Myofascial Pain Syndrome: Trigger Points and How to Release Them

Dec, 9 2025

Chronic muscle pain that won’t go away-even after rest, ice, or painkillers-might not be a strain, a pinched nerve, or arthritis. It could be myofascial pain syndrome (MPS), a hidden culprit behind many persistent aches. Unlike general soreness, MPS comes from specific knots in your muscles called trigger points. These aren’t just tender spots; they’re hyperactive zones that send pain signals to other parts of your body, making it easy to misdiagnose. You might think your headache is from stress, your shoulder pain is from typing too long, or your jaw ache is from grinding your teeth. But if the pain keeps coming back in the same patterns, it could be your muscles talking in code.

What Exactly Are Trigger Points?

Trigger points are tiny, tight bands of muscle fiber, usually 2 to 10 millimeters across, that feel like little marbles under your skin. They form when muscle fibers stay locked in contraction, often because of injury, overuse, or poor posture. Think of it like a knot in a rope-you can’t just pull harder to fix it. The muscle is stuck, and that tension cuts off blood flow, creating a chemical soup of pain-causing substances like acetylcholine, serotonin, and acid. The pH in these spots drops to around 4.3, which is as acidic as a lemon. That’s why pressing on them hurts so much-and why the pain often spreads.

There are two types: active and latent. Active trigger points hurt on their own. You don’t even need to touch them. You feel the ache in your neck, your shoulder, or even your tooth. Latent ones only hurt when you press on them. But they’re still trouble-they can become active again if you get stressed, sleep poorly, or sit slouched at your desk for too long.

The most common muscles affected? The upper trapezius (that ridge from your neck to your shoulder), the levator scapulae (running down the side of your neck), and the temporalis (in your temples). These are the muscles that tense up when you’re stressed, hunched over a screen, or clenching your jaw. Studies show over 65% of people with chronic muscle pain have trigger points in these areas.

How Is It Different From Fibromyalgia?

A lot of people confuse myofascial pain syndrome with fibromyalgia. They both involve pain, but they’re not the same. Fibromyalgia causes widespread, symmetric pain all over the body-both sides of your neck, back, hips, knees. It’s more about sensitivity than knots. Trigger points, on the other hand, are local. You can find them. You can press on them. And they refer pain in predictable patterns. Press a trigger point in your trapezius, and you’ll feel pain near your ear or temple. Press one in your gluteus medius, and your hip or thigh might throb. That’s not random. That’s a map.

Doctors used to think fibromyalgia and MPS were the same. But research shows they’re separate. One key difference: trigger points cause a local twitch response. If you press just right, the muscle fiber jumps. That doesn’t happen with fibromyalgia’s tender points. Also, trigger points can be treated and often resolved. Fibromyalgia is a central nervous system condition-harder to reverse.

Why Do Trigger Points Form?

It’s not just about being lazy or sitting too long. Trigger points develop from a mix of physical, chemical, and lifestyle factors:

Acute injury: A car accident, fall, or sports trauma can set off trigger points. Up to 70% of people with whiplash develop MPS within weeks.
Chronic posture: Forward head posture-common with phone and computer use-makes your upper traps work overtime. Studies show this increases trigger point risk by 3 to 5 times.
Structural issues: A leg length difference of more than 1 cm? That throws off your pelvis and spine. Risk of MPS goes up by 40%.
Nutrition and hormones: Low vitamin D (under 20 ng/mL) is linked to 60% higher MPS rates. Hypothyroidism shows up in 15-25% of chronic cases.
Stress: When you’re anxious, your muscles stay tight. No relaxation. No recovery. Just constant tension.

How Do You Find a Trigger Point?

Finding trigger points isn’t magic. It’s skill. A trained therapist will feel for taut bands in your muscles, then press slowly. If you feel pain right there-and it radiates to another spot-that’s a trigger point. The gold standard is the local twitch response: a quick, involuntary spasm when the point is pressed. It’s not always visible, but you’ll feel it.

But here’s the problem: not all providers know how to do this right. Studies show inter-rater reliability varies wildly-from poor to excellent-depending on training. Some therapists miss them. Others press too hard. That’s why so many people say, “I had trigger point therapy and it didn’t help.” They didn’t get the right treatment.

A person hunched over a laptop with glowing muscle knots beneath skin, contrasted with a calm, stretched version under golden light.

Proven Ways to Release Trigger Points

There’s no one-size-fits-all fix, but several techniques have strong evidence behind them:

Ischemic Compression

This is the simplest and most accessible method. You press directly on the trigger point with your thumb, knuckle, or a tennis ball. Hold for 30 to 90 seconds, until the pain eases by about 50%. Then release slowly. Repeat 2-3 times. Do this daily. It’s low-tech, cheap, and works for 60-75% of people in the short term.

For upper traps: Lean against a wall with a tennis ball between your shoulder blade and spine. Roll slowly until you find the knot.
For temporalis: Use your index finger to press along your temple, just above your jawline. Hold until the ache softens.

Dry Needling

This is when a therapist inserts thin needles into the trigger point-no medicine, just the needle. It often causes a twitch. Studies show 65-80% of patients get relief that lasts 4 to 12 weeks. It’s not acupuncture. It’s a targeted muscle intervention. The needles reset the muscle’s electrical activity. It’s not painless, but it’s fast. Most people feel better within 24-48 hours.

Trigger Point Injections

A small amount of lidocaine (a numbing agent) is injected directly into the trigger point. It gives immediate relief-70-85% of patients report pain dropping within minutes. But the effect fades after 2-8 weeks. A Cochrane Review found no real difference between lidocaine injections and dry needling at the 4-week mark. So if you’re avoiding needles, dry needling is just as effective.

Spray and Stretch

This is a classic technique. A cold spray (like ethyl chloride) is sprayed over the area where the pain is referred-say, your shoulder or head-then the muscle is gently stretched. The cold numbs the skin and tricks the nervous system, making stretching easier. Works best for neck and jaw pain. About 50-65% effective.

Instrument-Assisted Soft Tissue Mobilization (IASTM)

Therapists use metal or plastic tools to scrape along the muscle. It breaks up adhesions and stimulates blood flow. Good for stubborn knots that don’t respond to pressure alone. Success rates: 55-70%.

Low-Level Laser Therapy (LLLT)

A non-invasive option using specific wavelengths of light (808-905 nm). It reduces inflammation and helps muscle cells recover. Not a quick fix, but useful for people who can’t tolerate pressure or needles. Studies show 40-60% pain reduction after 6-8 sessions.

Why Do Symptoms Come Back?

Even if you get relief, MPS often returns. Why? Because the root causes are still there.

A study of over 1,200 patients found that those who did a combination of manual therapy, dry needling, and daily home stretches saw a 65% drop in pain at 12 weeks. Those who didn’t stick with home care? Only 35% improvement. And 40-60% of people had symptoms return within six months without maintenance.

The key is consistency. You can’t just treat the trigger point and forget about your posture, your sleep, your stress levels. If you’re still hunched over your laptop for 8 hours a day, the knots will come back. If you’re low on vitamin D, your muscles won’t recover properly.

What You Can Do at Home

You don’t need to see a specialist every week. Here’s a practical daily plan:

Self-massage: Use a tennis ball or foam roller for 10-15 minutes a day. Focus on your upper back, neck, and jaw.
Heat before stretching: Apply a warm towel or heating pad (40-45°C) for 15 minutes before stretching. Heat relaxes the muscle, making stretches safer and more effective.
Posture checks: Set a timer to check your posture every hour. Shoulders down, chin slightly tucked, screen at eye level.
Stretch daily: Do 3 sets of 10 reps of neck retractions, shoulder rolls, and chin tucks-twice a day.
Check your vitamin D: Get a blood test if you’re constantly tired or sore. Many people with chronic pain are deficient.

A therapist's needle turning a muscle knot into a flower, surrounded by icons of therapies in rainbow swirls.

When to See a Professional

If you’ve tried home care for 4-6 weeks and your pain hasn’t improved-or it’s getting worse-it’s time to see someone trained in myofascial therapy. Look for a physical therapist, chiropractor, or sports medicine doctor with certification in trigger point therapy. The American Academy of Physical Medicine and Rehabilitation offers a 40-hour certification program. Ask if they’ve trained with Travell and Simons’ methods or use the Trigger Point Therapy Workbook as a reference.

Avoid providers who just “massage” without identifying specific trigger points. You need precision, not pressure.

The Bigger Picture

Myofascial pain syndrome is one of the most common-but least understood-causes of chronic pain. It’s responsible for nearly a third of all musculoskeletal visits to primary care doctors. And because it’s not visible on X-rays or MRIs, it’s often missed. That’s why people end up with unnecessary scans, nerve blocks, or even surgery.

The good news? MPS responds well to non-drug treatments. In fact, with the opioid crisis, non-pharmacological options like trigger point therapy have grown 200% since 2015. It’s not a fringe practice anymore. It’s becoming central to pain management.

You don’t have to live with pain that feels like it’s coming from nowhere. The trigger points are real. The relief is possible. It just takes knowing where to look-and how to release them.

Can trigger points be seen on an MRI or X-ray?

No, trigger points cannot be seen on standard imaging like MRI, X-ray, or CT scans. They’re functional, not structural-they’re areas of abnormal muscle activity and biochemical changes, not tissue damage or bone misalignment. That’s why many people get misdiagnosed; doctors order scans looking for a structural problem and find nothing. Diagnosis relies on physical examination: finding taut bands, localized tenderness, referred pain, and a local twitch response.

Is dry needling the same as acupuncture?

No. Acupuncture is based on traditional Chinese medicine and targets energy pathways called meridians. Dry needling is a Western medical technique that targets specific trigger points in muscles. The needles are inserted for the same reason: to release muscle tension-but the theory, placement, and training behind them are completely different. Dry needling is taught in physical therapy and medical schools; acupuncture requires separate licensing.

How long does it take to see results from trigger point therapy?

Some people feel relief within hours-especially after dry needling or trigger point injections. With self-care like ischemic compression, it may take 3-7 days of consistent daily work to notice a difference. For lasting results, most people need 4-6 sessions over 2-4 weeks, combined with home exercises. Chronic cases may take longer, but improvement usually starts within the first two weeks.

Can stress cause trigger points?

Yes. Stress triggers the body’s fight-or-flight response, which keeps muscles tense. Over time, this constant tension leads to muscle fatigue and the formation of trigger points. People under chronic stress are far more likely to develop MPS, especially in the neck, shoulders, and jaw. Managing stress through sleep, breathing exercises, or therapy isn’t just helpful-it’s essential for long-term relief.

Why does my pain move around?

That’s referred pain-a hallmark of trigger points. A knot in your upper trapezius might cause pain in your temple, ear, or even your hand. A trigger point in your gluteus medius can mimic sciatica. The pain doesn’t move because the problem is moving-it’s because the nerve pathways from that muscle send signals to distant areas. Once the trigger point is released, the referred pain stops. That’s why mapping your pain patterns is so important for diagnosis.

Are trigger point injections painful?

There’s a brief sting when the needle goes in, followed by a deep ache as the trigger point is activated. Many people describe it as a “good hurt”-like when a massage hits the right spot. The discomfort lasts only seconds. The numbing effect of lidocaine kicks in quickly, and most people report significant relief within minutes. If you’re anxious about needles, dry needling or ischemic compression are equally effective alternatives.

Next Steps: What to Do Today

If you’ve been living with unexplained muscle pain:

Find one area where you feel a knot-probably your neck, shoulder, or upper back.
Use a tennis ball or your fingers to apply steady pressure for 60 seconds. Breathe through it.
Notice if the pain spreads to another spot. That’s a sign of a trigger point.
Do 10 minutes of self-massage daily for a week.
Check your vitamin D levels with your doctor if you’re still sore after a few weeks.

You don’t need to wait for a diagnosis to start feeling better. The tools are simple. The knowledge is here. Your muscles are trying to tell you something. Listen to them.