Trigger Points and Osteopathy

Trigger points (TrPs) are relatively controversial due to the difficulties in studying and defining them. They produce patterns of pain and other symptoms that are felt when another area is irritated, stretched, or engaged. They can make relatively simple muscle problems look like something much more complicated, so they do bear thinking about. For example, the illustration below shows how the cheek muscle can refer pain into the teeth, making the issue look dental when it’s actually soft tissue.

Trigger points in the head and neck

Hallmarks of Trigger Points

Trigger points are “knots” within muscles. They form where a band of muscle fibres contract and do not release. When this knot is massaged or prodded, it is very sensitive, twitchy, and might cause pain elsewhere in the body. For some people, this pain is present continuously. Maps of the pain patterns have been developed, as certain TrPs typically cause the same patterns of pain in different people.

Referred Pain

You might have found a trigger point in yourself before, when trying to work through a “knotty” muscle and feeling a nearly unremarkable twinge elsewhere. This is an example of referred pain. Maybe the best known pattern of referred pain is when a heart attack causes arm pain, with or without chest pain. This happens because of the way the brain interprets the pain signals. The nerves supplying the heart and the arm are closely related, and the brain mixes up where the pain should be. This mechanism can also be seen in back pain that affects the leg- which is not always sciatica.

With trigger points, the pattern of referred pain is different. The examples above follow patterns laid out by the major nerves that run from the spinal cord, between vertebrae to the rest of the body. But trigger point pain does not follow these patterns, or the closely related dermatomes. Their mechanism has not been fully explained, but they follow their own predictable patterns.


Fibromyalgia shares some features with trigger points. Both are characterised by areas of tenderness, but fibromyalgia affects much more than soft tissue pain. Poor sleep, brain fog, and digestive changes are commonly associated with fibromyalgia too. You can read more about the condition here.

Managing Trigger Points

Frustratingly, TrPs are still largely unexplained. Their specific mechanism has yet to be explained, but we know there are some features that are routinely associated with them. Addressing these points may therefore start to make a positive impact on your pain.

Your osteopath will look at your case as a whole with an aim to identify any potential causes. Some factors are out of our control- TrPs become more common with age or following trauma. But vitamin deficiencies, a sedentary lifestyle, and hypermobility can all play a role, and may be changed. Working to ease discomfort to allow you to be more active may play a key part in your recovery.

Treating the painful area may also be appropriate. This is especially true for cases where the pain has persisted for over three months, as the body begins to process pain differently when it becomes chronic. In these cases, techniques to gradually desensitise the area will likely be more appropriate than techniques to massage or stretch the muscles.

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