Recovery Insights Blog | Foundational Rehab

That Spot That Hurts When You Press It

You know the feeling: a tight, tender spot in your muscle that hurts when you press on it—and sometimes sends pain radiating to other areas. You might call it a "knot." Clinically, it's often called a trigger point.

These spots are real, common, and treatable. But there's more nuance to them than you might think.

What Are Trigger Points?

A trigger point is a hyperirritable spot within a taut band of muscle. Characteristics include:

**Tender when pressed:** More painful than surrounding tissue

**Taut band:** A tight rope-like area within the muscle

**Referred pain:** Pressure often causes pain to radiate to another area

**Local twitch response:** Sometimes the muscle twitches when pressed

Common locations include:

Upper trapezius (top of shoulders)

Levator scapulae (side of neck)

Infraspinatus (back of shoulder blade)

Quadratus lumborum (side of low back)

Piriformis (deep buttock)

Suboccipital muscles (base of skull)

What Causes Them?

The exact mechanism is debated, but contributing factors include:

Muscle overload

Sustained contractions (holding postures)

Repetitive movements

Acute overload from lifting or strain

Poor posture

Forward head position strains neck muscles

Rounded shoulders load upper back muscles

Prolonged sitting compresses hip muscles

Stress

Tension accumulates in muscles (especially shoulders and jaw)

Stress hormones affect muscle tone

Inactivity

Muscles that don't move develop problems

"Use it or lose it" applies

Sleep position

Awkward positions during sleep

Referred pain from other sources

Sometimes what feels like a trigger point is actually referred from joints, discs, or viscera

The Referred Pain Pattern

One hallmark of trigger points is referred pain—pressing one spot causes pain somewhere else. Classic patterns:

Upper trapezius trigger point → headache up the side of the head

Infraspinatus trigger point → shoulder and arm pain

Quadratus lumborum trigger point → hip and buttock pain

Piriformis trigger point → buttock and leg pain (mimics sciatica)

These patterns are fairly predictable and can help identify the source of mysterious pain.

How to Release Trigger Points

Self-Massage and Pressure

Tools:

Tennis ball, lacrosse ball

Foam roller

Massage gun/percussive device

Theracane or similar tools

Your fingers (for accessible spots)

Technique:

1. Find the tender spot

2. Apply sustained pressure (uncomfortable but not excruciating—aim for 6-7/10 discomfort)

3. Hold for 30-90 seconds

4. You should feel the tension start to release

5. Breathe slowly and try to relax

Frequency: Can do daily for problem areas. 1-2 minutes per spot is usually sufficient.

Foam Rolling

Foam rolling can help, but technique matters:

Roll slowly—fast rolling isn't effective

When you find a tender spot, pause on it

Apply sustained pressure rather than rolling back and forth rapidly

Breathe and try to relax into it

Stretching

Stretching the affected muscle can help, but:

Stretch after releasing the trigger point, not before

Gentle, sustained stretches (30+ seconds)

Don't push into pain

Combine with trigger point release for best results

Heat

Heat can help relax tense muscles before or after treatment:

Warm shower or bath

Heating pad

Warm towel

Professional Treatment

If self-treatment isn't enough:

Massage therapy

Targeted soft tissue work by a skilled therapist.

Dry needling

A practitioner inserts thin needles into trigger points. Can produce rapid release, especially for stubborn points.

Physical therapy

Addresses trigger points plus the underlying causes (posture, weakness, movement patterns).

Addressing the Root Cause

Releasing trigger points provides relief, but they'll return if you don't address why they formed:

Posture

If trigger points are in your upper back and neck:

Workstation ergonomics

Reduce forward head posture

Take movement breaks

Address rounded shoulders

Movement

Static muscles develop trigger points:

Move regularly throughout the day

Stretch and strengthen affected areas

Don't stay in one position too long

Strength

Weak muscles get overloaded more easily:

Strengthen commonly affected areas

Focus on postural muscles

Build endurance, not just strength

Stress Management

Tension accumulates in muscles:

Notice where you hold tension

Practice relaxation

Address stress sources

Sleep

Improve sleep position and quality:

Proper pillow support

Avoid stomach sleeping

Address sleep issues

When Trigger Points Aren't the Answer

Sometimes what seems like a trigger point is actually:

Joint dysfunction referring pain to muscles

Disc or nerve issue

Visceral referred pain

Fibromyalgia or central sensitization

If trigger point treatment isn't helping or symptoms are unusual, consider other causes. Persistent issues warrant professional evaluation.

A Balanced View

Trigger points are real and treating them often helps. But they're also sometimes over-diagnosed—not every tender spot is a trigger point, and not every problem needs myofascial release.

The best approach:

Use self-treatment for obvious muscle tension

Address underlying causes (posture, stress, inactivity)

Seek professional help if self-treatment isn't working

Consider that the problem might be something else if progress stalls

The Bottom Line

Trigger points—those tender spots that radiate pain when pressed—are common and often treatable. Self-massage, foam rolling, and stretching can help, especially when combined with addressing root causes like posture and stress.

For persistent or severe cases, professional treatment (massage, dry needling, physical therapy) can provide additional relief.

The key is treating the knots while also asking why they formed in the first place. Address both, and you'll get lasting relief.

Foundational Rehab programs include self-treatment techniques for common trigger points alongside the strengthening and movement work that prevents them from returning.

Trigger Points and Muscle Knots: What They Are and How to Release Them