The trigger point you can feel might not be the one causing your pain

One of the most common things clients say on the treatment table is: “It hurts right here — can you focus on this spot?” And I do focus on that spot, but usually not for the reason they’re asking. The spot that hurts is often the referral site, not the source of the problem. And if we only work where it hurts, we’re chasing symptoms.

What trigger points actually are

A trigger point is a hyperirritable band within a muscle — tight, tender, and palpable. What makes them unique is their ability to refer pain, numbness, or other sensations away from the point itself, to predictable patterns mapped out in Janet Travell’s reference atlases decades ago.

These patterns are consistent enough that an experienced therapist can often guess which trigger point is active just by where you describe the pain. A headache behind the eye? Often a trigger in the upper trapezius or suboccipital muscles. Pain in the middle of the forearm? Frequently coming from trigger points in the scalenes in the neck.

Why dig-where-it-hurts fails

If you have referred pain in your shoulder blade and you keep rolling a lacrosse ball into your shoulder blade for relief, you might get five minutes of reduced sensation. Then the pain comes back, usually by the end of the day, because the actual driver — maybe a trigger point in your scalene or infraspinatus — never got touched.

This is why a good massage session usually includes a fair bit of palpating around the area before the therapist settles into deep work. We’re trying to figure out which band of muscle, when compressed, reproduces your pain pattern — not a generic textbook pattern.

How we actually release them

The effective techniques aren’t glamorous. Sustained compression (90 seconds to 2 minutes) at the right intensity, then passive lengthening of the muscle. Sometimes slow, stripping strokes along the fiber direction. For some trigger points, contemporary acupuncture (dry needling) is more effective than manual compression because it reaches layers of muscle that fingers can’t.

The wrong technique — aggressive digging, rapid friction, or trigger point tools used without understanding the referral — can actually sensitize the tissue further. That’s why some people come to RMT and leave feeling worse before they feel better. It’s usually a dose and precision problem, not a “your muscles are resistant” problem.

What you can do at home

• Map your own referral patterns. Notice where your pain is and where compression reproduces or relieves it. These two locations are often not the same.
• Use sustained pressure, not aggressive rolling. Finding a tight band and holding for 90 seconds beats quick deep pressure almost every time.
• Address the postural contributor. Trigger points that keep returning are usually downstream of a posture or movement pattern that’s loading the muscle repeatedly. Fix the load, and the trigger points stop coming back.

If you’ve been chasing the same spot for months with temporary relief, the problem almost always isn’t that you need to press harder. It’s that you’re working on the referral, not the source.