Trigger points — why pain hits in one spot but radiates to another

What a trigger point is — and why it isn't what it seems

A trigger point is a hypersensitive, tightly localised nodule within a taut band of muscle. Put simply: a section of muscle that has contracted more than the surrounding tissue and hasn't returned to a resting state. Press on one — palpate it, in clinical terms — and the person may react with a reflex: an involuntary twitch, a wince, or pain that "fires" into a completely different area.

An important distinction that often gets lost: a trigger point is not inflammation, not calcification, and not a "knot" in the anatomical sense (even though that's the common name for it). It's a neuromuscular phenomenon — a local breakdown in communication between the nervous system and muscle fibres that keeps a group of muscle cells locked in a permanent, involuntary contraction.

• Active point — causes pain on its own, without external pressure; often the "pain" that brought you in for treatment.
• Latent point — doesn't hurt day to day, but produces referred pain or a wince only under a therapist's touch; it can sit silent for years.
• Satellite point — a trigger point that developed as a secondary reaction to another, primary point; treating the primary point often makes the satellite disappear on its own.

Why pain radiates elsewhere — the mechanism

This is the heart of the puzzle, and the most common question: why does my head hurt when the tension sits in my neck and shoulders? Or: why do I feel pain in my elbow, when the therapist always returns to the same spot between my shoulder blades?

The answer lies in how the nervous system processes and "addresses" pain signals. Sensory fibres from different areas of the body converge on the same neurons in the spinal cord — and the brain, with no direct view of where the signal originated, mixes up the addresses. This is called referred pain, a well-documented neurological phenomenon.

Importantly, referral patterns are predictable and repeatable. A trigger point in the sternocleidomastoid muscle (SCM) at the side of the neck often produces headache pain at the front of the head, above the eye, or behind the ear. A point in the trapezius often refers to the temple or the back of the neck. These patterns are consistent enough to have been mapped — and a therapist experienced with trigger points can "read the map backwards": start from where the pain is and trace its source elsewhere.

Where trigger points come from

A trigger point doesn't appear without cause. It's muscle tissue's response to overload — and overload can take many forms. The most common causes aren't one-off injuries (though those play a role too), but something more everyday, and for that reason more insidious.

1. 01

   Static overload

   Long hours in the same position — working at a computer, driving, looking at a phone. Muscles held in isometric tension for hours, without movement or release, become prone to developing trigger points.

2. 02

   Cumulative micro-trauma

   Repetitive movements — typing, playing an instrument, manual work. Each of these is harmless on its own; the problem lies in the sum of thousands of repetitions without adequate recovery.

3. 03

   Acute overload or injury

   A sudden heavy load on a muscle, an unexpected wrench, a car accident with a whiplash mechanism — any of these can trigger a point that, left untreated, persists for months.

4. 04

   Stress and emotional tension

   A nervous system stuck in "fight or flight" mode maintains elevated muscle tension. Chronic stress favours the formation of trigger points — particularly in the muscles of the neck, upper back and shoulders.

5. 05

   Postural imbalances

   Asymmetrical posture — one shoulder blade higher than the other, spinal curvature, a difference in leg length — means some muscles chronically work harder than others. This creates an ideal environment for trigger points.

How a therapist "finds" trigger points

Diagnosing trigger points relies mainly on palpation — examining by touch. An experienced therapist feels a taut band within the muscle — like a cord or a bowstring running through the tissue — and within it, a firmer, hypersensitive point. Pressing on this point often triggers a characteristic response: pain the client recognises (as in, "yes, that's exactly where it hurts!") appearing in the referral area typical for that point.

That moment of recognition — when pressure applied far from the site of symptoms reproduces familiar pain — is the key diagnostic signal. Clients often describe it as "that's it" or "how did you know it was there?" There's no mystery to it: it's simply knowledge of referral maps combined with a sensitive palpating touch.

What can be done about a trigger point

The good news is that trigger points respond well to manual therapy in many people — and this doesn't require a scalpel or advanced equipment. The foundation is direct mechanical work with the tissue: pressure, stretching the taut band, myofascial release techniques. The goal is one thing — letting the tissue return to the resting state it lost.

• Ischaemic compression — gradual, sustained pressure on the point, which can feel uncomfortable but should stay within tolerable limits; once released, local blood flow increases, which supports release of tension.
• Myofascial release techniques — slow work with entire fascial chains, not just the point itself, since tissue rarely functions in isolation.
• Deep tissue massage — work on deeper muscle layers, with clear pressure applied across the fibres.
• Positional and proprioceptive techniques — a gentler approach, in which the therapist places the muscle in a position of minimal tension, signalling it to "forget" the contraction.
• Dry needling — an acupuncture needle inserted directly into the trigger point triggers a characteristic "twitch response", after which many people experience release. The method commands respect among physiotherapists, though its indications and mechanism are still being researched.

What you can do between sessions

Manual therapy works — but it lasts an hour, while your body functions around the clock. What you do between sessions has a real impact on how quickly symptoms ease, and whether they return. This isn't about overhauling your lifestyle — just a few mindful habits.

• Breaks from static positions — every 45–60 minutes, stand up, change position, move your shoulders and neck. Muscles need the signal that they don't have to hold one position forever.
• Stretching — gentle, without forcing the range. A muscle with a trigger point is often already tight; aggressive stretching can backfire.
• Heat therapy — heat (a heat pack, a warm shower) supports release and can reduce discomfort between sessions. Cold works well for acute inflammation, but for trigger points, many people find heat more effective.
• Stress and sleep quality — these sound obvious, but they're a real factor. Chronic nervous tension keeps muscles on high alert. Whatever helps you switch off — use it regularly.
• Self-mobilisation with a ball — a soft tennis ball or fascia ball pressed against a tight muscle (for example, between the shoulder blade and the spine) can bring relief to areas a therapist's hands don't reach day to day. Do this carefully, without exceeding your pain threshold.

Massage and trigger points — when to combine them

Trigger point work doesn't need to happen in isolation — and it rarely gives the best results as a standalone tool. Relaxation massage, deep tissue massage and fascial techniques often work as a team: they relax the broader context (the whole tense body, the nervous system, tissue quality) while the therapist works on a specific point.

For many people, regular, targeted work brings more than symptom relief — it also brings greater body awareness: a sense of where tension sits before it turns into pain. That's something no tablet can offer — and it's what gives working with a therapist long-term value, not just a quick fix.