Musculoskeletal · Patient education from the Pegasus Peak physiotherapy team.
Reviewed by the Pegasus Peak physiotherapy team — AHPRA-registered physiotherapists led by principal physiotherapist Kosta Logothetis. Last reviewed 2025-11-23.
Trigger points explained, what they are, why they form, and how to treat them with symptom relief, load management, and targeted rehabilitation strategies.
Muscle knots: real, but more nuanced than most people think. Here's the evidence — and what actually works.
When it comes to muscle pain and tension, trigger points are one of the most frequently discussed yet often misunderstood topics in musculoskeletal health. Though the concept has evolved significantly over the past few decades, trigger points continue to play a central role in the understanding and management of myofascial pain.
Trigger points are hyperirritable areas found within taut bands of skeletal muscle fibers. The concept was first described over 30 years ago by Travell and Simons, who classified them into two types, active and latent trigger points.
Active trigger points are tender to touch and create a predictable pattern of referred pain. Latent trigger points, on the other hand, are present but not yet painful until provoked or stressed (Diakow, 1992).
Everyone has latent trigger points, but they only become clinically relevant when pain develops, a phenomenon referred to as myofascial pain syndrome.
Emphasized photo of a trigger point along the upper traps
Although the existence of trigger points is well-documented in clinical practice, the exact mechanism behind their formation remains debated, as no single anatomical or biomechanical cause has been conclusively proven. However, two of the main leading theories attempt to explain their development.
According to this model, muscle fibers become overactive, leading to localized inflammation and a shortage of oxygen and nutrients. This hypoxic environment causes the muscle fibers to shorten, creating a cycle of increased metabolic demand and pain sensitivity (Frontiers in Medicine, 2024). The resulting microenvironment fosters the palpable lumps that are identified as trigger points.
Trigger points can also be explained through the concept of sensitization, a process where the nervous system becomes hypersensitive to pain.
Peripheral sensitization occurs when pain receptors at the muscle level are repeatedly stimulated, increasing local sensitivity.
Central sensitization involves changes within the spinal cord and brain that heighten pain perception, even after the initial cause subsides (Fernández-de-las-Peñas et al., 2007, Woolf, 2011).
This mechanism helps explain why some people experience widespread or chronic myofascial pain, even in the absence of significant structural damage.
While the underlying causes may still be under investigation, treatment strategies are generally well established. Managing trigger points effectively involves three key steps,
The initial goal of treatment is to reduce pain and discomfort. This can be achieved through several manual or adjunct therapies, all of which aim to restore blood flow and relax shortened muscle fibres.
Common approaches include,
These treatments offer short-term relief, making it easier to transition to long-term rehabilitation.
Active trigger points do not form spontaneously, they typically arise as a response to excessive load. “Load” does not always mean heavy lifting, it can also involve repetitive movements, prolonged positions, or sudden increases in activity.
Identifying and modifying these contributing factors is key. For example, if calf trigger points arise from increased walking distance, temporarily reducing the duration of the walks/load allows the muscle to recover. Nevertheless, supportive tools such as strapping or taping can also help deload the affected area while maintaining functional activity.
Exercise is the final and most important step in resolving trigger points long term. The aim is to facilitate muscular adaptation so that the muscle can tolerate load without recurring pain.
If trigger points developed from repetitive low-load activity (e.g., prolonged sitting or light repetitive lifting), focus on endurance exercises for the involved muscles.
If they resulted from heavy, infrequent lifting, target strength development through low-rep, high-load exercises.
The key is progressive loading; the exercise should challenge the muscle without reproducing pain. Over time, this retrains the muscle to perform efficiently under everyday demands which prevents the active trigger points from reforming.
Trigger points remain a complex but important concept in understanding myofascial pain. While the exact mechanism is still under debate, most agree that they result from a mix of neuromuscular, vascular, and metabolic factors.
Effective treatment hinges on addressing both the symptom and the cause, easing pain through manual therapy, reducing aggravating load, and progressively reloading the muscle through exercise can reduce recurrence and maintain long-term muscular health.
Diakow, P. R. (1992). Differentiation of active and latent trigger points by thermography.Journal of Manipulative and Physiological Therapeutics, 15(7), 439–441.
Fernández-de-las-Peñas, C., Cuadrado, M. L., Arendt-Nielsen, L., Simons, D. G., & Pareja, J. A. (2007). Myofascial trigger points and sensitization: An updated pain model for tension-type headache.Cephalalgia, 27(5), 383–393.
Lim, E. C. W., Tay, B. K. J., Jeyaraman, M. M., Tow, N. S., Lo, W. L. A., & Ho, C. Y. (2024). Understanding myofascial trigger points: Integrating clinical insights and physiological mechanisms.Frontiers in Medicine.https://doi.org/10.3389/fmed.2024.1433070
Woolf, C. J. (2011). Central sensitization: Implications for the diagnosis and treatment of pain.Pain, 152(3), S2–S15.
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