How to Treat Trigger Points in 7 Steps (Knot in Neck Relief)

You know that feeling as if you had a knot in your neck? That’s a trigger point. Almost everyone gets them and they can be very painful.

Most people completely rely on their therapist to release them. This can be super frustrating if you don’t get an appointment in time.

In this article, I will show you how to treat trigger points yourself in 7 simple steps. You can easily do this at home and don’t need a therapist for this.

With this approach, you can finally manage your neck pain and get back to doing what you love. Oh, and the best part is: You can apply these steps to any trigger point in your body, not only your neck.

What Trigger Point Therapy Usually Looks Like:

I worked in a physio clinic for two years before starting my own business.

At least every fourth patient I had was complaining about trigger points in the neck.

What did the treatment look like? Push into the trigger point for about 30-60 seconds and then let go. Repeat for as long as necessary.

Does this sound familiar to you?

The trigger point definitely felt softer afterward and the patient reported less pain.

Did that help long term, though?

Nope. The trigger point was just as tight the next time I saw the person.

That was super frustrating – for the patient and me.

Let’s face it. Something has to change about this approach. Unless you want to be dependent on seeing your physio every week.

I analyzed the scientific literature on trigger points. This way we can cut through all the nonsense out there. And we can focus on what actually works.

The 7 Steps of Modern Trigger Point Therapy:

I will walk you through the 7 crucial steps of managing trigger points now. I will also tell you, why each step is important for you to know. And trust me, you have to wait until you’ve heard steps 6 & 7!

1. What Are Trigger Points?

Trigger points are sensitive spots in your muscles that can feel like there’s a knot in there.

I’ll quote Paul Ingraham here, who’s done amazing work on trigger points:

“Almost everyone gets them sometimes, kind of like pimples, and they can really hurt.” – Paul Ingraham

2. How does a trigger point develop?

Why do you have to know this?

Simple. If you understand how something occurs, you can act accordingly. I’m not only referring to treatment but also to prevention.

The most popular explanation is the so-called “integrated hypothesis” by Gerwin et al. (2004).

According to this, several factors can lead to areas with poor blood circulation:

• overuse
• underuse
• pain
• injuries

This causes those areas within the muscle to become overly acidic.

What does that mean? You know this feeling when your legs burn when doing exercises like leg extensions?

That’s caused by a build-up of an acidic environment in the muscle. This is uncomfortable and explains the sensitivity.

Plus, it leads to a small part of the muscle tightening up – kind of like a micro-cramp.

This cramp then kicks off a vicious cycle:

1. Tension
2. Worse blood flow to that muscle area
3. More acidity
4. More tension
5. etc.

All this causes discomfort and pain.

This problem is often referred to as an “energy crisis.” It all sounds nice, but there’s still no scientific proof for it.

There are also a few other hypotheses.

For example that trigger points are the result of a misinterpretation of the brain. Or that an irritated nerve is the cause.

Regardless of the hypothesis, trigger points have not been scientifically proven through:

• muscle biopsies (extracting muscle tissue)
• tissue biochemical analysis
• muscle activity measurements
• or imaging techniques like MRIs.

So we know through clinical observation that these painful spots exist. They often cause radiating pain (like in sciatica). But we still don’t know how to reliably prove their existence.

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3. How Can You Find Trigger Points?

You need to know this. If you can’t find them, how do you want to treat them, right? (I’ll answer this question in step 4)

The best method for finding a trigger point is touch. Here are the typical criteria used to identify a trigger point:

1. A therapist will touch your muscles and look for a particularly sensitive spot.
2. If he finds one, he presses on it.
3. If that triggers your symptoms, then you’ve found the trigger point.

Now the big question is:

If 5 different therapists search for your trigger points, will they find the same spots? Unlikely. This highlights the work of Rathbone et al. from 2017.

4. Do You Need to Pinpoint Trigger Points Exactly?

To answer the question in step 3: no, you don’t have to know exactly how to find a trigger point to work on them in general.

If you work with massage, heat pads, foam rollers, etc. you cover a huge area. And this area also contains the trigger points.

Another cool thing is that we often do trigger point therapy intuitively. You know when you’re massaged and a spot feels particularly tight or uncomfortable?

You tend to say, “Can you spend a bit longer or press harder there?”

But even when using something like a foam roller, you tend to linger on those uncomfortable spots. And usually, you feel better afterward.

This leads us to step 5.

5. Are Trigger Points Always Hard?

That is an interesting question. Because your natural tendency would be to say: “Of course they are. I can feel it!”

But why is this important to know in the first place?

Because your physio might say that you have a trigger point because she notices a tight spot. Yet, it might not even be a trigger point.

Andersen et al. looked at this in their study in 2010.

Are neck muscles harder at sensitive spots compared to less sensitive areas? What do you think?

They found no connection. That means the sensitive spots weren’t harder at all.

Interestingly, they discovered that many people had two super sensitive spots in common. And those spots were the SOFTEST areas of the neck! Crazy, right?

Let’s answer the big question now:

6. How Does Trigger Point Therapy Work?

As mentioned: we don’t know exactly how a trigger point develops. That’s why people talk about various mechanisms for trigger point therapy.

Starting with the most common hypothesis (the one about little cramps in the muscle). If this is right, then breaking this vicious cycle shouldn’t be too hard.

All you have to do is to use a foam roller on a regular basis. This way you can help prevent the muscle from becoming overly acidic and tightening up at that spot. Paul Ingraham had a great analogy for this.

Think of flushing out metabolic waste like popping a pimple.

Or otherwise think of using a foam roller like kneading dough to keep it soft and pliable.

Kneading helps prevent the dough from becoming tough and difficult to work with.

It’s the same with the foam roller. It removes tension and increases circulation. Making the muscles nice and soft.

Then there’s the idea that trigger points could be a misinterpretation of the brain.

If that’s true then trigger point therapy could easily promote a “re-interpretation.”

After treatment you tend to feel better, right?

This way, your brain can re-learn that nothing is threatening there. And this will reduce its protective responses (aka tension and pain).

Lastly, there’s the hypothesis about nerve involvement suggested by Quinter et al. (2015). If that’s correct, then gently moving the nerve with light pressure could help.

But is it even important to know which mechanism is at play?

It doesn’t seem so. There are many ways to address all through foam rolling, massage etc.

And that leads us to the last point.

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7. How to Treat Trigger Points Yourself?

Dr. Janet Travell is one of the pioneers of trigger point therapy. She wrote that almost any physical intervention can ease a trigger point. Some common methods include:

• Dry needling (where you insert acupuncture needles into trigger points).
• Injections of painkillers or Botox.
• Ultrasound therapy.
• Cold or heat therapy.
• Laser therapy.
• Electrotherapy.
• Magnetic field therapy.
• Manual therapy.
• Self-massage with something like a foam roller.

There have also been some studies examining these treatment methods. There was no clear winner with outstanding results.

In some studies, electrotherapy and laser therapy did well. In others, dry needling was effective.

But we shouldn’t take these results too seriously since the study quality was quite poor (Stoop et al. 2015).

I’m not a fan of patients becoming dependent on therapists.

That tends to happen with most of these treatment methods. The exceptions are:

The simplest and cheapest way to relieve trigger points is by working with a foam roller.

By the way: I’d suggest you get a medical check-up beforehand. That’s important to rule out any other issues that could cause neck pain.

Back to trigger point therapy now.

If you find uncomfortable spots, stay there for a while.

For the neck, you can use a tennis ball, foam roller or golf ball. I also like to work with a peanut to reach the muscles next to the cervical spine.

Feel free to test different intensities.

You can do that by applying more or less pressure. You can also use different tools. The softer the tool is, the lower the intensity (tennis ball vs. golf ball).

Whether this actually relieves a trigger point is hard to say. Why?

Because we don’t even know how to prove their existence. But you can judge for yourself if you feel better afterward. And that’s what matters most!

If there are any updates in research on this topic, I’ll let you know.

Very important side note here: If you press hard enough, everything hurts.

So don’t overdo it! AND the trigger points should be in the muscles, not on bones or anything.

Please remember: not everything that feels like a bump is a trigger point. It could be a bone beneath a muscle.

If you don’t pay attention and press hard, you might damage the muscle and/or nerves.

So listen to your body about what feels “comfortably painful” and what doesn’t.

You’ve tried a lot and your pain isn’t improving?

Then book a free pain analysis call with me. In this call, we can find out if our online pain coaching would be the right fit for you. If you’re interested, just click on this link.

Conclusion & Next Steps:

Let’s summarize the most important points now:

I want you to get started with your trigger point therapy right now. Get yourself a foam roller or tennis ball. Then massage out the sensitive area.

I’d do this daily or even many times a day in the beginning. You can decrease the frequency as the pain gets better.

This article is about trigger point therapy. But I have to mention that you should try to look for exercises that move and strengthen the affected area.

Because we know that strength training helps neck pain long term.

If you need any help with exercise selection or creating a rehab program, then check out my book: Pain Free Athlete

And if you’re dealing with neck pain, then check out this article now.

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