Trigger point therapy is often used by massage therapists as a pain management technique to reduce or eliminate the need for NSAIDs (non-steroidal anti-inflammatory drugs) and other pain medication. It is one of the most effective ways to quickly wipe out chronic pain of muscular origin.
Not everyone with low back pain finds relief, certainly, but it's easy to try at home. After a few sessions, you'll know if you're going to see results or not. If you do, terrific. If not, what have you lost?
How Does It Work?
As I've said elsewhere in this blog, you don't generally feel the pain in the trigger point, itself. Rather, that muscle refers pain elsewhere.
So, for example, a trigger point deep in your iliopsoas muscle (psoas) might cause pain down the front of your leg. Once you've released the trigger points causing your pain, the injured muscle can once again start to work as it should and the pain will ease.
One session of trigger point release may relieve your pain, but more commonly several sessions are needed for significant long-term relief. That is one reason self-application of the therapy at home is so helpful; you can work out trigger points several times a day, whenever it's convenient for you.
A Word of Caution Before You Start
Massage is generally benign, but it can have unanticipated effects on the body and there are risks associated with it. Always check with your healthcare provider before starting any kind of self-massage at home.
Also, your author is neither a healthcare professional nor a massage professional. I'm someone who has used trigger point therapy for many years to ease my own low back pain. I wanted to share what I've learned with others. But I don't want to cause you harm. This page is not medical advice; these are ideas informed by my personal experience of using this therapy on myself and reading a number of books on trigger point therapy over the years. Many techniques originated elsewhere - such as the Trigger Point Therapy Workbook - but I have modified them to work for me.
Please use caution and make wise decisions for your own body.
When seeking trigger points, if you think you may be pressing directly on an artery, an internal organ, a bone, or anything else besides a voluntary muscle, stop and ask a health care professional before proceeding further in that area.
To be safe, some areas to avoid when you are first learning about trigger points are:
A trigger point is always located on a muscle. It may or may not be able to be palpated (sensed by the fingertips). Upon pressing down on the spot firmly, you'll notice a tender or even painful feeling. Pressing on it may also recreate your referred low-back pain.
It's not necessary to be muscle-literate to find trigger points. After you've become more experienced, you'll learn precisely which muscles are involved in your pain - their names, their shape, the direction of their fibers, where they are, what they do, and, if you're ambitious, their origins and insertions.
But you don't have to worry about that now, at the finding-out stage. You can get started with these techniques even if you don't know the difference between your gluteus maximus and gluteus medius muscles. This exercise is a test - one of exploration.
All you need to get acquainted with your own personal trigger points is about an hour of your time, plus:
The muscles frequently housing trigger points that cause low back pain extend from the waistline (about the level of your navel) down to the knees, front and back. They include the muscles attaching to the spine, around the hips and buttocks, inside the pelvis, and the fronts and backs of the thighs.
For this exploratory session, you will work your trigger points in three sections - first the buttocks, then the legs, then the hips.
After each section, you should pause to test your progress to see if anything has changed. Get up, walk around, sit down - do anything you need to figure out if your pain has changed at all.
Stand close to a wall with your back to the wall.
Holding the sock by the "leg," dangle the tennis ball between the wall and your body. Systematically move the sock along the entire region of your buttocks, pressing back against the wall on each new area.
The tennis ball, wedged between your body and the wall, is your tool to help you identify tender points. You will press slowly but quite firmly, because you are working not only the superficial gluteal muscles but also the deeper, smaller buttock muscles, such as the piriformis.
When pressing over your muscles, always go slowly. This helps prevent bruising. Linger wherever you identify spots that hurt when pressed. Over each tender spot, roll the ball slowly but firmly for about ten seconds.
This "release" of the trigger point may hurt moderately, but it should not be excruciating. After about ten seconds, stop and move on to the next point.
Continue on in this way, locating and releasing all the trigger points you can identify in the region of the buttocks. Be as thorough as possible and try not to neglect any areas.
When you're done with this and each section, remember to take a break, get up, walk around and test to see if your pain has diminished.
The hamstrings are the muscles that run along the backs of the thighs from the bottom of the buttocks down to the knees.
Seat yourself comfortably on a dining room or folding chair - or any chair with a hard seat.
Explore with the tennis ball again, working down the back of each leg from the groin to the sides of the knees. Do each leg one at a time, releasing each trigger point as you identify it, using the tennis ball for ten seconds as described in the previous section. Avoid the area directly behind the knee bone.
The farther you move down the leg, the narrower the muscles will get. You will probably have to switch from the tennis ball to using your fingers and thumbs in order to locate and target the trigger points.
To release these smaller trigger points with your thumb, use a slightly different technique: Massage the spot deeply with the pad of your thumb for about ten seconds, going back and forth over the muscle but not rubbing across the skin, itself. Again, it should hurt somewhat, but not be agonizing.
The quadriceps are the muscles that extend along the fronts of the thighs from the base of the groin to the knees. You will work these with your thumbs instead of the tennis ball.
Lie down on a bed with your legs folded at the knees and your back propped up on cushions or pillows. Reach down with your thumbs and work up this time, starting from the knee and moving up the thigh until you reach the groin, first on the front, then the outside of the thigh.
Identify trigger points as before. This time, again, you will be using the thumb-release technique described in the last section.
Avoid the inside of the thigh. Repeat on the other leg.
The last section is your hips.
Work the trigger points on your hips on both right and left sides all the way from the waist down to where the cleft of the buttocks begins.
For this, work once more against the wall with the tennis ball-sock tool and apply deep pressure for ten seconds on each trigger point, carefully avoiding getting too close to the lumbar spine or any bony projections.
When seeking trigger points, if you think you may be pressing directly on an artery, an internal organ, a bone, or anything else besides a voluntary muscle, stop and ask a health care professional before proceeding further in that area.
To be safe, some areas to avoid when you are first learning about trigger points are:
- bony areas such as your vertebrae (spine), skull, and ribs
- the fronts and sides of your neck
- your abdomen
- the backs of your knees
- the insides of your thighs, and
- your calves.
How to Recognize a Trigger Point
Finding Trigger Points
But you don't have to worry about that now, at the finding-out stage. You can get started with these techniques even if you don't know the difference between your gluteus maximus and gluteus medius muscles. This exercise is a test - one of exploration.
Supplies
- a tennis or lacrosse ball inside a long sock
- your thumbs
- a hard chair (like a dining room or folding chair).
Locate the Trigger Points Affecting Your Back
The muscles frequently housing trigger points that cause low back pain extend from the waistline (about the level of your navel) down to the knees, front and back. They include the muscles attaching to the spine, around the hips and buttocks, inside the pelvis, and the fronts and backs of the thighs.
For this exploratory session, you will work your trigger points in three sections - first the buttocks, then the legs, then the hips.
 |
| Illustration of 3 Sections to Massage for Low Back Pain - Legs, Buttocks, Hips |
Find Trigger Points in Your Buttocks
Stand close to a wall with your back to the wall.
Holding the sock by the "leg," dangle the tennis ball between the wall and your body. Systematically move the sock along the entire region of your buttocks, pressing back against the wall on each new area.
The tennis ball, wedged between your body and the wall, is your tool to help you identify tender points. You will press slowly but quite firmly, because you are working not only the superficial gluteal muscles but also the deeper, smaller buttock muscles, such as the piriformis.
When pressing over your muscles, always go slowly. This helps prevent bruising. Linger wherever you identify spots that hurt when pressed. Over each tender spot, roll the ball slowly but firmly for about ten seconds.
This "release" of the trigger point may hurt moderately, but it should not be excruciating. After about ten seconds, stop and move on to the next point.
Continue on in this way, locating and releasing all the trigger points you can identify in the region of the buttocks. Be as thorough as possible and try not to neglect any areas.
When you're done with this and each section, remember to take a break, get up, walk around and test to see if your pain has diminished.
Find Trigger Points in Your Hamstrings
The hamstrings are the muscles that run along the backs of the thighs from the bottom of the buttocks down to the knees.
Seat yourself comfortably on a dining room or folding chair - or any chair with a hard seat.
Explore with the tennis ball again, working down the back of each leg from the groin to the sides of the knees. Do each leg one at a time, releasing each trigger point as you identify it, using the tennis ball for ten seconds as described in the previous section. Avoid the area directly behind the knee bone.
The farther you move down the leg, the narrower the muscles will get. You will probably have to switch from the tennis ball to using your fingers and thumbs in order to locate and target the trigger points.
To release these smaller trigger points with your thumb, use a slightly different technique: Massage the spot deeply with the pad of your thumb for about ten seconds, going back and forth over the muscle but not rubbing across the skin, itself. Again, it should hurt somewhat, but not be agonizing.
Find Trigger Points in Your Quadriceps
The quadriceps are the muscles that extend along the fronts of the thighs from the base of the groin to the knees. You will work these with your thumbs instead of the tennis ball.
Lie down on a bed with your legs folded at the knees and your back propped up on cushions or pillows. Reach down with your thumbs and work up this time, starting from the knee and moving up the thigh until you reach the groin, first on the front, then the outside of the thigh.
Identify trigger points as before. This time, again, you will be using the thumb-release technique described in the last section.
Avoid the inside of the thigh. Repeat on the other leg.
Find Trigger Points in Your Hips
The last section is your hips.
Work the trigger points on your hips on both right and left sides all the way from the waist down to where the cleft of the buttocks begins.
For this, work once more against the wall with the tennis ball-sock tool and apply deep pressure for ten seconds on each trigger point, carefully avoiding getting too close to the lumbar spine or any bony projections.
Move Around to Test for Success
Now, get up and move around again, carefully attempting movements that normally would hurt. Try to gauge:
- Has your pain changed? If so, how?
- Has your pain lessened?
- Has your pain moved?
- Has your range of motion increased? Decreased?
If your pain has lessened or moved elsewhere or your range of motion has increased, these are promising signs. It is probably a good idea to repeat this trigger point therapy session at home again to check if you see further improvements. Try it a few times a day.
If the pain is worse, overall, then perhaps trigger point therapy is not a helpful adjunct to your pain management program.
Round off your massage by drinking a tall glass of water and taking a warm shower or bath. Drink plenty of fluids the rest of the day, and don't be surprised if you get a little sore.
I hope this quick tutorial helped you. Please let me know if you have any concerns or questions.
