximal or distal) before directly attacking

• Invite more movement, proprioceptive input, and functional reintegration

• Collaborate with other practitioners (physio, chiropractor, etc.)

It’s rare that one press “fixes” a chronic Latin trigger point in 10 minutes. Patience, consistency, and respectful progress are essential.

Scientific Evidence — What It Supports & What It Doesn’t (Yet)

Because you asked “Are trigger points real?”, I owe you a fair look at the research.

Supporting evidence

• Some EMG / ultrasound studies show spontaneous electrical activity or “endplate noise” in palpable bands consistent with motor endplate dysfunction.

• Research supports that manual pressure in trigger points can reduce pain and increase pressure pain thresholds (i.e. less sensitivity).

• Some RCTs (though limited) show benefits of myofascial trigger point therapy (MTrP therapy) for conditions like tension-type headache, myofascial pain syndrome, etc.

• Meta-analyses often conclude that trigger point therapy is promising, though heterogeneity of studies makes conclusions provisional.

Weaknesses / gaps

• Small sample sizes, lack of blinding, inconsistent protocols

• No universal “gold standard” for diagnosing trigger points

• Limited imaging/histologic proof

• Uncertain long-term durability (many studies look short-term outcomes only)

In short: the evidence base is supportive, but not conclusive. Practitioners must fill in gaps with clinical judgment, feedback, and experience.

How to Teach Trigger Point Work Safely & Effectively

If you're a trainer or mentor (or aspire to be), here’s what I’ve learned over the years about teaching good trigger point therapy (versus just showing a technique).

1. Start with palpation fundamentals
   Teach sensitivity, discriminative touch, layers — let your students feel gradually deeper. Drill tactile discrimination (soft vs firm, yielding vs taut).

2. Stress feedback loops
   Encourage students to frequently check with clients (“does this feel more, less, same?”), not just “power through.” Teach them to adapt mid-treatment.

3. Teach mapping, but not dogma
   Trigger point referral charts are tools, not rules. Encourage students to test, verify, and adapt.

4. Encourage “less is more”
   It’s better to start gentler and escalate, than start too hard and provoke soreness or guarding.

5. Incorporate screening, functional context
   Show students how trigger point work relates to posture, movement, joint function, and neural dynamics.

6. Provide case studies / feedback loops
   Use real clients, before-after scenarios, and hands-on assisted mentoring.

7. Encourage ongoing refinement
   Trigger point work is an art as much as science. Encourage your students to keep a journal, collect feedback, test, and evolve.

If you're interested in deepening your practice and perhaps teaching, I’d love for you to check out our online trigger point therapy courses, part of the NAT / Niel Asher Education offerings. (You can see more here: NAT Trigger Point Therapy Courses)
These courses combine theory, palpation drills, clinical case studies, and feedback loops tailored for therapists aiming to elevate their work.

Client Communication & Informed Consent

A good therapist isn’t just a skilled hand — you’re also a guide and educator. With trigger point work (which often involves discomfort), transparency and consent matter.

• Explain to clients what a trigger point is (in simple terms), why you think you’re approaching it, and what you’ll feel (some discomfort, but not sharp pain).

• Set expectations — relief may come gradually, and soreness afterwards can occur.

• Check in frequently — during treatment: “Is this okay? Do you need me to back off a little?”

• Teach self-care — show clients gentle stretches or self-release (if safe) so they can assist their own recovery.

• Track progress — use notes, photos, range-of-motion measures, pain scales so both you and the client see change over time.

When clients feel involved in their process, outcomes and satisfaction tend to improve.

Sample Case: From Skepticism to Breakthrough

Let me walk you through a real (anonymized) case that illustrates the power and the nuance of trigger point therapy.

Client background
“Amy” was a software engineer in her 30s, complaining of long-term upper trapezius/neck pain, frequent tension headaches, and stiffness. She sat at her desk 8–10 hours a day, with head-forward posture and minimal exercise.

Initial assessment
Movement testing showed limited cervical extension, side-bending, and rotation. Palpation revealed several taut bands across upper traps and splenius, one particularly tender nodule midway between C7 and the acromion. Pressing that spot reproduced a headache sensation behind the eye (a known referral pattern).

Treatment steps

• I used ischemic compression gradually (10 s → 20 s → 30 s) while watching her facial feedback

• I followed with slow strokes across the upper trap in cross-fiber direction

• After some softening, I gently stretched cervical side-bending and scapular retraction

• I also checked shoulder girdle and scapular mechanics, noting her left scapula was slightly protracted

• I gave a simple self-care stretch (standing side-bend with arm overhead) and a gentle self-release instruction using a tennis ball

Follow-up & progression
In the next session, the “hot” spot was much less sensitive. I explored adjacent muscles and found a bit of rhomboid tension. Over 4–5 sessions, pain and headache frequency dropped significantly. With posture and strengthening corrections, she reported much more freedom of neck motion and fewer tension days.

What’s important: at each session I re-palpated, adapted strategy, and worked in the context of her movement and habits — not just punching “the trigger.”

Practical Tips & Tricks (from My Toolbox)

Because I love sharing what works, here are some pearls I’ve picked up over my years:

• Warm the area first (heat, light strokes) before heavy pressure

• Use the client’s breath: ask them to exhale while you apply pressure

• Start with milder pressure, build gradually

• Use multiple angles (perpendicular, oblique) to probe the spot

• Sometimes press just beside the “hot” nodule, not directly on top (especially in sensitive cases)

• Use short rests: press 10–20 s, rest 5–10 s, press again

• Use cross-fiber strokes to “flush” the area

• Use tools if your thumbs or fingers fatigue (wooden tools, balls, etc.)

• Always compare sides (left vs right) and before vs after in a session

• Don’t ignore the “satellites” — often treating a neighbor muscle can calm the main one

• Be cautious after treatment — clients sometimes feel soreness or fatigue, so plan lighter sessions or rest afterward

When Trigger Point Therapy Doesn’t Help — What Then?

Even a great trigger point therapist will encounter times when the work doesn’t seem to help (or only partly helps). Here are some alternative or complementary paths I take:

• Refer out for further assessment (imaging, nerve conduction, orthopedic consultation)

• Neural mobilization — if there’s a nerve entrapment or tension component

• Joint mobilization / chiropractic input — sometimes joint restrictions (e.g. cervical facets) perpetuate muscular tension

• Visceral / systemic considerations — sometimes hormonal, endocrine, or systemic issues (sleep, nutrition, stress) are underlying amplifiers

• Pain neuroscience education — when sensitization and fear-avoidance patterns are strong

• Movement therapy, corrective exercise, ergonomics — to reduce re-irritation

It’s not a failure — it’s just one piece of the care puzzle.

Who Should (and Shouldn’t) Use Trigger Point Therapy?

Good candidates:

• Clients with myofascial pain or MPS (myofascial pain syndrome)

• Clients whose symptoms show signs of local tenderness, referral, or banded tension

• Clients motivated to do follow-up self-care and movement

• People in relatively good health without serious systemic contraindications

Contraindications / caution:

• Acute inflammation or infection in the area

• Recent surgery, fractures, or open wounds

• Severe osteoporosis or structural instability

• Bleeding disorders or use of blood-thinners (be extra cautious with pressure)

• Cancer in the area (unless cleared)

• Pregnancy (some areas are sensitive; always proceed with caution and check with their healthcare provider)

Always screen carefully, and when in doubt, err on the side of gentler approaches or referral.

The Future of Trigger Point Therapy: Integration, Research, and Teaching

Looking ahead, here are what I see as helpful directions for the field:

• Better imaging / biomarkers — if we could better visualize or quantify trigger point zones (via elastography, ultrasound, MRI), it would help the science.

• Standardized protocols — more consistent definitions, pressure parameters, outcome measures in studies.

• Integration with pain neuroscience — combining manual work with patient education and sensorimotor retraining.

• Tech-assisted palpation / feedback — imagine sensors or pressure-feedback tools helping guide therapists.

• Online / blended learning — offering rigorous but remote courses (practical video + mentoring) to elevate global therapist standards.

That last point is something close to my heart. Which brings me to one more plug: if you’re a serious therapist (novice or experienced) wanting to deepen your understanding of trigger point therapy — not just the “how” but the “why” and how to apply it elegantly — check out the NAT / Niel Asher Education trigger point therapy courses. They’re structured to blend theory, palpation exercises, case study learning, and practical feedback. You can glance at the offerings here: NAT Trigger Point Therapy Courses

Final Thoughts: Real, Useful, but Not Magical

So — are trigger points real? My bottom-line: yes — but they are real as complex, multifaceted neuromuscular phenomena, not as magical instant-fix balls. They are one lens, among many, through which to view pain and tension. The best therapists treat them humbly, carefully, and in context.

If you’re a massage therapist or manual bodyworker, I encourage you to test, feel, refine your approach. Aim to develop sensitive palpation, curiosity, and a feedback-based mindset. Use trigger point therapy neither as a crutch nor a fetish, but as a powerful tool in your toolkit.

If you ever want help refining your palpation, discussing tricky cases, or exploring advanced trigger point strategies — I’m here. And if you want to join us in the online courses, we’d be honored to guide your journey.

Thanks for reading. Keep your hands curious — and your listening sharp.