Dr. Peter Borten, LAc, DAOM

Articles and Resources on All Facets of Health and Healing

Trigger Points: A Revolution Waiting to Happen

Often in human history, the significance of a major discovery hasn’t been appreciated until a much later date. Sometimes the one who made the discovery died before the world recognized their achievement. One such discovery, still awaiting the widespread recognition it deserves, is the concept of myofascial trigger points.

The Pioneering Work of Janet Travell, MD

Janet Travell, who coined the term “trigger point,” was born in 1901. She graduated with honors from the medical college at Cornell University in 1925. In the following decades, she became interested in muscular pain, and began to develop new techniques for treating it. In 1955, she was called on by John F. Kennedy (a senator at the time) for help with debilitating back pain due to injuries he sustained in World War II. Travell cured Kennedy’s pain, and after he won the presidency, he made her the first woman to hold the post of personal physician to the President. He later credited Travell with saving his political career, which he and his family felt would have been otherwise derailed by his pain.

What Are Trigger Points?

In 1983, Travell and colleague David Simons, MD, published the first volume of an opus on the subject of muscular pain. In this book, Myofascial Pain and Dysfunction, Travell and Simons explore the phenomenon of trigger points. (Not to be confused with acupuncture or acupressure points, though they do share many of the same locations.)

They define a trigger point as a highly irritable nodule of tissue that occurs in a taut band of muscle. Often the muscle feels like it’s incapable of relaxing and softening, because the trigger point causes the muscle’s fibers to become chronically shortened. Trigger points tend to form in predictable places and produce predictable patterns of pain.

A trigger point’s pain pattern is often much broader than the irritable region itself. Especially interesting is that in many cases, the pain occurs at a different place than where the trigger point is located. There may be no pain at the trigger point itself. This is why Travell and Simons’ work was so groundbreaking. Before these maps were developed, almost nobody would have thought to investigate, for instance, the front of the neck as the possible origin of pain in the upper back.

An Unrecognized Epidemic

In my experience (and that of many other medical professionals), the vast majority of chronic pain is due to trigger points. Besides pain, trigger points cause a wide range of other symptoms that usually aren’t suspected to come from our muscles. Trigger points in the back, shoulders, and neck frequently cause numbness and tingling in the arms and hands. Trigger points in the neck can cause nasal and sinus symptoms that mimic allergies or a sinus infection. They can also cause migraines, earaches, jaw problems, vision changes, hearing loss, and coughing. Frequently, the symptoms of trigger points are misdiagnosed as problems with the internal organs. For instance, trigger points in the chest muscles can produce pain like a heart attack, and trigger points in muscles of the abdomen or lower back may seem to be disorders of the intestines or reproductive organs.

Trigger points form as a result of muscle abuse, and there are many ways to abuse muscles. Some of the most common are repetitive motions (such as typing, mousing, clenching tools, and other occupational tasks) and extended time in an unnatural position (such as holding a phone between the ear and the shoulder, or sleeping in a car). Also common are accidents, athletics, poor posture, tightening due to stress, and carrying bags. Immobility could also be considered a form of abuse, as a lack of stretching and exercise makes our muscles more prone to damage.

Travell and Simons mapped out all the major sites where trigger points occur and explained what kinds of symptoms each one produces. It’s been over 25 years since their first book was published, yet this information has been mostly ignored by the medical mainstream. I have seen hundreds of patients with chronic pain who have taken painkillers or have been to pain specialists, surgeons, and other healthcare practitioners without getting any real improvement.

When I examine their muscles, I find trigger points – almost without exception. About nine times out of ten, when the trigger points are released, there is significant, if not total, relief. I don’t mean to imply that the practitioners my patients saw before me aren’t good at what they do; just that they either didn’t consider trigger points or didn’t know how to treat them. Neither is it my intention to toot my own horn when I say that I was able to help these folks get relief when other doctors weren’t. There is certainly skill involved in effectively releasing trigger points, and my technique has improved over the years, but I am simply utilizing an understanding of basic human anatomy and the maps developed by these groundbreaking doctors.

Our Overlooked Muscles

As Dr. Simons points out, despite the fact that muscles comprise so much of the human body and have so many functions, there is no field of medicine that focuses specifically on them. This honor is left mostly to acupuncturists, massage therapists, and physical therapists.

Travell and Simons initially deactivated trigger points by either injecting them with a small amount of a numbing agent or spraying them with a coolant and then forcibly stretching the muscle. However, it was later discovered that a trigger point can be mechanically released by probing at it in a certain manner with an acupuncture needle, even without injecting anything into it. This practice was readily adopted by acupuncturists, who use fine needles that can be maneuvered with great precision.

Travell and Simons also discovered that certain massage techniques are highly effective at releasing trigger points. While most acupuncturists, massage therapists, physical therapists, and chiropractors have some familiarity with trigger points, if you decide to see someone for trigger point release, ask if this is something they specialize in.

Finding Trigger Points

Finding trigger points takes practice and sensitivity, but I believe that anyone who is willing to thoroughly investigate their body can hone in on the source of the problem, with the help of trigger point charts and a friend (or some basic tools). Travell and Simons’ books are wonderfully comprehensive, but not really accessible for the average reader.

If you don’t have much experience, the key is to feel all the possible regions where trigger points may occur that could potentially produce the pain you’re experiencing. I developed a tool for this on the site of the pain patch I developed. You can click HERE to go to the site – then click on Pain Expert in the menu bar. When you discover a trigger point, pressing on it will sometimes, though not always, elicit a pain in the place and manner that you’ve been experiencing. What is more common is that the trigger point itself is just very tender and uncomfortable to work on. Later, after you’ve treated it with massage, acupuncture or the Imbue Pain Relief Patch, your pain will feel better. With more practice, you will begin to feel that a trigger point usually feels like a small lump or grain in the muscle. The muscle a trigger point occurs in will sometimes feel stringy, like one or more cords, rather than a smooth, pliable, and cohesive mass of muscle. When the taut muscle is “plucked” by strumming a finger across it, you will often see a twitch that extends a few inches from where you plucked it.

Managing Your Own Pain

Much of the work of managing trigger points can be done by you at home. Balls are my favorite tool for self-treatment of trigger points. You can lie on a ball in just the right spot, or you can stand with a ball between your body and a wall, to deliver pressure at a rate you can control. (Lying on a ball delivers more pressure than leaning on a ball against a wall.) Tennis balls are decent, especially if the area you’re working on is very tender. I usually prefer a solid ball, such as a lacrosse ball or high bounce ball. Larger balls are usually too wide to really get into trigger points, although they can be good for stretching larger areas. Yamuna balls, used in Body Rolling, are fantastic maintenance tools, and can also work at releasing trigger points (especially the small ones). There are also a number of tools, such as the Thera Cane, that can make it easy to access areas that are otherwise difficult to get to. While I own and use these tools, I feel there’s no substitute for getting worked on by another human being, so I strongly recommend also utilizing acupuncture and massage.

If lying on a ball to treat part of your back, you’ll usually have your knees bent and your feet flat on the floor. If you want to get more pressure on the spot you’re working on, you can lift your buttocks off the floor. Whether using a ball, a tool, or another person’s hands or elbows, the idea is to exert deep pressure on the trigger point, but not to the degree that you tighten up or brace against this pressure. In this state of deep pressure on the trigger point, breathe deeply, especially accentuating and lengthening your exhales as you aim to consciously relax into the pressure. Imagine you are fully allowing the ball/tool/hand/elbow to enter into your body, as if opening your muscles. The point can be held in this way for anywhere from about ten seconds to a couple minutes. It is important to learn to feel your limit. You don’t need to withstand sharp, burning, or intense pain – this is usually inadvisable anyway. If you overdo it, you can cause yourself more irritation.

If you simply hold a trigger point in this way, and relax and wait, this is often sufficient to get it to release. However, because our muscle cells have “memory,” they may return to a semi-contracted state within hours or days. You may have to repeat this procedure several times to break the muscle’s habit of re-tightening at this spot. Also, if you continue to overdo the same movements or postures that led to the trigger point in the first place, this practice may need to be an ongoing part of your self maintenance. Sometimes the practice can be more subtle, yet just as effective. One can get a trigger point to release with light pressure or even with no pressure at all – simply by consciously relaxing and lengthening the affected muscle. (Some find it’s easier to get a muscle to relax if they tighten it first.) But most people get faster results with fairly deep pressure. Occasionally, adding some movement to the pressure produces even better resolution of the problem.

There are two primary forms of movement to try. The first is to move slowly along the muscle in the same direction that its fibers run. For instance, if working on the forearm, these muscle fibers all run more or less parallel to the length of the bones (that is, basically from the elbow toward the hand). For example, if you found a trigger point in the meaty area of the upper forearm, just below the elbow, you would first apply pressure by slowly entering the muscle (with a thumb, a ball, a Thera Cane, etc.) as deeply as is comfortable. Then, while maintaining this pressure, glide very slowly down the forearm a few inches (toward the hand). If this is done without any oil or lotion, you will not be sliding over the skin, but instead moving the skin over the underlying muscle. You can do a stroke like this several times and then give the muscle a rest.

The second form of movement is referred to as “cross fiber,” because it entails moving side to side, back and forth across (or perpendicular to) the direction the muscle fibers run. This is often a more painful form of massage, and it definitely has the potential to leave a muscle irritated, but it sometimes helps release a very stubborn trigger point. (For this reason, body workers occasionally recommend application of a cold pack after this kind of work, to reduce the potential for provoking inflammation.) You won’t always know which direction a muscle’s fibers run unless you look at a diagram of it. However, most of the superficial muscles of the body run longitudinally – that is, parallel to the vertical axis and long bones of the body. The muscles of the neck and back run mostly parallel to the spine. The muscles of the arms and legs run mostly from the shoulders to the hands and the hips to the feet.

The only drawback to using balls, tools, and massage to release trigger points is that it can be somewhat painful work. But in my opinion, a few minutes of pain in order to alleviate a persistent problem is a very reasonable trade-off. After you work on one point, move on to the next tender spot you find. To make progress on significant or longstanding pain, you need persistence and patience.

The key to lasting relief from trigger points is using our bodies in a smart fashion. Pay attention to ways that you perform motions repetitively or utilize muscles unevenly. If you’ve ever worked with a trainer, you know how important good form is when exercising. Poor form is the main cause of athletic injuries, and the same is true in everyday life. Our daily activities – gardening, painting, operating cars and machinery, picking up children –  frequently constitute an all-day workout. Yet, few of us tend to our bodies as if this were the case, by stretching, hydrating, taking frequent breaks, getting massage, etc.

If your business offers a consultation with an ergonomics specialist or occupational therapist, take advantage of it. If you spend much time working at home, do an ergonomics assessment of your home desk. Resist the temptation to work on your computer while slumped on the couch. Adjusting your work station to minimize postural stress can make a huge difference in how you feel at the end of the day. Although maintaining perpetual awareness of how you’re using your body may seem a daunting task, the good news is that as you work out your trigger points and return to balance, you also become more conscious of when you’re using your body in an unhealthy way. As with President Kennedy, trigger point treatment may be the key to resurrecting a life that seems doomed to be painful.


  1. I am 27 years old. January 2013 one day I felt a horrible pain in my upper back just above where mid back would be. It’s hard to sometimes touch the exact spot of pain but it pretty much always feels like it is in the exact same area. My MRI showed nothing. My x ray showed nothing. I see a physical therapist who isn’t sure if what he is doing is right bc he doesn’t know what the problem is fully. They have been saying they think I am having muscle spam deep in there. It is not the kind of spasm (if that is what it is) that makes it where you are bent over and can’t straighten up. The pain doctor just gives me pain medicine and doesn’t seem to do anything but that. Activity greatly aggravates and causes this pain. For example cleaning my house thoroughly will cause a lot of pain. My husband gives our daughter all her baths bc bending over the tub would cause me pain. The pain is not immediate, like a sharp pain or anything. It gradually comes on and then the more I continue to do once it starts the worse it gets. I can most always get it to calm down and feel better if I lay down or relax into the couch for awhile. I have so many goals in my life and I want to be more active with my three year old. I miss working out (which causes a lot of pain.) I want my old life back. I don’t want to take pain medicine. I feel like I can’t get any real help. I don’t want it to be like this forever.

    • Peter Borten

      March 24, 2014 at 4:42 AM

      I’m sorry to hear of your intense and longstanding pain. I strongly recommend you see an acupuncturist for a series of treatments. I treat people with stories much like yours all the time, and they virtually always make great and rapid improvements with acupuncture. Especially given the absence of any structural reason for your pain, it’s the kind of thing I can usually correct within just a few treatments.
      Good luck & be well,

    • I had a similar problem that lasted for 3 years. A chiropractor found that I had a twisted rib that was pinching a nerve. It is now 5 years later and my back and shoulder still aren’t completely fixed. I see a sports therapist, massage therapist and acupuncturist at this point. It helps to keep the spasms from being to painful, but does not get rid of them.

    • Elisabeth Cassidy

      July 27, 2017 at 3:28 AM

      EXACT same story I have. The pain is literally so bad I become nauseous from it. Tried everything. MRI, X-rays and nerve tests all came back fine. No one could explain issue. Now I realize its all a result of muscle spasms. Did dry needling today and I think I’ve found what I’ve been praying for.

  2. Hello. I am 24 years old, and I am so glad to have found this site.

    Three years ago, I developed bronchitis, and the coughing was atrocious… some of the worst I’ve ever had in my entire life. After it cleared up, I felt different…and I’ve NEVER felt the same since. What happened is that I noticed there was pressure just under my ribcage every time I took a deep breath. I’d feel a tight “pulling” feeling, and sometimes I’d feel little pain signals shooting off to the sides of my abdomen. Doctors shrugged it off.

    But…a year later, I started randomly developing pain throughout my body. I literally had myofascial trigger points and restrictions ALL over my body….from my back, into my butt muscles, and into my legs. My knees started snapping when they flexed… it was EXTREMELY uncomfortable to sit. The sides of my torso were extremely painful. Everywhere on my body essentially started to burn, tingle, and sting. I cried all the time and was in deep depression.

    Then I found a lovely woman, a registered massage therapist trained in myofascial massage. She palpated me and it is of her opinion that the “pressure” under my ribcage is actually a trigger point in the diaphragm muscle. She thinks that this was caused from the coughing, and that the trigger point in this area affected my breathing techniques, which further perpetuated satellite trigger points in these other areas.
    She CURED me of the pain at the sides of my torso (it was my worst pain), but her techniques haven’t been effective in treating the other pain, and to this day, it remains. It burns just to sit here and type this.

    I have yet to try acupuncture for this. Does my story sound as if it would be effective at treating my problems? I’m exhausted from this pain, and the pressure when breathing is relentless and disheartening 🙁

    Many thanks,

    • Peter Borten

      April 4, 2014 at 5:56 PM

      Hi Danny,
      Sorry to hear you’ve been in so much pain. Yes, find a good acupuncturist. This is generally very treatable with acupuncture. It may be trigger point pain, or may be nerve pain, by the sound of it. Some people report relief from nerve pain with an antioxidant called alpha lipoic acid. The dose used in studies for nerve pain is 600 mg twice a day (taken with some food in the stomach to prevent a heartburn sensation).
      Be well,

      • Hi Peter,
        Nerve pain has been ruled out. My massage therapist tested for it, and not only that, when she palpated the back of my legs, we felt those taut bands of muscle, and it did elicit that infamous “twitch” response. Same thing with my buttocks. I’m desperate, and not necessarily full of money right now, but I am praying that acupuncture can be the resolution I need. Are there certain criteria you recommend when tracking down a good acupuncturist?


        • Peter Borten

          April 4, 2014 at 9:25 PM

          Hi Danny,
          I’m not sure that your massage therapist could definitively rule out nerve involvement through manual testing, but I’m definitely supportive of pursuing the release of trigger points before investigating neurological options. I tend to assume that pain is myofascial unless proven otherwise, and the twitch response indicates TPs are present. As for finding a practitioner, it’s hard to say what to look for or ask, since there are practitioners who are excellent at pain relief who might not have done any special additional training (beyond their regular schooling). And there are probably practitioners who specialize in pain treatment yet are not remarkably effective. But you have to start somewhere, so I would recommend asking if pain treatment is one of their specialties. You might also ask if they’ve done training in either Mark Seem’s style (an osteopath who helped pioneer trigger point based acupuncture) or the Matt Callison’s style of motor point based sports acupuncture. These people will tend to be trigger point oriented (or at least have a good sense of the muscles they’re treating) in their approach. Again, though, others utilizing different styles may yet be quite good. I’d find someone you get a good feeling about and if you don’t notice any improvement at all within 3 treatments, find someone else.
          Good luck,

    • hey Danny I have similiar symptoms which i believe is caused by a trigger point in my diaphragm. Can you tell me how it was your therapist cured it?

  3. I have upper back pain since two years, shoulders, neck ,back and upper spine..highly irritable spot in between my shoulder blades and spine. It aggravates with activity. I am not able to do anything substantial in my life. Plz help.

    • Peter Borten

      July 23, 2014 at 10:17 PM

      Roll on a hard ball in this area. It should be intense. Do it for 15 minutes every day.
      Get acupuncture, if possible.
      Get deep massage regularly.
      Improve your posture.
      Do yoga.
      Drink lots of water.

  4. I have had ongoing back pain for a couple of years now. It is located in my mid back, right side, but off center of my spine. I have tried massage, chiropractic care and muscle relaxers, only to have very, very temporary pain. This place will “catch” enough to take my breath and leave me immobile for about 10 seconds and then it eases up.
    An x-ray shows nothing, but just tonight, my husband told me as he was massaging that particular spot that it felt stringy. I don’t recall doing anything that would have caused the injury. The pain now radiates from that central location down towards my right hip and around my rib cage. Any advice?

    • Peter Borten

      September 2, 2014 at 4:48 AM

      Hi Jennifer, You have “myofascial trigger points” in the muscles of your back. That’s what that stringy feeling is – individual muscle fibers have become taut because of localized shortened segments within them. Chiropractic has nothing to do with that, unfortunately. Massage could take care of it if you saw someone who really specializes in trigger point massage and knows how to release trigger points. But my favorite way to release them is to put acupuncture needles directly into them. The release is basically instantaneous, and when part of a more comprehensive treatment to address the deeper mechanisms that are perpetuating the holding in that area, a few (probably 3-6) treatments should take care of it completely. Not every acupuncturist works this way (nor is it the only way to “get the job done” with acupuncture, but in my experience, it’s the most direct and fastest, especially combined with complementary points on the limbs). If you tell me where you’re located I may know someone I can refer you to – otherwise you can just try someone who feels good to you and if you don’t get results within a few treatments, see someone else. There is absolutely, 100% certainly, a way to cure this kind of pain with acupuncture. good luck.

  5. Hi, thanks for your response. It’s good to know that this has a name. It’s been pretty debilitating. I live in Pleasant Hill, Il., which is a couple hours north of St. Louis, Mo. and quite a distance from Chicago. I would love to find someone close who could handle this issue without too much travel. Thanks so much!

  6. Peter Borten

    September 9, 2014 at 8:00 AM

    Hi Jennifer, I asked my colleagues and unfortunately, no one knew anyone in your area. Hopefully there ARE some acupuncturists and you can find one who does good work. I’m sure you could find one closer to St. Louis, and it might be worth the drive. Check out some of the criteria to look for that I mentioned to people who commented above. Good luck & be well. Peter

  7. Hi,
    I play baseball year round all the time and the last couple of months i first had this pain in between my shoulder blades and on my shoulder blade that got worse with any activity. Eventually, after a month off and deep tissue massage it went away.
    About a month ago I was hitting and I strained an intercostal muscle and it is starting to heal but I have all these pains and tightness in my upper back shoulder and rib cage. My muscles feel like a rope. My back discomfort won’t go away. What should I do?

    • Peter Borten

      February 9, 2015 at 7:18 PM

      Hi David,
      Get more deep tissue massage – or acupuncture. If you’re going to be making big athletic demands on your body, some sort of maintenance practice needs to be part of your routine. If you’re on a budget, you may be able to do your own maintenance by rolling on a lacrosse ball. I like to do this on a carpeted floor or exercise mat. For the upper back, lie down, bend your knees, place your feet flat on the floor, and place the ball under your back in the painful area. Usually this will be right along the inside border of the shoulder blade (rhomboids, trapezius, serratus posterior superior) and then right along the upper border of the shoulder blade (supraspinatus, trapezius, levator scapula), and probably also right over the main flat part of the shoulder blade itself (infraspinatus, teres minor & major) and maybe along the outer edge (latissimus dorsii). You can lift up your butt to get more of your weight on the ball. You can either just lie there on it, letting it sink in at each spot for a minute or so, then move it slightly to a new spot. Or you can roll a bit or shimmy side to side a bit to get more “cross fiber” massage on the area. Methodically cover every painful spot. This whole process might take you 15-30 minutes. If you do it on a regular basis, it could be all the maintenance you need. You might have to roll onto your side to get into the intercostal muscles and serratus anterior. And you might have to lie face down on it to get it into the pectoral muscles, too.
      Good luck,

  8. You have cracked the code of pain!!!

    Needles are the set of tools in medicine for the treatment of long-term pain!!!
    This is a universal truth and certainty that will be forever!
    Thanks to Gunn, Cannon, Travell & Simons’, Rachlin, Baldry, Seems, Helms, Starlanyl, Hackett, Cyriax, Craig, Gokavi, Lennard, Burke, DiFabio and Pybus, B.J./D.D. Palmer, Wyburn-Mason,and Chaitow.

    The tool can be a metal wire-like needle, a hypodermic needle, a wire probe, or a surgical blade.

    I have done my best to research every article related to myofascial pain syndromes, trigger point therapies, dry needling, acupuncture, prolotherapy and any high-technical injections. What I found is a common thread that explains everything.
    #1. They all use a metallic tool that is inserted into the flesh or muscle and this activates the innate healing cascade.
    #2. They all use a metallic tool that is inserted into the flash specifically the muscle which depolarizes the muscle which causes it to relax. So a contracted tight muscle that is in a state of constant activation will completely relax and elongate. The elongation of this muscle could be anywhere from a millimeter to a few inches, depending on the muscle. This elongated relaxed muscle is not pulling on bony attachments, compressing arteries and nerves, and restricting blood flow.
    # 3. They all use a metallic tool that is inserted into the flash from the skin, adipose tissue, fascia through the muscles and to the bone. This metallic tool can be used as a pro which can stimulate the dense tight contracted muscle fibers which again will awaken the natural innate healing cascade. The beauty of it is that it does it through a pinpoint incision through the skin. So in essence this is a surgical technique.

    Gunn, realized that the needle was doing 3 events simultaneously to reverse the cause of pain:
    1) The needle is like a probe to be uses as a tool to stimulate all of the devolved, stale, tight muscle tissues through a minute pinhole;
    2) He found Cannon’s Law of depolarize to link the ability of the stainless steel needle which can now safely and effective repolarize a tight muscles which makes it relax and elongate. Thus in a better resting state for a complete healing cycle;
    3) The needle was like a safe key to ignite our natural innate ability which is a function of the healing cascade of wound repair.
    4) All event happen simultaneously to ignite helain in the best cellular/subcellular environment possible.

    Gunn’s insight are amazingly profound, safe, low-tech, highly effective and follows all the known laws of biology, physic and nature. http://www.istop.org/drgunn.html

    Cannon WB, Rosenblueth A. The Supersensitivity of Denervated Structures: A Law of Denervation.New York: MacMillan; 1949.

  9. Hi,

    Great article here.

    I have had shoulder impinment for almost 2 years in my right shoulder. It is much better now than when I first went for help with a physio. However I have been signed off from him now as the nhs will only allow a patient to be seen for this kind of treatment for a year, that is before surgery is offered. I feel like at the beginning it was a weak supraspinatus that caused my impingment which was due to weight lifting. That seems to have been cured with the exercise prescribed by my physio. Now though I feel like I have been left with several trigger points in my upper back, maybe infraspintis as well, that are just so stubborn. I roll on a tennis ball (as I have for the last few months) and instantly I have far more range of motion in my shoulder, but an hour or two sometimes a day later the tightness returns. I am very physical and desperate to get back to exercising with my partner but this reoccuring pain is stopping me from doing so. Do you have any advice for me? Thank in advance


    • Peter Borten

      November 21, 2015 at 3:02 AM

      Hi Barry, I’m glad you are keen to do your own treatment and investigation. It may be that the shoulder points you have gotten to are actually “satellite” trigger points under the control of a more central trigger point or points. Possibly you have the right points but just need to work them more frequently in order to completely deactivate them. Or it could be that some behavior (postural stress) is simply undoing your work. Check out Claire Davies’ Trigger Point Workbook for more self treatment ideas. More thoroughly investigate all around the shoulder – front and back – and also be sure to check the scalenes. They are quite unpleasant to work on, but a little work goes a long way. Another muscle you probably haven’t gotten to is subscapularis, which is mostly hidden on the front surface of the shoulder blade – though there are some ways of accessing it.
      Check out the Pain Expert site I created: http://www.thedragontree.com/shoulder-pain/
      Be well,

  10. I used to get migraines nearly every five weeks or even less, up to four years ago. I started studying and practicing TP resolution techniques and after about a year into it, I learned the dozens of TPs around the neck, in the jaws, and in the shoulder that can cause migraines.
    I have discovered that the TPs in my neck was coming from walking with a roll toward the outside, my big toe had to work beyond its normal capacity to maintain my balance, which is an amazing task. The toe would ask for help form the next muscles up the chain, on top and bottom of my feet, which had to work beyond their capacities, and up to the outside of the shin, the calves, buttocks, the lower back and all the way to the shoulder muscles would have to work harder for my bad walking habit.
    I learned that if you resolve the top of the chain of pain, you can trace the cause down to the little guy, you index finger perhaps, through all the intermediary muscles. I say the index finger because I damaged it in a skiing accident when another skier dragged my pole which extended my hand, arm, elbow, and shoulder.
    A well known doctor (to several sports teams in Boston) diagnosed it as a mild to serious rotator cuff damage. For two years I suffered until I slowly traced nearly every muscle that holds the shoulder together and found the trigger points that were created and eventually that lead to one in my index finger. When I finally resolved that, my shoulder came back 100%. It took nearly two weeks, but that is fifty two times quicker than the two years I had the pain with no end in sight.
    Anyhow, you can best learn by practice. Never give up, if it works once, the tendency is to assign the relief to something else and shy away using the idea again as if it didn’t work, you wold lose your religion. I am an atheist, but his religion is here to stay, it is part of our evolution. Our muscles are as bad as our eyes.

  11. I am very interested in your article and thank you for sharing it.
    I have a problem with a long-standing cough. I have had hospital treatment but nothing much showed up despite x-rays, CT[V], Echo-cardiogram, Doppler scan except that I had a wheeze and attributed to asthma. But then it did not explain the hacking cough which I still have some months later.
    What seems strange even extraordinary is that I find that I get intense coughing and choking simply by digging my elbow – right or left – into the pillow or mattress and explosive cough follows. Also by pushing down on my legs on a certain spot evokes a major coughing attack.
    It is as though my entire nervous system has been put on the alert and makes me cough just by lying down. A congestive cough comes from nowhere.
    The doctor has told me it is post-nasal drip but this seems strange when the cough is evoked by my inadvertently bending over or pushing on my legs.
    Does anyone have any suggestion how to stop this terrible sensitivity please as it is wrecking my life.
    Thank you so much

    • Peter Borten

      November 20, 2015 at 6:52 PM

      Hi Rosey,
      It sounds like more investigation is in order. Unfortunately, I can’t do that over the internet. I have some suggestions, but really, you’ll need to find someone who thinks outside the box. I’d look into finding a skilled acupuncturist who also prescribes customized herbal formulas and/or a naturopathic physician. Has anyone tested you for GERD (acid reflux)? The irritation caused by acid in the esophagus can cause coughing, and it would almost always be worse with bending over or lying down, especially if you also have a hiatal hernia. Post-nasal drip is absolutely a realistic cause of chronic cough; though it doesn’t explain why you can induce the cough in some of the ways you mentioned, it’s nonetheless worth FIGURING OUT. WHY do you have post-nasal drip? Allergies? To What? Could there be mold in your living space? Consider an air filter, mold testing, etc. Even if the nasal mucous isn’t the cause of the cough, I believe it’s still worth treating. Probably you have some underlying digestive weakness and perhaps a need for probiotics. There seems to be a connection between the health of the gut lining, which is in many ways mediated by the bacteria in your gut, and the lining of your lungs. I’m glad the imaging studies have shown nothing serious in your lungs, but of course you still have this cough, so you need to find someone more clever than your current doc and see them IN PERSON so they can do real investigation. Heck, it could even be caused by muscular issues – as I’m sure you’re considering, given the article you’re commenting on – such as trigger points in the sternocleidomastoid muscle of the side of your neck. Find a good acupuncturist and/or naturopathic physician who can do a thorough examination and help you figure this out.
      Be well,

  12. Hello. In a desperate search for relief I have stumbled upon your site. I have been suffering from inexplicable aches and pains for the past 8 months and due to how widespread the pain is my doctors suspected it is a ‘posture problem’. I am very tall ( 6 feet) and I’ve always exercised to keep my back strong and my spine upright. I suspect my pain are trigger points because they correspond completely to Travell and Simon’s locations and produce the same symptoms. The doctors gave me physical therapy (exercises), electricity treatment and ultrasound. Nothing helped. In the past few months the number of active trigger points shot up to about 30 in my back and I fear I am developing some in my legs as well. I have become completely inactive from it, suffer from insomnia, dizziness, headache and vision problems. I live in a underdeveloped country and I don’t think the doctors even know about the trigger points. There are no specialized massage therapists in my area but there are regular ones. What would you recommend for me? Are there any herbal remedies for it? Should I do light activity or nothing at all? I supplement with magnesium because I heard it is a muscle relaxant…I also put topical ibuprofen on my back to be able to sleep. Can these trigger points ever really be cured? I’m only 24 and I feel my life is already over because of this ailment. Please, please reply with something I am willing to try anything because I feel like my life is gone…

    • Peter Borten

      May 9, 2016 at 4:31 AM

      Hi there, Sorry to hear of your pain. You can probably work them out yourself if you are determined and resourceful. Get The Trigger Point Workbook by Clair Davies – he explains good ways to get into these muscles yourself. Usually rolling on a lacrosse ball or using a thera-cane (or similar device) can do it. A good massage therapist really doesn’t need to specifically know about trigger points in order to help you … someone who is talented and intuitive usually just knows what to do. However, you might ask them to hold the points when they find them.
      Yes, they can be cured – especially in a 24 year old.
      good luck,

  13. What can be done when trigger points simply will not release? I’ve been dealing with the most stubborn and deep trigger points located in my upper back and neck that most professionals I’ve consulted have ever worked on. For the most part, many simply refuse to release, despite frequent manipulation by competent therapists. The pain I deal with daily is ruining my life. What else can be done?

    • Peter Borten

      February 6, 2017 at 10:17 PM

      Hi Michelle, have you had acupuncture on those points? It’s one of the best approaches. However, if it’s not working, and neither is massage, I would guess that these are actually “satellite” trigger points to some other, deeper or distant trigger point or structural imbalance. If it’s in your upper back and neck, check out the scalenes, pecs, and the psoas.
      – Peter

  14. Thank you so much for this article! It may have given me a new perspective on my problem. I have been unable to walk for more than 10-15 minutes for over a year now. After I start walking, I feel my trapezius muscles getting tighter and they soon start giving me a very bad pain that forces me to stop and lie down. It feels like they can’t even stand the weight of my head. In general, even if I don’t walk, my trapezius muscles are always very tight and hard. I’ve seen around ten doctors and nobody could solve the problem (chiropractors, physiotherapist, neurologist, orthopedist, a muscle doctor that we call “fisiatra” here in Italy; which suggested chiropractic treatments, massages, postural training). It feels to me, after reading your article, that it’s possible that I have triggers points that I can’t get rid of. I feel like I removed the cause of the problem, which was my poor posture) but I can’t get rid of the tightness in the muscles. I live in Italy and when it comes to certain things we are not so advanced. I would be very happy if you could suggest an expert that I could see here, if you know one. Or just suggest where to look, because right now I feel very lost. Thanks again for your article!

    • Peter Borten

      February 6, 2017 at 10:20 PM

      Hi there,
      I’m sorry to hear that it’s difficult to find someone who does this kind of work in Italy. You might try looking up trigger point work or myofascial release work. Or there may be people trained by Leon Chaitow – you can look him up and perhaps he has a practitioner list. Or a rolfer – look for rolfing – might be able to help too. Or an acupuncturist may be able to help if they do this kind of work. Finally, you may be able to accomplish some of this work on your own. I recommend the book, “Trigger Point Workbook” by Claire Davies. He explains how to address these trigger points yourself.
      Be well,

  15. Hello,

    I have pelvic pain and associated problems, e.g. urinary frequency, penis pain, etc. and have been diagnosed with Pudendal Nerve Entrapment. I went through directed cortisone shots that diagnosed this nerve as the culprit, and the shots temporarily alleviated the pain/problems, as the suggestion to minimize hip flexion keeps the pain and symptoms down somewhat.
    However, I’ve also recently noticed many trigger points in my lower abdominal region (probably from my years of doing sit-ups, core and strength training…). When I grab the muscle bands in my pelvis and squeeze them they break down easily between my fingers into strands with what often feels like BBs in between these chords, or even obvious larger marble size trigger points that may dissolve with a just a little pressure. By the way, I noticed that by pushing on a couple of these trigger points I can duplicate the pain in my penis, and create the immediate need to urinate. So I’m seeing a connection here.
    My question is: is it O.K. to pinch and squeeze these muscle chords, what feels like gristle, between my fingers, rolling them, and having this muscle break down into fibers where I can feel the trigger points, then gently working (when not too painful) these trigger points between my fingers until they break down?


    • Peter Borten

      February 6, 2017 at 10:14 PM

      YES. it’s very ok. And while you’re at it, get a lacrosse ball, lie down on the floor with your knees bent and place the ball under your butt. Explore the whole region, including right over your sacrum itself and the whole gluteal area. You can also try crossing the ankle of the side you’re working on over the opposite knee – that may help you get deeper into this area. Spend a good hour exploring this area, letting the ball sink in until there’s a distinct release and some improvement of tenderness, moving inch by inch.

      • Thanks Peter!

        That’s excellent advice about the ball. As you’ve correctly surmised I’m riddled with trigger points in that area as well. Even a very spongy ball was too much at first. A while back I purchased a Rumble Roller, the softer version, and that’s been working out just great, and recently I’ve been using a tennis ball to get deeper. The lacrosse ball is next 🙂

        Thanks again Peter for the confirmation and peace of mind.


  16. Hello I have been having shoulder and back pain to the point I can’t lift my arm without unbearable pain . I have had this for over 10 yrs but just recently it’s to the point I lost my job I have seen many doctors and specialist and always the same thing pills that don’t work . I have monster trigger point knots I work on every day nothing works .I don’t have money to see a bunch of doctors and the pain is just horrible under the shoulder blade and numbness in my back where the knots are do you have any helpful ideas the pain is ruining my life any help would be greatly appreciated thanks.

  17. Hi, I am Dr. Janet Travell’s daughter, Virginia Street. I was looking something up on Google about her & found this nice article you wrote about her. Thanks!

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