Finding Myofascial Trigger Points
A Practical Guide to Working with Myofascial Trigger Points
When patients present with persistent pain, the root cause often lies in overlooked myofascial trigger points (MTrPs). While many practitioners are aware of trigger points and their referral patterns, few adopt a consistent, step-by-step protocol to locate all potential culprits and address the contributing factors that keep these taut bands active. A broad, strategic plan—rooted in both clinical assessment and patient participation—is key to achieving long-term relief.
Below is an outline of how you can refine your trigger point therapy approach to significantly improve patient outcomes.
A Hidden Source of Pain
Muscle pain is the most common cause of pain - but it may not show up on imaging or lab workups. Additionally, trigger points and muscle pain can cause referred pain which originates outside the immediate region where pain is felt. Simply probing painful spots (ashi points) may uncover only a fraction of the involved sites. This mismatch between pain location and the actual trigger point emphasizes the importance of conducting “detective work” to find and treat hidden sources.
Why Trigger Points Matter
Referred Pain: Many trigger points refer pain to remote regions of the body, confusing both the patient and the practitioner.
Perpetuating Factors: Chronic conditions, lifestyle habits, nutritional deficits, and biomechanical stressors can keep triggers active indefinitely.
Patient Engagement: Once they understand how trigger points form and linger, patients can play a proactive role in their own healing.
Detailed Patient Histories and Pain Mapping
The foundation of good clinical practice starts with comprehensive data collection. Encourage patients to map their discomfort on a body diagram at every visit, noting how severe and frequent each complaint feels. Instruct them to mark specific zones—no large circles or ambiguous scribbles—and compare their maps to common trigger point referral charts. This targeted “pain mapping” will guide your investigation.
Key Points for Effective Mapping
Frequency and Intensity: Ask patients to rate each site of pain to gauge changes between sessions.
Progress Tracking: Improvement can manifest as either a decrease in pain intensity or a reduced area of discomfort.
Identifying Red Flags: If certain pain patterns do not improve or worsen, additional medical evaluation may be warranted.
Mastering Referred Pain Patterns
Because the majority of trigger points exist outside their referral zones, you need a reliable system to match symptomatic areas with typical (and sometimes atypical) referral patterns. Mastery of these patterns ensures you can systematically check the right muscles—even if they do not lie near the reported pain.
Use of Guides and Charts: Invest in at least one comprehensive text dedicated to trigger point therapy that includes “pain guides,” listing muscles by the regions where they refer discomfort.
Overlapping Referrals: Multiple trigger points from different muscles can blend into a “composite” pattern. For instance, migraines may involve the trapezius, sternocleidomastoid (SCM), and suboccipital muscles simultaneously.
Example: Temporal Headaches
If your patient reports frequent temple pain, you might start by examining the temporalis muscle. However, trigger points in the SCM, trapezius, and even posterior cervical muscles could also generate similar temple pain patterns. Mapping these possibilities in advance helps you avoid missing a crucial hidden trigger point.
Looking for Additional Clues
Not all trigger point presentations are straightforward. Similar pain patterns can emanate from different muscles, and each muscle has its own set of telltale signs beyond just localized or referred pain. For instance, some triggers can cause seemingly unrelated symptoms like tinnitus, eye twitching, or digestive upsets.
Cross-Refer With Symptoms: Review your patient’s complaint forms for details like jaw clenching, ear ringing, or unusual muscle fatigue. These can point you toward lesser-known MTrPs.
Historical and Environmental Factors: A history of car accidents, repetitive strain at work, or postural deficits can all systematically activate trigger points.
Example: The “Chain Reaction”
When a primary trigger point remains untreated, it can refer pain to another muscle, eventually creating a “chain reaction” of satellite trigger points. Each subsequent muscle may develop its own referral pattern, complicating diagnosis. Understanding that local, satellite trigger points are rarely the origin of the problem helps you focus on the muscle that started the cascade.
Prioritizing Trigger Points to Treat First
If a patient presents with multiple pain complaints, trying to address everything in one session can dilute your effectiveness. Instead:
Focus on the Most Concerning Areas
Have your patient identify their top one or two priority complaints. This narrows your treatment scope, allowing you to work thoroughly on each region.Rank Muscles by Likelihood
Reference your trigger point guide, noting which muscles most commonly contribute to the pain. Where Drs. Janet Travell and David Simons might list the upper trapezius first for certain headache patterns, you may discover other patterns in your particular patient demographic.Watch for Immediate Feedback
If symptoms ease—even briefly—after needling specific muscles, that’s strong evidence you targeted at least one relevant trigger point. If relief evaporates quickly, re-examine perpetuating factors or investigate other involved muscles.
Identifying and Addressing Perpetuating Factors
Long-lasting improvement hinges on uncovering and mitigating any underlying issues that keep trigger points active. These factors are wide-ranging:
Nutritional Deficiencies: Lack of essential vitamins and minerals can hamper muscle recovery.
Postural Habits: Forward head position, slouched shoulders, or repetitive movements strain specific muscles repeatedly.
Sleep Disorders: Chronic insomnia or poor sleep quality leaves muscles in a constant state of tension.
Emotional Stress: Persistent anxiety or unrelenting work stress can induce or exacerbate trigger point formation.
Systemic Illness: Conditions like hypothyroidism or anemia can generate fatigue and muscle hypersensitivity.
Where appropriate, refer your patient to allied health professionals for lab work, imaging, or specialized interventions. Although it’s outside many acupuncture scopes to diagnose medical conditions, awareness of these possibilities allows you to guide patients toward comprehensive care.
Empower Patients With Self-Help
Even with regular clinical visits, patients spend most of their lives self-managing. Show them targeted pressure techniques, stretches, and ergonomic modifications that align with their unique situation. Small, realistic steps are more effective than sweeping lifestyle overhauls that may overwhelm them.
Practical Self-Care Strategies
Short, Targeted Exercises: Simple neck stretches or jaw-release movements if they sit at a desk all day.
Ergonomic Adjustments: Encouraging breaks from computer tasks, adjusting seat height, or using a lumbar support pillow.
Mindful Stress Reduction: Basic breathing exercises or guided meditation to reduce muscle tension associated with stress.
Nutritional or Sleep Recommendations: Suggest incremental changes, such as reducing caffeine late in the day or exploring magnesium supplementation if indicated.
By teaching these self-care methods, you empower patients to take control of their healing process. That empowerment often leads to faster, more durable improvement.
The Path to Consistent Results
Trigger point work can be exceptionally rewarding once you adopt a structured approach. Rather than randomly poking at painful spots, each step in this process—comprehensive histories, precise mapping, targeted muscle checks, prioritizing the worst symptoms, eliminating perpetuating factors, and involving patients in self-care—forms a cohesive system that boosts your success rate and patient satisfaction.
Taking time to master these strategies will sharpen your clinical skills, reduce patient frustration from recurring pain, and build a stronger therapeutic alliance. Whether you practice acupuncture, physical therapy, or another holistic modality, the real power lies in combining meticulous evaluation with personalized treatment plans.
By embracing this systematic trigger point protocol, you not only help patients feel better faster—you also equip them with the knowledge to stay pain-free in the long run.
Step-by-Step Summary to Identifying Hidden Myofascial Trigger Points
Gather Comprehensive Patient Histories
Encourage patients to map their pain precisely on a body diagram.
Document pain intensity, frequency, and any associated symptoms or red flags.
Correlate Symptoms with Referral Patterns
Compare patient-reported pain areas to known trigger point referral guides.
Investigate muscles that refer pain to the region, even if they lie far from the reported discomfort.
Check for Overlapping or “Composite” Referral Areas
Recognize that multiple muscles may contribute to the same painful zone.
Rule out secondary “satellite” trigger points generated by long-standing primary triggers.
Identify Additional Clues and Contributing Factors
Look beyond pain for signs like jaw clenching, ear ringing, or posture issues.
Investigate lifestyle, work environment, or history of accidents that could perpetuate muscle tension.
Prioritize the Most Problematic Zones First
Focus on one or two priority complaints to achieve meaningful progress.
Use immediate symptom relief (or lack thereof) as feedback to guide further treatment.
Address Perpetuating Factors for Lasting Results
Evaluate exercise habits, nutritional deficiencies, stress, poor posture, and sleep quality.
Refer for further medical evaluation if an underlying condition is suspected.
Empower Patients with Self-Care Techniques
Demonstrate simple pressure release methods, stretching routines, and ergonomic tips.
Offer manageable, incremental lifestyle changes rather than overwhelming overhauls.
Monitor Progress and Adjust as Needed
Compare ongoing patient feedback and updated pain maps to identify treatment effectiveness.
Modify strategies, add new techniques, or explore additional trigger points if improvement stalls.
Over to you
If you liked this article, please share with friends and family who may be suffering with myofascial pain and trigger points.
FAQ Section
What are myofascial trigger points (MTrPs)?
Myofascial trigger points are tight, hyperirritable bands within a muscle that can cause local or referred pain. They often develop from stress, injury, or repetitive strain and can remain undetected if not systematically evaluated.
Why do trigger points often go undetected?
Many trigger points refer pain to areas far from their actual location, making it difficult to pinpoint the root cause based solely on pain symptoms. Imaging tests and standard exams may also miss these taut bands, so careful clinical assessment and “pain mapping” are crucial.
How is referred pain different from localized pain?
Referred pain occurs when a trigger point in one muscle sends pain signals to a distant body region, which can confuse both patients and practitioners. Recognizing typical referral patterns is key to locating and treating the true source of discomfort.
Can I manage my trigger points at home?
Yes. While professional assessment is highly recommended, patients can use self-care techniques such as targeted pressure (like gentle self-massage), stretching exercises, ergonomic adjustments, and stress reduction methods to help deactivate or prevent trigger points.
What role do perpetuating factors play in chronic pain?
Perpetuating factors—such as poor posture, nutritional deficiencies, stress, or underlying health conditions—can keep trigger points active over time. Addressing these issues alongside direct trigger point therapy is essential for long-term relief.
How do I know if I need professional help?
If your pain is persistent, worsening, or accompanied by other unexplained symptoms, it’s best to seek professional evaluation. A trained practitioner can help pinpoint underlying causes, provide targeted treatments like acupuncture or manual therapy, and offer guidance on lifestyle modifications.
What can I expect from a systematic trigger point therapy session?
In a structured session, your practitioner will take a comprehensive history, map out your pain patterns, and systematically check relevant muscles based on common referral zones. They’ll also address perpetuating factors and teach you self-care techniques for sustained improvement.
Sources:
Travell, J. G., Simons, D. G. (1993). Myofascial pain and dysfunction: The trigger point manual. London: Lippincott Williams & Wilkins.
Biel, A., & Dorn, R. (2010). Trail guide to the body: A hands-on guide to locating muscles, bones and more. Boulder, CO: Books of Dicovery.
Janda, Vladimír. “Muscle Function Testing.” (1983).
Disclaimer: This web site is intended for educational and informational purposes only. Reading this website does not constitute providing medical advice or any professional services. This information should not be used for diagnosing or treating any health issue or disease. Those seeking medical advice should consult with a licensed physician. Seek the advice of a medical doctor or other qualified health professional for any medical condition. If you think you have a medical emergency, call 911 or go to the emergency room. No acupuncturist-patient relationship is created by reading this website or using the information. Morningside Acupuncture PLLC and its employees and contributors do not make any express or implied representations with respect to the information on this site or its use.
Read more from our blog
