Last Updated on April 12, 2026 by MASSAGE Magazine
One session. That’s all it took to produce a statistically significant improvement in ankle range of motion in a randomized controlled trial on trigger point pressure release. For massage therapists who work with movement restrictions, that’s a result worth understanding in depth.
Here’s what the research found, how the technique works, and what it means for your practice.
What Did the Trigger Point Research Find?
A pilot randomized controlled trial published in the Journal of Bodywork and Movement Therapies found that a single session of trigger point pressure release on latent soleus myofascial trigger points produced an immediate and statistically significant increase in active ankle dorsiflexion range of motion.
The intervention group showed a mean increase of 3.3 degrees in ankle dorsiflexion immediately following treatment. The control group, which spent five minutes in the same prone position without any intervention, actually showed a slight decrease in range of motion. The difference between groups was statistically significant at p=0.03.
Those findings were later reinforced by a follow-up crossover randomized controlled trial that tested trigger point therapy on both the soleus and gastrocnemius in recreational runners. That study found clinically meaningful, large-effect-size improvements in ankle dorsiflexion for both muscles after a single session of myofascial trigger point therapy.
Who Were the Study Participants?
The original pilot study involved 20 healthy volunteers, five men and 15 women, with a mean age of 21.7 years. All participants had a confirmed restriction in active ankle dorsiflexion and the presence of latent myofascial trigger points in the soleus muscle.
Subjects were randomly assigned to either the intervention group, which received trigger point pressure release, or the control group, which received no treatment. Both groups were placed in the same prone position with both knees extended for standardization purposes.
What Is Trigger Point Pressure Release and How Does It Work?
Trigger point pressure release uses the barrier release concept. The therapist applies slow, increasing pressure directly on the identified trigger point until the first sign of tissue resistance is felt. That resistance is the barrier.
The therapist then holds that same pressure without increasing it and waits. The goal is to feel a release in muscle tension beneath the palpating thumb. Once that release occurs, the process moves to the next taut band identified in the muscle.
In the study, each taut band received approximately 60 seconds of treatment. The full intervention lasted three minutes when all three trigger points were present and identified. That’s a short, targeted technique with measurable outcomes.
What Is a Latent Myofascial Trigger Point?
Understanding this distinction matters clinically.
An active trigger point causes spontaneous pain, both locally and as referred pain in a predictable pattern. A latent trigger point does not cause spontaneous pain but is tender to palpation and can restrict movement and alter muscle activation patterns.
The study focused specifically on latent trigger points. This is important because latent trigger points are far more common in general populations than active ones, and they are frequently overlooked. A client doesn’t have to be in pain for trigger points to be affecting their range of motion and movement quality.
Why Does Ankle Dorsiflexion Matter?
Ankle dorsiflexion, the ability to bring the top of the foot toward the shin, is foundational to nearly every movement pattern that involves the lower body.
Restricted dorsiflexion affects gait mechanics, squat depth, stair climbing, running efficiency, and landing biomechanics. It is commonly linked to plantar fasciitis, Achilles tendinopathy, knee pain, and lower back compensation patterns. When a client presents with any of these issues, restricted ankle dorsiflexion is worth assessing before you assume the problem originates elsewhere.
What Is the Soleus and Why Is It a Target for Trigger Point Work?
The soleus is the deeper of the two calf muscles, sitting beneath the gastrocnemius. It plays a major role in plantarflexion and postural stability, particularly during standing and slow walking. Because it works constantly in weight-bearing positions, it accumulates tension and trigger point activity easily.
Soleus trigger points are a frequently overlooked contributor to ankle stiffness, heel pain, and lower leg tension. They are not always painful on their own, which is exactly why they often go unaddressed until they’ve been restricting movement for a long time.
How Should Massage Therapists Apply These Findings?
A few direct clinical takeaways:
- Assess ankle dorsiflexion actively. Ask clients to perform a simple heel-to-wall test before and after working the soleus. A measurable change after one session builds client trust and gives you trackable data.
- Palpate for latent trigger points, not just painful ones. Taut bands that aren’t actively painful are still functionally relevant. If pressure on a spot reproduces familiar tightness or restriction, it’s worth treating.
- Use the barrier release method deliberately. The key is patience. Apply pressure slowly, find the barrier, hold it, and wait for the tissue to release before moving on. Rushing through the technique reduces its effectiveness.
- Integrate trigger point work with movement reassessment. Have the client dorsiflex before and after. When they feel the change themselves, the value of the work becomes tangible.
- Consider the broader chain. Soleus restriction rarely exists in isolation. Check the gastrocnemius, tibialis posterior, and plantar fascia as part of the same assessment.
What Are the Limitations of This Research?
Being honest about research limitations makes you a better clinician and a more credible communicator with medical providers.
The original study was a pilot trial with only 20 participants, which limits its statistical power. The 3.3-degree improvement, while statistically significant, falls just below the five-degree threshold considered clinically significant for ankle dorsiflexion. The authors themselves note this and call for larger follow-up studies.
The follow-up study addressed some of these limitations and produced larger effect sizes, which strengthens the overall body of evidence. But this remains an area where more research is needed. The findings are promising and clinically relevant. They are not the final word.
How Does Trigger Point Work Fit Into a Broader Practice?
Trigger point pressure release is one of the most accessible advanced techniques a massage therapist can add to clinical practice. It requires no special equipment, integrates naturally into existing sessions, and produces outcomes that clients can feel immediately.
For therapists who work with athletes, movement-based clients, or anyone dealing with lower extremity complaints, understanding the soleus-ankle dorsiflexion connection alone can meaningfully change how you assess and treat.
The research supports what many experienced therapists already know intuitively. Targeted, precise work on trigger points changes how the body moves. Now there’s solid evidence to back it up.
Working at this clinical level means your practice carries real responsibility. Massage therapist liability insurance is what protects your license and income when the work you do is this specific and this hands-on. Make sure your coverage reflects the depth of your practice.
Originally reported by MASSAGE Magazine, April 2011. Substantially updated and expanded for 2026.