Massage Therapy Can Relieve Stress with Trigger Point Massage

American Massage Therapy Association

Thanks for Article from Amta Approved October 2006

Position Statement

It is the position of the American Massage Therapy Association (AMTA) that massage therapy can be effective for stress relief.

Background Information

Stress is a prevalent component in today’s fast-paced world which can negatively impact an individual’s health and well-being. Massage therapy has been shown to be a means by which stress can be reduced significantly on physical and psychological levels. While massage therapists know from experience that massage reduces stress, there is considerable research that validates our experience.

In a study on the effect of trigger point therapy1, there was a significant decrease in heart rate, systolic blood pressure8, and diastolic blood pressure8. Measures of oxygen consumption, blood pressure, and salivary cortisol levels were all lower after a 10 to 15-minute chair massage in controlled studies2, 3, 4. Changes in psychological states have been measured by physiological responses1, 3, the Perceived Stress Scale5, the POMS Depression Scale4,6, and the Anxiety State.

Massage Away the Pain — The Need-to-Know

Massage therapy is any treatment where a therapist (or masseuse) manipulates the body’s muscles and soft tissues to relieve pain or decrease stress. But all massage is not created equal! Strategies range from deep tissue (often called Swedish) massage to reflexology, where the therapist applies pressure to a specific point on the body in order to relieve pain.

And the list of ailments massage can be used to treat is just as long as the list of massage types. One recent study found that massage therapy can reduce pain, promote muscle relaxation, and improve both moods and sleep quality. Another study found that after subjects were massaged, the levels of cortisol (a hormone contributing to stress) in their saliva decreased. One study also found massage therapy’s pleasurable qualities can lead to recipients reporting a better body image, especially for women.

Worth Its Weight — Your Action Plan

Although massage therapy may be more expensive than a walk in the park or a bar of dark chocolate (don’t worry, everyone eats the whole thing sometimes), it’s possible the psychological benefits of massage therapy may far outweigh its heftier price tag.

But while the majority of massage side effects are stress-relieving and positive, there are a few concerns to consider before diving into deep tissue. Not just anyone can give a true therapeutic massage, so make sure to seek the services of a trained massage therapist. And while it’s normal to feel a little sore the day after many types of massage, it should never be painful or uncomfortable, so communication with the therapist is key.

What are Trigger Points?

(This link will take you to Trigger point info. From Wikipedia,
 the free encyclopedia.)



Based on the discoveries of Drs. Janet Travell and David Simons in which they found the causal relationship between chronic pain and its source, myofascial trigger point therapy is used to relieve muscular pain and dysfunction through applied pressure to trigger points of referred pain and through stretching exercises. These points are defined as localized areas in which the muscle and connective tissue are highly sensitive to pain when compressed. Pressure on these points can send referred pain to other specific parts of the body.


Trigger Point Therapy can relieve muscular aches and pains in association with these areas. It can also assist with the redevelopment of muscles and/or restore motion to joints. Trigger Point Performance products are specifically designed to support the massage associated with Trigger Point Therapy. Trigger points are described as hyperirritable spots in skeletal muscle that are associated with palpable nodules in taut bands of muscle fibers. Trigger point researchers believe that palpable nodules are small contraction knots and a common cause of pain. Compression of a trigger point may elicit local tenderness, referred pain, or local twitch response. The local twitch response is not the same as a muscle spasm. This is because a muscle spasm refers to the entire muscle entirely contracting whereas the local twitch response also refers to the entire muscle but only involves a small twitch, no contraction.


These trigger point charts show specific areas that have been identified as trigger points and typical trigger point referral patterns. By strengthening, toning, and massaging these areas, flexibility and strength that has been lost can potentially be regained.



Trigger Point Massage

As I began studying massage therapy I became increasingly interested in discovering what exactly caused certain areas of the body to refer pain. I was amazed that I could apply pressure to spots in the middle of the back and you would feel pain referring to your chest.

I then began studying Trigger Point Massage techniques. I had a basic knowledge of how muscle tissues responded during massage treatment and I was thoroughly interested in learning about the cause, symptoms, and treatments of trigger points.

What I had found in my search is that most trigger points are caused by repeated stress on individual muscles. This seems to cause a continual contraction of the muscle group which directly and indirectly causes these specific muscle knots.

What I have found is that during a trigger point massage session many of my clients also tell me that they can experience a release of other muscles in their body that are not related at all to the spots that I am focused on. I truly feel that while applying pressure to individual trigger points our bodies release levels of dopamine into our system to illicit pain relief.

With this additional pain reliever in the body, it allows my clients to become even more relaxed and almost enter a state of meditation. Trigger point therapy is extremely effective in alleviating symptoms of migraine headaches, sinus pressure, and back pain.

When receiving Trigger Point Therapy it is essential that you find a therapist that is qualified in the treatment. If a trigger point is stimulated too short a time it can actually activate the area to release more pain.

If a trigger point is pressed for too long, or too hard for too long, it can cause the area to feel as though it were bruised for a number of days following treatment. It is always best to go with a therapist that you feel comfortable with who has proved over time to be competent in their treatment styles as well as conscious of how you are receiving and experiencing the treatment provided.



To use Symptom Checker click on these links and simply move your cursor over the body figurine and click on the area where you feel pain.  A new window will then open and allow you to choose which pain pattern looks the most like the pain you are experiencing.  You may then click on that picture and review information pertaining to that specific muscle.


General information is provided for every muscle listed and is intended to educate the general population on the pain that arises from the muscular system.  This information is not intended to provide medical advice or to replace the advice of a licensed physician.  Portions of this information, however, may be used to provide material to your physician for review.

Click this link for the Trigger Point symptom checker

 The Trigger Point & Referred Pain Guide


To use the Trigger Point & Referred Pain Guide click on this link:

Benefits of Trigger Point Therapy

The treatment may help people with headaches and back pain

Trigger point therapy is an alternative therapy, the benefits of which include a focus on detecting and releasing trigger points. Located in the skeletal muscle, trigger points are spots that produce pain when compressed. In many cases, trigger points form as a result of trauma to the muscle fibers.

Typically used to treat pain-related conditions, trigger point therapy is sometimes referred to as myofascial trigger point therapy or neuromuscular therapy. A number of techniques can be used to release trigger points, including massage therapy, chiropractic care, and dry needling.

Uses for Trigger Point Therapy

In alternative medicine, trigger point therapy is used to treat a number of chronic pain conditions, including:

  • headache
  • temporomandibular joint pain
  • low back pain

In addition, some people use trigger point therapy as a treatment for osteoarthritis, carpal tunnel syndrome, tinnitus, migraines, sciatica and sports injuries.

Trigger Point Therapy vs. Traditional Acupuncture

One common form of trigger point therapy is dry needling, a technique that involves inserting a needle (without medication or injection) into trigger points. Dry needling should not be confused with acupuncture, a form of traditional Chinese medicine that involves using needles to stimulate points thought to connect with pathways that carry vital energy (or “chi“) throughout the body.

While there is some overlap between trigger point sites and acupuncture point sites, trigger point therapy is not focused on improving the flow of chi. Furthermore, while acupuncture is used to treat a broad range of health problems, trigger point therapy is primarily used for the treatment of musculoskeletal disorders.

Back Pain

When used in conjunction with other therapies, dry needling may be beneficial for people with chronic low back pain. That’s the finding of a 2005 research review published in the Cochrane Database of Systematic Reviews. However, since most of the reviewed trials were of poor quality, the review’s authors note that more research is needed on the effectiveness of dry needling in the treatment of low back pain.


Preliminary research indicates that trigger point therapy may help manage tension headaches, according to a 2012 report from Expert Review of Neurotherapeutics. However, there is currently a lack of clinical trials testing the use of trigger point therapy in the treatment of tension headaches.

Heel Pain

Trigger point therapy may help relieve plantar heel pain, suggests a small study published in the Journal of Orthopaedic and Sports Physical Therapy in 2011.

For the study, 60 people with plantar heel plan were split into two groups: One group regularly performed stretching exercises, while the other group underwent trigger point therapy (in addition to following the same stretching routine as the first group). After a month, the group who received trigger point therapy showed a greater improvement in physical function and a greater decrease in pain.

Parkinson’s Disease

Trigger point therapy shows promise in the treatment of certain symptoms associated with Parkinson’s disease, according to a pilot study published in Movement Disorders in 2006.

For the study, 36 people with Parkinson’s disease either received trigger point therapy or underwent a music-based relaxation therapy twice a week for four weeks. By the study’s end, members of the trigger point therapy group showed greater improvement in motor function. While both groups showed modest improvement in the quality of life, only members of the music relaxation group had improvements in mood and anxiety.

How to Use Trigger Point Therapy

If you’re interested in undergoing trigger point therapy, consult your physician for help in finding a qualified practitioner.

Due to the limited research, it’s too soon to recommend trigger point therapy as a treatment for any condition. It’s also important to note that self-treating a condition and avoiding or delaying standard care may have serious consequences. If you’re considering using trigger point therapy for any health purpose, make sure to consult your physician first.

Trigger Point Massage

Chronic pain is but one of several reasons you might find clients coming to you for massage therapy. Still, as more and more health professionals start valuing the role massage therapy can play in helping people deal with conditions that have pain as a major symptom, you might find an uptick in the number of clients looking to you for some relief.

And knowing ways you can help is going to be key.

Trigger points can be implicated in a wide range of common conditions that involve chronic pain, including sciatica, plantar fasciitis, low back pain, trigger finger and frozen shoulder, to name a few. By learning what trigger points are and the benefits massage therapy can provide, you’re giving yourself one more tool to use with clients who come to you in pain.

What are Trigger Points?

Trigger points are defined as “a focus of hyperirritability in a tissue that, when compressed, is locally tender and, if sufficiently hypersensitive, gives rise to referred pain and tenderness.” In other words: a trigger point is believed to be a localized spasm or knot in the muscle fiber that may cause pain to be referred to other, more distant parts of the body. “I have seen clients who have been told they have arthritis of the elbow when the problem was actually the bicep muscle being so tight that the arm could not straighten and stress was being placed on the inside elbow joint, causing both pain and an inflammation.”

Trigger points are typically caused by three types of muscle overload: acute, sustained and repetitive. “These types of muscle overload can occur in a variety of settings, including occupational and athletic settings, and can also result from underlying pathologies.”

Here is how a trigger point forms: Muscle overload causes an abnormal release of acetylcholine (from dysfunction in motor end plates). This release causes an influx of calcium into the sarcomeres in the affected area which, in turn, causes these sarcomeres to contract. “Because of the sarcomere contraction, there is an increase in the tension of the muscle fiber,” This tension creates contraction knots in the short sarcomeres, and these knots evolve into a trigger point. The lengthened sarcomeres along with the contraction knots, referred to as the trigger-point complex, constitutes the taut band in several adjacent fibers.”

But for clients who may not be as versed in anatomy and physiology as you, you might consider finding more common ways to talk to them about what’s happening. “I always use an analogy of taking a 12-inch piece of rope and tying knots in it until it’s only 10 inches long,” The client can easily understand what’s happening. The knot is getting tighter and the fibers on either side of the knot are being overstretched.”

Take shoulder and elbow pain as an example. “The two-headed biceps muscle originates at the shoulder at the supraglenoid tubercle and the coracoid process of the scapula and inserts into the tuberosity of the radius and bicipital aponeurosis, “When the muscle contracts normally, a person will take their straight arm and touch their shoulder. However, when the muscle is in spasm, they won’t be able to fully straighten the bent arm.” In this case, your client may be feeling shoulder pain that is actually the result of a tight biceps muscle.

How Massage Can Help

Perhaps one of the biggest benefits of massage therapy is that it’s noninvasive and fairly easily tolerated by the client. “Second, “is that other forms of treatment may not address all of the necessary areas.” Meaning, again, that some of your clients may be feeling pain in one area whose source is actually in another. “A massage therapist can understand the relationship between each of the muscles that have an impact on a joint, “Knowing which muscle needs to be released first in order for subsequent muscles to be effectively treated is immensely helpful.”

That a massage therapist is focused on muscles, tendons and insertion points is also helpful. A massage therapist can use the referral patterns of the trigger points to follow the point of pain described by the client back to the originating muscle, locate the trigger point in that muscle and apply direct pressure to release the spasms,”

Typically, massage therapists use a type of compression—sometimes referred to as digital pressure—to help relieve trigger points. “The goal of treating trigger points is to remove the spasm and return the sarcomere to its original length,” Digital pressure works by applying pressure to a ‘knot’ for anywhere from 30 seconds to 90 seconds until a change in the tissue is felt.”

While doing this work, clearly communicating with your clients is imperative, as they may experience some pain and you need to be able to adjust pressure when necessary. “Unlike a relaxing massage, trigger point therapy can be uncomfortable to receive, especially while applying the direct pressure on the trigger point, I always explain to clients that it’s very important for them to tell me immediately if the pain is not tolerable so I can adjust my pressure.”

Nicola shoots for a seven out of 10 on a client’s pain scale, cautioning that massage therapists don’t want to be too aggressive with this work and cause irritation to the tissue. “Once the therapist feels the tissue change “they should remove the pressure and perform some general massage strokes to the area.”

So, while you are used to checking in with clients during a massage therapy session, doing so more frequently may be necessary when doing trigger point work. “What may be just fine in one area might be intolerable in another, “ I ask my clients over and over ‘Is this pressure OK?’ Sometimes we laugh because I ask so often, but they definitely get the point that it’s vital for me to know how they are doing during the entire massage therapy session.”

Clients who are in chronic pain, no matter what the cause, are looking for one thing: relief. More and more, massage therapy is proving helpful. For your clients who look to you for help managing chronic pain, understanding—and being able to treat—trigger points can sometimes make all the difference.

*Disclaimer: This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider.
Please consult your healthcare provider with any questions or concerns you may have regarding your condition.
The information provided is for educational purposes only and is not intended as diagnosis, treatment, or prescription of any kind. The decision to use, or not to use, any information is the sole responsibility of the reader.

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