Fibromyalgia: What You Need To Know About “Muscle Knots” or Trigger Points


If you hurt all over and feel worn out, you may have stress on muscle fibers what leads to the formation of Trigger Points in muscles innervated by sciatic nerve. Trigger points may also manifest as tension headache, tinnitus, temporomandibular joint pain, decreased range of motion in the legs, and back pain. These symptoms are very similar to Fibromyalgia or Chronic Fatigue Syndrome symptoms, where Fibromyalgia can be diagnosed by 18 specified painful Tender Points around the neck, shoulder, chest, hip, knee, and elbow regions. Finger pressure to these areas for patients with Fibromyalgia can be very painful. This happens because 90 percent of the 18 predetermined Tender Points are actually Myofascial Trigger Points. Trigger Points are firm nodules that you can often feel in your tight, rope-like muscles. Pressing on a Trigger Point hurts in the area and also shoots pain to other regions, while pressing on just a Tender Point is believed to only cause discomfort to the local area. These 18  specific Tender Points  are located at nine bilateral locations and occur on both the right and left sides of the body symmetrically:


Occiput: bilateral, at the suboccipital muscle  insertions. (Where the neck muscles attach at the base of the skull)
Low cervical: bilateral, at the anterior aspects  of the intertransverse spaces at C5-C7. (Front lower neck)
Trapezius: bilateral, at the midpoint of the upper  border. (Midway between the neck and shoulder)
Supraspinatus: bilateral, at origins, above the  scapula spine near the medial border. (Muscle over the upper inner shoulder  blade)
Second Rib: bilateral, at the second costochondral  junctions, just lateral to the junctions on upper surfaces. (Edge of upper  breast bone)
Lateral epicondyle: bilateral, 2 cm distal to the  epicondyles. (2 cms below side bone at elbow)
Gluteal: bilateral, in upper outer quadrants of  buttocks in anterior fold of muscle. (Upper outer buttock)
Greater trochanter: bilateral, posterior to the  trochanteric prominence. (Hip bone)
Knee: bilateral, at the medial fat pad proximal to  the joint line. (Just above the knee on the inside)

Pain in at least 11 of the 18 Tender Points is  required for an FM diagnosis. The Trigger Points generally involve  taut, ropy bands of muscle fibers. There may also be hard lumps or nodules in  the area. Trigger Points are formed when acute trauma or  repetitive microtrauma leads to the development of stress on muscle fibers.  Although anyone can have Trigger Points, they are frequently associated with a  form of chronic muscle pain called myofascial pain syndrome. It’s not unusual  for someone with Fibromyalgia to also have MPS, which may be one of the reasons  Tender Points and Trigger Points are often confused.

Difference Between Tender Points and Trigger Points

Tender Points Trigger Points
The specific point is  tender. The point itself may or may not be  tender.
Tender points do not cause referred  pain. Trigger points refer pain to other  areas.
There are always multiple  points. There may be a single point or  multiple points.
Points occur in specific symmetrical  locations. Points may occur in any skeletal  muscle.

So, let’s talk in a little more detail about Muscle Knots or Trigger Points

Muscles account for more than 60% of the human body mass, making up the largest part of our bodies. They are responsible for all movement of the human body. With such an enormous responsibility, it is easy to see how muscles can be subjected to wear and tear, fatigue, overuse, and repetitive injury.

When we want to move or use our muscles, the muscle contracts, and this is typically a voluntary action. However, sometimes the entire muscle contracts involuntarily, which we call a spasm. Muscles are also subject to another condition, known as a Trigger Point, which is essentially an involuntary contraction of only a small portion of the muscle, creating pain as a protective muscle function.

Trigger Points have been studied and shown to be the most common cause of musculoskeletal pain. Pain clinic doctors have found that Trigger Points are the main source of pain nearly 75% of the time! A unique feature that distinguishes Trigger Points from other muscle pain is that Trigger Points almost always refer pain to other areas of the body. This is why many treatments are ineffective. Most treatments assume that the area of pain should also be the source of pain, yet the actual cause could be in a completely different location.

So, Trigger Point therapy can reduce pain, increase movement, and allows the muscles to lengthen and become stronger again. To treat Trigger Points, moderate pressure must be applied to the Trigger Point. If you press hard into your muscle, this creates pain, which leads to muscle tension. If it hurts – you’re not doing it correctly!

Pressure should be applied slowly and released slowly for best results. The pressure should be maintained until there is a change in light moderate pain. If there is no decrease in pain after one minute, stop the pressure—this is probably not a Trigger Point! After applying pressure to Trigger Points, the relaxed muscle can be carefully stretched.

Trigger Point Therapy can be used to help you with these common conditions:


Tips for safe and successful treatment
  • Before treatment, rate your pain on scale of 0 -10 (0=best, 10=worst)
  • Maintain pressure until your pain has increased to a level of 2 or 3.
  • Deep (but NOT too hard) stroking is just sometimes more effective than fixed pressure.
  • Do NOT murder the tight spot! Attacking the muscle may bring temporary emotional relief, but when you press hard into your muscle, this creates pain, which leads to muscle tension. So you’re actually working against the muscle release!
  • Apply and release pressure slowly (or like I learn from my Siberian Shaman Teacher, you can release muscle knots by slowly pulling the Pressure Point area).
  • Apply pressure or pulling for 1 minute – if there is no decrease in pain, leave it alone…this is not a Trigger Point.
  •  Treat Trigger Points on both sides of the body, not just the effected side.
  • Repeat treatments for best results.
  •  Use Hot type ( NOT Cold type of therapy what slows blood circulation) of noninvasive and nonaddictive pain-relief therapy. Heat opens up blood vessels, which increases blood flow and supplies oxygen and nutrients to reduce pain in sore muscles, ligaments and tendons. The warmth also decreases muscle spasms and can increase range of motion.
  • Trigger Point Therapy you can combined with Pain Relieving Herbs. Please check our Community Forum “A Future Without Chronic Pain”.

 The Infraspinatus Muscle Location and Trigger Points

The Infraspinatus, one of the rotator cuff muscles, lies on the outside of the lower 2/3 of the shoulder blade. It functions primarily to rotate your arm outwards and to pull your arm back, such as when swinging a bat or golf club.

Trigger Points in the Infraspinatus are commonly overlooked, due to the unique referral pattern. Although this muscle is located on the back, the primary referral pain is to the front of the shoulder. Pain can also be found along the outer portion of the shoulder, extending into the upper arm as well.

A common condition known as “Frozen Shoulder” causes weakness and stiffness in the shoulder. This true condition is caused by adhesions and scar tissue in the joint. Trigger Points in the Infraspinatus muscle can mimic the symptoms of “Frozen Shoulder.” Trigger Point treatment with the Pressure Pointer can help to alleviate many of these symptoms.

Infraspinatus is a very common cause of anterior shoulder pain, bicep pain, mid-scapular pain even tingling and numbness into the forearm/hand.

Trapezius - Trigger Point MapThe Trapezius muscle location and Trigger PointsThe Trapezius is a major source of headache pain, typically the type of pain experienced as a “tension headache.” It can also be a cause of dizziness, jaw, and toothache pain. Tightness felt in the neck and back of the skull often comes from Trigger Points in the Trapezius. If neck massage does not relieve the sensation of tightness in the neck, Trigger Points in the Trapezius are the most likely culprit. Computer users and others who use their arms for extended periods of time will recognize the burning pain between the shoulder blades. Referred pain from the Trapezius can be found in such a wide variety of locations, that it commonly leads to misdiagnosis, including shoulder bursitis, headaches, disc compression, or a “pinched nerve.” Using the Pressure Point may help alleviate your symptoms.

The Levator Scapula muscle location and Trigger Points The Levator Scapula muscle’s main function is to raise the shoulder blade. Stress and tension keep the shoulders raised, creating increased tension in the Levator Scapula Muscle. Poor posture can also be a factor. When Trigger Points exist in this muscle, it can be very painful. This muscle is typically involved when you find yourself unable to turn your head. In this case, the direction which you cannot turn is the side that of the problematic Trigger Point. Using the Pressure Pointer to treat the Trigger Points can help restore full movement. Trigger Points in this muscle also create pain and stiffness along the neck and the edge of the shoulder blade.

The Subscapularis muscle location and Trigger Points   The Subscapularis trigger point is very elusive and causes all sorts of problems in function and creates pain. This is the number one trigger point that is overlooked in most shoulder pain problems. BE CAREFUL! This trigger point can be excruciatingly painful when pressure is applied. It can feel like your arm is being ripped out of the socket. That is a normal side effect feeling of an intense trigger point but will subside in time. Trigger Points in Subscapularis also create pain along the shoulder, mid-back, wrist, and arm. You also can have headaches or Cervical pain.


The Soleus muscle location and Trigger Points Every condition and symptom from the bottom of the foot up should have the Soleus mixed into the evaluation process. It can be linked to many dysfunctions because of its intense integration into the gait cycle. The Soleus is also a primary muscle to help pump blood back to the heart from the lower extremity. This pump movement mechanism can be slowed down when the muscle is not functioning at max capacity, thus decreasing blood flow to the heart. This can lead to decreased endurance and sports performance because of the decreased supply of oxygen. Sudden onset of dizziness when standing from a seated position can also be a problem with this trigger point. The delayed blood flow upon rising makes you dizzy. Work the muscle and notice an improvement. It has even been linked to chronic jaw pain! The gait cycle is altered as a result of dysfunction in this muscle. The toe off phase and ankle joint dorsiflexion will be compromised leading to increased movement in the hip joint. This is a recipe for disaster. So if there is a hip issue, check the Soleus. Checklist for symptoms of the Soleus is Plantar Fasciitis, heel pain, shin splints, neck, back, hip and knee pain, Headaches and TMJ.


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