Trigger Points: Pain Science or Placebo? Cutting Through the Compression Hype

“That’s your trigger point right there.”

“Let me release this knot.”

“We just need to deactivate that tight band.”

Sound familiar?

Trigger points — or “knots” — have become one of the most commonly used explanations for musculoskeletal pain in physio clinics, massage rooms, and gyms around the world. But how much of it is real… and how much is ritual?

Let’s dive into the science, the myth, and what actually helps — beyond poking around until someone flinches.

Where It All Started: The Trigger Point Origin Story

The modern concept of trigger points was popularised in the 1950s–90s by Drs. Janet Travell and David Simons, who published detailed maps of “myofascial trigger points” and their referred pain patterns.

Their theory proposed:

• Painful, hyperirritable spots in muscle

• Palpable “taut bands” that referred pain elsewhere

• Local twitch responses triggered by pressure

• Relief of symptoms via needling, pressure, or manual release

It was a compelling idea at the time — neat, anatomical, and promising fast relief.

But as research progressed, the theory started to unravel.

Problem #1: No Evidence in Cadavers

Despite decades of searching, researchers have never conclusively found trigger points in cadaveric tissue. No knots. No taut bands. No visible lesions. Nothing that reliably distinguishes a “trigger point” from normal muscle.

If these “knots” were structural entities, we’d expect to find them consistently. But we don’t. That’s a major red flag.

In science, absence of evidence — especially after 70+ years of searching — usually means the phenomenon may not exist as originally described.

Problem #2: Poor Reliability in Diagnosis

Trigger point diagnosis relies almost entirely on palpation — a fancy word for “feel around until it hurts.”

But here’s the problem:

• Studies show low inter-rater reliability. That means two experienced clinicians might feel the same muscle and disagree entirely on whether a trigger point exists.

• Subjectivity is rampant — what one person calls a trigger point, another might call general tenderness or guarding.

• Even “objective” features like twitch responses or pain referral patterns vary wildly between individuals.

This makes the whole diagnostic process more art than science — and that’s dangerous when it forms the basis for treatment.

So What Are People Actually Feeling?

If there are no visible knots in tissue and clinicians can’t reliably agree on what they’re feeling… why do trigger point treatments sometimes work?

Here’s the likely explanation:

Trigger points are a neurological phenomenon — not a structural one.

That hypersensitive spot you feel?

• It’s likely a region of altered sensory processing

• The “taut band” may just be increased resting tone

• The tenderness is likely linked to central sensitisation, stress, or poor load tolerance

In other words, your nervous system is amplifying input, not highlighting broken or knotted tissue.

Why Poking, Pressing, and Needling Sometimes “Works”

When someone applies pressure to a painful spot, a few things happen:

• Descending inhibition: The brain sends signals to calm the area down

• Distraction and novelty: Sensory input competes with the perception of pain

• Placebo and expectation: If you expect it to work, it often will (for a while)

• Local blood flow and reflex changes: The area may briefly relax due to improved circulation or altered muscle tone

But these effects are short-term and non-specific. The same relief can come from massage, ice, heat, dry needling, stretching, or even just walking.

They don’t prove the existence of a knot — they prove the plasticity of the nervous system.

So… Are Trigger Points Bullshit?

Not exactly.

Painful spots in muscle are real.

But the explanation — that they’re structural “knots” needing to be pressed or needled away — doesn’t hold up.

The term “trigger point” is often a label applied to a symptom, not a validated medical finding. It offers a sense of understanding, but can easily lead to:

• Over-treatment

• Passive dependency

• A fragile mindset around movement

What starts as helpful reassurance can quickly become a limiting belief:

“I can’t train today, my trigger points are flaring up.”

What Actually Works Instead

If you’ve been chasing “release” for months and seeing little lasting change, it’s time to shift the focus:

1. Load

Gradually load the area with structured strength training. This improves tissue tolerance, desensitises hypersensitive spots, and restores confidence in movement.

2. Movement Variability

Stop moving the same way every day. Introduce novel, non-threatening movement patterns — rotation, tempo work, light mobility — to help the nervous system downregulate threat.

3. Education

Understanding that pain does not equal damage is empowering. Knowing your “knot” is likely just sensitivity — not structural breakdown — reduces fear and improves outcomes.

4. Consistency

As with anything, there is no magic button. Progressive movement over time will do more for pain relief and resilience than any tool, thumb, or needle ever could.

5. Calm the System

Stress, poor sleep, and mental load all amplify sensitivity. Manage these inputs to reduce noise in the system — sometimes your “trigger point” isn’t a muscle, it’s your nervous system asking for a break.

Conclusion: Less Poking, More Progress

Trigger points aren’t useless — but they’re not what you’ve been told.

They’re not knots.

They’re not lesions.

They’re not something you need to beat into submission with a foam roller.

They’re a pain experience, shaped by your nervous system, stress levels, training history, and movement habits.

The fix isn’t more pressure — it’s more perspective.

Stop chasing compression. Start chasing control.

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