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WHY (K)NOT?

Unravelling myths about Muscle Trigger Points

As a physiotherapist, I often get asked why knots develop in muscles. Most people know that they are associated with tight muscles. But, are there more to these knots, or muscle trigger points, than meets the eye?


In this blog article I will look at a few common assumptions, or myths, about muscle trigger points to give you a better understanding of how they can contribute to your symptoms.


MYTH #1: A muscle spasm and a muscle trigger point is basically the same thing.

The term muscle trigger point (or knot) and muscle spasm are often used interchangeably, but they are not the same. A general muscle spasm refers to increased neuromuscular tone/tension of the ENTIRE muscle. A muscle trigger point, on the other hand, is usually described as a hyperirritable spot in a muscle that is associated with a tender nodule in a taut band. This taut band is caused by localized involuntary shortening of muscle fibres within the muscle.


MYTH #2: Muscle trigger points cause tightness in the muscle but doesn’t really contribute to pain, especially when that pain is going down my arm or leg.

It is a well-known fact that muscle trigger points make a muscle tight leading to restricted movement. However, some trigger points can also spontaneously cause pain.

Muscle trigger points can be classified as active or latent. An active muscle trigger point is a symptom-producing trigger point that causes local pain (pain in the area of the knot) or referred pain (pain away from the area of the knot e.g. pain down the arm/pain into the head i.e. headache). Latent trigger points only cause pain when they are stimulated by, for example, pressing on them.


Secondary trigger points called satellite trigger points can also develop in the pain referral zone even though that is not where the symptoms originate from. These satellite trigger points will often remain active until the primary trigger point is deactivated.


MYTH #3: Trigger points can only be found in muscles.

Trigger points are mostly found in muscles, but there are also other types called attachment trigger points and ligamentous trigger points. Attachment trigger points arise where the tendon of a muscle attaches to the bone and can become very tender (e.g. tennis elbow). If these trigger points are not treated it can lead to degenerative processes in adjacent joints. Trigger points can even develop in ligaments. An example is trigger points that develop within the patella (kneecap) ligament and when treated, it can be very helpful for some knee pain syndromes.


MYTH #4: Muscle trigger points are always movement or posture related.

Poor posture, muscle overuse, muscle weakness and injuries are big contributing factors to the development of muscle trigger points, but there are many other factors that should be considered as causes of muscle trigger points:

  • Ageing

  • A lack of exercise and sedentary lifestyle

  • Chronic stress (see my previous blog post on how stress affects the body 😊)

  • Sleep disturbance

  • Vitamin deficiencies (vitamin C, D, B, folic acid and iron)

  • Hypermobility of joints

These aspects are especially important to consider in patients who present with chronic myofascial pain syndromes.


MYTH #5: It is difficult to treat muscle trigger points and make the knots go away.

The treatment of muscle trigger points involves taking a holistic approach to the body. It is not just about pushing on the knot until you hope it goes away. Your physiotherapist at Christiaan Moolman Physiotherapy Inc. is trained in many effective ways to treat trigger points and help prevent recurring problems.


Myofascial Dry Needling is a very effective, evidence-based technique used in the treatment of muscle trigger points. A thin needle is inserted into the skin and muscle in the area of the trigger point. This technique aims to treat the trigger point by eliciting a local twitch response in the muscle which:

  • Helps to normalize the chemical environment around the active trigger point (reducing substances in the muscle that causes the sensation of pain).

  • Disrupts the contraction knots and helps them to release.

  • Triggers specific changes that encourages the normal muscle regeneration process.

It is just as important to address the underlying factors that lead to muscle trigger point formation. Your physiotherapist can help you to address muscle imbalances and weaknesses. Trigger points often form when a muscle is too weak to perform its job, overworked because it has to take over the job of another weak muscle (i.e. compensation patterns develop) or when endurance is lacking with repetitive/sustained contraction. The Be Activated® treatment system offered at Christiaan Moolman Physiotherapy Inc. is a great way to address muscle imbalances and compensation strategies of the body by helping you to activate your muscles in the correct sequence so that they can do the job they were intended to do.


None of us will ever be completely trigger point-free but addressing them at the right time can help you to combat the debilitating effects of pain, increase your performance, decrease risk of injuries and live a more optimal life. So, why (k)not?

Reference list:

Dommerholt J. et.al., 2006. Trigger Point Dry Needling. The Journal of Manual and Manipulative Therapy, 14(4), pp. E70-E87.

Physiopedia Contributors, 2020. Trigger Points. [Online]

Available at: https://www.physio-pedia.com/index.php?title=Trigger_Points&oldid=236993

[Accessed 12 June 2020].

Dommerholt J. et. al. 2006. Myofascial Trigger Points: An Evidence -Informed Review.The Journal of Manual and Manipulative Therapy, 14(4), pp. 203-221.

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