Social Wellness Massage

“Why does pressing on a knot sometimes make my muscle jump, and how can that actually help?”

What is a Trigger Point?

A trigger point is a tight, irritable spot in your muscle that can feel like a small knot. These spots often cause pain when touched, and that pain can even travel to other areas (called referred pain).

What Happens When You Press On It?

When I or another therapist applies pressure to a trigger point, the muscle may twitch suddenly. This is called a localised twitch response. It can feel strange at first, but it’s a good sign. It’s like the muscle is “resetting” itself.

Why It Helps

That twitch can:

• Release tightness
• Reduce local and referred pain
• Improve blood flow to the area
• Help the muscle relax and return to its normal function

Who It’s For

Trigger point therapy is useful for:

• Chronic pain
• Stiffness or restricted movement
• Headaches
• Muscle tension from stress or posture

Does It Hurt?

It can feel tender or intense during treatment, but most people feel relief shortly after. Some mild post-treatment soreness is normal.

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If you’re after a more scientific version….

Trigger points are hyperirritable spots in skeletal muscle, often found in taut bands of muscle fibres. They are associated with sustained contraction, motor endplate dysfunction, and ischemia. Palpation typically reproduces the patient’s pain, including referred pain patterns.

The Localised Twitch Response (LTR)

An LTR is an involuntary spinal cord reflex, which is a sudden contraction of the taut muscle band in response to mechanical stimulation (e.g. needling or pressure). It reflects local depolarisation and can be an indicator of effective treatment. LTRs have been correlated with:

• Reduction in spontaneous electrical activity (SEA)
• Restoration of sarcomere length
• Increased oxygenation and perfusion

LTR is like a “reset” signal to the neuromuscular system.

Proposed Mechanisms of Action

1. Neuromuscular Reset
   • LTR may disrupt abnormal endplate activity and restore normal motor unit recruitment.
   • Trigger points show abnormal spontaneous electrical activity on EMG. This normalises after LTR.
2. Improved Blood Flow
   • Ischaemia is common at active trigger points. Manual release and LTR improve microcirculation and tissue oxygenation (Shah et al., 2008).
3. Mechanical Disruption
   • Compression, stretch, or dry needling can mechanically disrupt contracted sarcomeres.
4. Pain Modulation
   • Stimulating the trigger point activates descending inhibitory pathways, reducing nociceptive transmission.
   • Pressure may also gate nociception via the Gate Control Theory (Melzack & Wall).

Clinical Evidence

A 2017 systematic review by Tough et al. found that trigger point therapy (manual or needling) significantly reduced myofascial pain, with effects persisting for weeks post-treatment. LTRs were associated with better outcomes in multiple RCTs.

Key randomized control trial findings:

• Fernández-de-las-Peñas et al. (2005): Manual trigger point release improved pain and ROM in patients with cervicogenic headaches.
• Dommerholt et al. (2006): Trigger point dry needling with elicited LTRs resulted in significantly greater pain reduction than needling without LTR.
• Cummings & White (2001): Meta-analysis found dry needling more effective than placebo for trigger point pain when LTRs were present.

When to Use Trigger Point Therapy

• Chronic myofascial pain
• Postural or overuse syndromes
• Muscle tension headaches
• Restricted ROM
• Pain with unclear origin (especially referred patterns)

References

1. Shah JP, Thaker N, Heimur J, Aredo JV, Sikdar S, Gerber LH. (2015). Myofascial trigger points then and now: a historical and scientific perspective. PM&R.
   https://doi.org/10.1016/j.pmrj.2014.11.010
2. Tough EA, White AR, Cummings TM, Richards SH, Campbell JL. (2009). Acupuncture and dry needling in the management of myofascial trigger point pain: a systematic review and meta-analysis of RCTs. European Journal of Pain.
   https://doi.org/10.1016/j.ejpain.2008.01.006
3. Fernández-de-las-Peñas C et al. (2005). Manual therapy versus dry needling for the treatment of myofascial trigger points in the upper trapezius: a randomized clinical trial. Clinical Rehabilitation.
   https://doi.org/10.1191/0269215505cr871oa
4. Cummings TM, White AR. (2001). Needling therapies in the management of myofascial trigger point pain: a systematic review. Arch Phys Med Rehabil.
   https://doi.org/10.1053/apmr.2001.25047