Overworked woman with back pain in office sitting on chair with bad posture

The term “myofascial trigger points” certainly describes a phenomenon: sore, stiff, aching spots.

Evidence-based massage encourages the integration of current research into our practices, this requires reviewing the scientific literature as it relates to a number of concepts that are held near and dear in the world of massage therapy.

As health care professionals it is important that we continue to strive for explanations that are in line with the current scientific understanding of how the body works. So, it is not surprising that three decades after the original publication of The Trigger Point Manual by Janet G. Travel, M.D., and David G. Simons, M.D., there is updated information about myofascial trigger points and the role they play in myofascial pain syndrome.

What has changed?

With the rise in popularity of pain science, this is an excellent opportunity to look into the phenomenon of myofascial triggerpoints and see what has changed.

Scientific research does not only change the way we assess and treat injuries, it also involves using precise terminology and clear definition when we communicate with massage therapy clients and other health care professionals.

When it comes to myofascial pain syndrome, there is a need to update the way we talk about myofascial trigger points. This statement may make massage therapists uncomfortable, but this is actually an opportunity to advance our understanding of pain.

A change in thought regarding myofascial trigger points was sparked by a critical review published in the journal Rheumatology. This scientific article shines some much-needed light on the dogmatic view of myofascial trigger points, stating that past theories have been “flawed both in reasoning and in science.”

Some massage therapists take this as a knock against the efficacy of trigger point therapy, which it is not. Instead, this article serves to deconstruct the known etiology of myofascial trigger points, by calling into question long-held assumptions about these enigmatic sore spots.

One of the primary issues the authors have with attributing people’s pain to myofascial trigger points is that such attribution is an oversimplification of a complex process, that often disregards that notion that pain is an experience, thus ascribing patients pain solely to myofascial trigger points or other tissue-driven pain problem is often an oversimplification of a complex process.

The etiology of these sore spots is still not well understood, but that does not deny the existence of the clinical phenomenon.

Here we are nearly 35 years after the publication of Travell’s and Simon’s book and there is an effort to establish standardized terminology. Recently an international panel of 60 clinicians and researchers was consulted to establish a consensus for the identification of a myofascial trigger point. The panel agreed on two palpatory and one symptom criteria: a taut band, a hypersensitive spot, and referred pain.

This provides a bit of clarity, but when it comes to the etiology of these sore spots, it is still not well understood. Currently, there are a number of explanatory models for the clinical phenomenon that is known as a myofascial trigger point, including the integrated hypothesis, neurogenic inflammation, and central sensitization.

Even though researchers are still unsure what tissues are involved and how these change in response to treatment, the term “myofascial trigger points” certainly describes a phenomenon: sore, stiff, aching spots.

As a profession, it is important that we strive for explanations that are in line with the current scientific understanding of how the body works. Myofascial trigger points describe an observable phenomenon, but there is still no consensus on the etiology of these sore spots, how local tissues change in response to treatment and what role they play in the generation and propagation of myofascial pain syndrome.

What we call a myofascial trigger point may represent neuroplastic changes of the peripheral or central nervous system, or it could be a physiologic dysfunction involving local soft tissue. We should acknowledge that there is still uncertainty on the subject and update the way we communicate with patients and other health care providers.

However, the way I see it, this does not mean we need to abandon treatment approaches that provide clients with pain relief.

Bodies are Dynamic & Complex

From a clinical perspective, bodies are dynamic and complex; this is why ascribing clients’ pain solely to myofascial trigger points or other tissue-driven pain problem is often an oversimplification of a very complex process.

Whether we are correcting a local pathology, providing sensory input resulting in the descending modulation of pain, or a combination of both, many clients continue to benefit from trigger point therapy.

So, even if our explanations have changed, what hasn’t changed is that many aches and pains can at least be helped by a combination of manual therapy, stretching, and education.

About the Author:

Richard Lebert is an educator and health care professional with a focus on interprofessional collaboration and person-centered care. He is Associate Faculty in The School of Health Science at Lambton College and a Registered Massage Therapist with over 10 years of experience. In addition to his training as a massage therapist, Richard has certification in Medical Acupuncture from McMaster University and a Certificate of Online and Open Learning from The University of Windsor.

Download a copy of Lebert’s free E-book Evidence-Based Massage Therapy: A Guide For Clinical Practice.


Bron, C., Dommerholt, J. D. (2012). Etiology of Myofascial Trigger Points, Current Pain and Headache Reports.

Chen, Q., Wang, H., Gay, R. E., Thompson, J. M., Manduca, A., An, K., Basford, J. R. (2016). Quantification of Myofascial Taut Bands, Archives of Physical Medicine and Rehabilitation.

Donnelly, J., Fernandez de las Penas, C., Finnegan, M., Travell, J. (2019). Travell, Simons and Simons’ Myofascial Pain and Dysfunction (3rd ed.). Wolters Kluwer.

Fernández-de-Las-Peñas, C., & Dommerholt, J. (2018). International Consensus on Diagnostic Criteria and Clinical Considerations of Myofascial Trigger Points: A Delphi Study. Pain medicine (Malden, Mass.), 19(1), 142–150.

Gerwin, R. D., Cagnie, B., Petrovic, M., Van Dorpe, J., Calders, P., & De Meulemeester, K. (2020). Foci of Segmentally Contracted Sarcomeres in Trapezius Muscle Biopsy Specimens in Myalgic and Nonmyalgic Human Subjects: Preliminary Results. Pain medicine (Malden, Mass.), pnaa019.

Quintner, J. L., Bove, G. M., & Cohen, M. L. (2015). A critical evaluation of the trigger point phenomenon. Rheumatology (Oxford, England), 54(3), 392–399.

Shah, J. P., Thaker, N., Heimur, J., Aredo, J. V., Sikdar, S., & Gerber, L. (2015). Myofascial Trigger Points Then and Now: A Historical and Scientific Perspective. PM & R: the journal of injury, function, and rehabilitation, 7(7), 746–761.