Trigger point therapy: what it is and who needs it

A trigger point is a hyperirritable spot within a taut band of skeletal muscle. It produces pain locally when pressed and, characteristically, refers pain to a predictable distant location. A trigger point in the upper trapezius refers pain to the temple and the back of the eye. A trigger point in the gluteus minimus refers pain down the lateral thigh in a pattern that mimics sciatica.

These referral patterns are consistent and documented. They do not show on imaging. They are identified by examination and palpation, which is why trigger point pain is frequently undiagnosed for years.

Trigger points develop when a muscle is held in a shortened position under sustained load. Desk workers develop upper trapezius trigger points from sustained cervical extension and shoulder elevation. Runners develop gluteal trigger points from sustained hip flexion during training. The sustained shortening reduces blood flow to the motor end plate, producing acetylcholine accumulation and a maintained contracture.

Once formed, trigger points alter muscle recruitment. The affected muscle becomes less efficient, requiring other muscles to compensate, creating a chain of secondary trigger points in the compensating structures.

Sustained ischaemic compression: direct pressure applied to the trigger point until the referred pain and local tenderness reduce. Typically held for 60–90 seconds. Active release technique: sustained pressure applied while the muscle is moved through its range. Both are used at Achilles Clinic depending on the trigger point location and client tolerance.

Dry needling (inserting an acupuncture needle directly into the trigger point) is a more direct mechanical intervention. Achilles Clinic does not currently offer dry needling, where this is indicated, we will direct to an appropriate referral.

Trigger point therapy is most useful for: desk workers with chronic neck and upper back tension producing headaches, endurance athletes with gluteal and posterior leg patterns that have not resolved with stretching or massage, people with chronic pain presentations where the pain does not clearly localise to a specific joint or structure, and clients who have been told their pain is unexplained.