Myofascial Pain Syndrome: How Trigger Points Cause Pain and How to Release Them

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 condition hiding in plain sight. Millions of people live with it, often misdiagnosed for years. The real culprit? Tight knots in your muscles called trigger points. These aren’t just sore spots. They’re active pain generators that send discomfort shooting into your neck, shoulder, head, or even down your arm-mimicking other conditions like sciatica or carpal tunnel. The good news? You don’t need surgery or strong drugs to find relief. Understanding how trigger points work and how to release them can change everything.

What Exactly Are Trigger Points?

Trigger points are tiny, hyperirritable spots inside a taut band of muscle. Think of them like a cramp that never unwinds. They’re usually 2 to 10 millimeters across-small enough to miss on an MRI, but big enough to cause major pain. When you press on one, you might feel a sharp ache right where you’re touching. But here’s the twist: the pain often travels. A trigger point in your upper trapezius (the muscle that runs from your neck to your shoulder) can make your temple throb. One in your jaw muscle can feel like a toothache. That’s why so many people end up seeing dentists, neurologists, or orthopedists before anyone checks their muscles.

There are two types: active and latent. Active trigger points hurt even when you’re not touching them. They’re the ones keeping you up at night or making it hard to lift your arm. Latent ones only hurt when pressed-like a ticking time bomb. Many people have latent trigger points without knowing it, until an injury or stress wakes them up.

What makes them so painful? Inside these knots, your muscle cells are stuck in a constant contraction. They’re burning through energy, starving for oxygen, and dumping out chemicals like acetylcholine, serotonin, and substance P-substances that turn up the volume on your pain nerves. The pH in the area drops to around 4.3, which is as acidic as a lemon. That acidity keeps the pain going in a loop: muscle tightness → less blood flow → more chemicals → more pain → more tightness.

How Is Myofascial Pain Different From Fibromyalgia?

A lot of people confuse myofascial pain syndrome with fibromyalgia. They both cause chronic pain, but they’re not the same. Fibromyalgia is widespread. It hits both sides of your body symmetrically-both hips, both knees, both shoulders. The pain is diffuse, and pressing on tender spots doesn’t send pain radiating. It just hurts right there.

Myofascial pain is different. It’s regional. One side of your neck. One shoulder blade. One side of your head. And the pain doesn’t stay put. It refers-meaning it travels along predictable paths. A trigger point in your levator scapulae (a muscle connecting your neck to your shoulder blade) can make your inner shoulder burn. A trigger point in your temporalis (a jaw muscle) can cause forehead pain or even mimic migraine symptoms.

Doctors have a way to tell them apart. Fibromyalgia has 18 tender points, all in specific locations, and they’re painful only when pressed. Myofascial pain has trigger points in taut muscle bands, and they cause referred pain, a local twitch when touched, and often a popping sensation under the fingers. If your pain follows a pattern-like always radiating from your right shoulder to your thumb-it’s more likely MPS.

What Causes Trigger Points to Form?

Trigger points don’t appear out of nowhere. They’re triggered-literally-by something. The most common causes:

• Posture: Sitting hunched over a desk all day? That’s a recipe for trigger points in your upper traps and levator scapulae. Forward head posture increases their prevalence by 3 to 5 times.
• Injury: A car accident, even a minor one, can leave behind trigger points. Up to 70% of people with whiplash develop MPS within weeks.
• Overuse: Repetitive motions-typing, lifting, playing an instrument-can overload muscles and create knots.
• Structural issues: If one leg is even 1 centimeter shorter than the other, your pelvis tilts. That stresses your lower back, hips, and glutes, leading to trigger points.
• Systemic factors: Low vitamin D (under 20 ng/mL) is linked to a 60% higher chance of MPS. Hypothyroidism shows up in 15-25% of chronic cases. Poor sleep and stress make everything worse.

It’s not just one thing. It’s usually a combo. You sit too long. You get a minor injury. You’re stressed. Your vitamin D is low. And suddenly, your shoulder won’t stop aching.

How Do You Find a Trigger Point?

Finding a trigger point isn’t like finding a bruise. You can’t see it. You have to feel it. A trained therapist will press along the muscle with their fingers, looking for three things:

• A taut band-a rope-like tightness in the muscle.
• A tender spot within that band-often the most painful point.
• A local twitch response-when the muscle jumps or twitches under pressure.

That twitch is a big clue. It’s an involuntary contraction caused by the sudden release of acetylcholine. It happens in 70-85% of active trigger points. If you don’t get a twitch, you might not be on the right spot.

Some muscles are notorious for trigger points. The upper trapezius is the most common-65% of MPS cases involve it. Then come the levator scapulae, temporalis, rhomboids, and quadratus lumborum. If you have chronic headaches, check your neck and jaw. If your lower back flares up, look at your glutes and hips.

Self-checking works too. Use your fingers or a tennis ball against a wall. Roll slowly over the muscle. When you hit a spot that makes you gasp, hold it for 30 seconds. If the pain radiates, you’ve probably found a trigger point.

Trigger Point Release Techniques That Actually Work

There are several ways to release trigger points. Not all are equal. Some are quick fixes. Others offer lasting relief when done right.

Ischemic Compression

This is the simplest and most effective method for home use. You press directly on the trigger point with your fingers, a tennis ball, or a foam roller. Hold steady pressure until the pain drops by about 50%-usually 30 to 90 seconds. Then slowly release. Repeat 3-5 times. Do this daily.

Why it works: The pressure temporarily cuts off blood flow to the area. When you release, fresh blood rushes in, washing out the pain chemicals and bringing oxygen. Studies show 60-75% short-term relief.

Pro tip: Breathe deeply while pressing. Holding your breath tenses your muscles and makes it harder to release the knot.

Dry Needling

This is when a therapist inserts thin, solid needles-like acupuncture needles-into the trigger point. No medicine is injected. The needle itself causes a twitch response. That twitch breaks the sustained contraction.

It’s not magic. It’s physics. The needle disrupts the abnormal electrical activity in the muscle. Studies show 65-80% of patients get pain relief that lasts 4 to 12 weeks. It’s especially helpful for deep muscles you can’t reach with your fingers, like the piriformis or psoas.

Don’t try this at home. It requires training. A bad needle job can bruise or even puncture a lung (rare, but possible).

Spray and Stretch

This technique uses a cold spray (like ethyl chloride) on the skin over the area where the pain radiates. Then, the therapist stretches the muscle while the skin is numb.

The cold temporarily blocks pain signals, letting you stretch deeper without triggering a protective muscle spasm. It’s especially useful for neck and shoulder trigger points. Success rates are around 50-65%.

Instrument-Assisted Soft Tissue Mobilization (IASTM)

Therapists use small metal or plastic tools to scrape over the muscle. The tools help detect and break up adhesions in the fascia around the trigger point. It’s less about pressure and more about sliding the tissue layers apart.

Studies show 55-70% effectiveness. It’s great for people who’ve had long-term pain and feel “stuck.”

Low-Level Laser Therapy (LLLT)

This uses red or near-infrared light (808-905 nm) at low energy. It doesn’t heat the tissue. Instead, it stimulates mitochondria-the cell’s energy factories-to work better and reduce inflammation.

It’s painless. You feel nothing. But studies show 40-60% pain reduction over several sessions. It’s not a magic wand, but it’s a good add-on for stubborn cases.

Why Some People Don’t Get Better

Not everyone responds to trigger point therapy. And when it doesn’t work, it’s rarely because the technique is wrong. It’s usually because the root cause wasn’t addressed.

Here’s what goes wrong:

• Only treating the symptom: You get a few dry needling sessions, feel better, and go back to your slumped posture. The trigger point comes back.
• Bad technique: A therapist who doesn’t know where to press or how to interpret twitch responses can make things worse.
• Ignoring systemic issues: Low vitamin D? Thyroid problems? Poor sleep? These keep trigger points active. Fix the muscle, but leave the chemistry unbalanced, and you’re fighting a losing battle.
• No home maintenance: One session won’t fix years of tension. Daily self-care is non-negotiable.

A 2020 study of over 1,200 MPS patients found that those who combined manual therapy, dry needling, and daily stretching saw a 65% drop in pain. Those who didn’t stick with home care? Only 35% improvement-and most of them relapsed within 6 months.

What You Can Do at Home

You don’t need a clinic to manage myofascial pain. Here’s a simple daily routine:

1. Heat first: Apply a warm towel or heating pad (set to 40-45°C) to the area for 15 minutes. Heat loosens the muscle and increases blood flow.
2. Ischemic compression: Use a tennis ball or foam roller. Target the tight spots. Hold for 60 seconds. Repeat 3 times per spot.
3. Stretch gently: After compression, stretch the muscle slowly. Don’t bounce. Hold each stretch for 30 seconds. Repeat 3 times.
4. Posture check: Every hour, sit up straight. Roll your shoulders back. Tuck your chin slightly. Set a phone reminder if you have to.
5. Check your vitamin D: Get a blood test. If it’s under 30 ng/mL, supplement with 1,000-2,000 IU daily. It’s cheaper than endless therapy sessions.

One Reddit user, u/JawPainSufferer, said: “Ischemic compression taught by my PT helped my TMJ pain more than the $400 mouthguard.” That’s the power of simple, consistent action.

When to See a Professional

If you’ve tried home care for 4-6 weeks with no improvement, it’s time to see someone who knows trigger points inside out. Look for:

• Physical therapists certified in dry needling or myofascial release
• Chiropractors trained in trigger point therapy
• Doctors with experience in pain management or sports medicine

Avoid providers who treat trigger points like a one-time fix. Good practitioners will teach you how to manage it yourself. They’ll ask about your sleep, stress, posture, and diet-not just your pain.

And if you’re being told you have “nerve damage” or “degenerative disc disease” but your imaging is normal? Ask if trigger points could be the real issue. Studies show up to 30% of patients diagnosed with radiculopathy actually have MPS.

The Bigger Picture

Myofascial pain syndrome is a quiet epidemic. It’s not glamorous. It doesn’t make headlines. But it’s responsible for 85% of pain complaints in some musculoskeletal clinics-and 30% of all primary care visits for muscle pain. And because it’s so misunderstood, people end up getting unnecessary MRIs, injections, and even surgeries.

What’s changing? The opioid crisis pushed medicine toward non-drug solutions. Trigger point therapy is now in the American Society of Anesthesiologists’ guidelines for chronic pain. Insurance is starting to cover dry needling. More therapists are getting trained.

But the real shift is happening in patients’ living rooms. People are learning to press their own knots. They’re checking their vitamin D. They’re sitting up straighter. They’re taking back control.

Myofascial pain isn’t your fault. But healing it? That’s your job. And you’re already on the way.