self-care of trigger points and referral patterns

To complement “Self-Massage: 6 Steps to Pain Relief,” in the March 2016 issue of MASSAGE Magazine.

Self-care for massage therapists is essential, for our health, happiness and career longevity. If we don’t have time to book a massage, self-care is the best way to ensure healthy, pain-free, strong muscles and fascial systems—and even a small amount of self-care can help keep our muscles in great shape.

Here we’ll look at muscles in four areas of particular concern to massage therapists: The scalene, sternocleidomastoid, soleus and suboccipitals.


referred pain IScalene

Trigger points in the scalene muscles can be particularly troublesome for massage therapists. These cervical neck stabilizers are especially prone to problems when kept in a shortened position, as when looking downward or looking downward and bent to the side.

The referred pain pattern, as shown here in red stippling, can be felt into the front of the chest, down the radial forearm and into the thumb, index and middle finger. This referred pain can be disabling and career-ending for a massage therapist who does not consider these muscles when trying to get rid of arm, hand, wrist or finger pain or numbness or tingling.

Prevention: Be sure to maintain as neutral as possible a sleep position, preventing your neck from being too far rotated to one side or the other. Allow gentle inhaling of breath to occur at the diaphragm by relaxing the abdominal muscles. Avoid upper-chest breathing or any breath where the scalene muscles in the neck are unnecessarily used for inspiration of breath.



referred pain pattern IISternocleidomastoid

Trigger points in the sternal or clavicular division of the sternocleidomastoid muscles can cause pain into the forehead, temple, cheeks, ear, mastoid process and top of head. These are the hallmarks of chronic headache sufferers. Even an occasional headache is one too many.

As massage therapists stand looking downward for much of the workday, these neck rotators and flexor muscles are prone to trigger-point formation. The pincer technique using the thumb and pointer finger is the best way to apply trigger-point pressure release to the sternocleidomastoid muscle.

Prevention: Don’t sleep on your stomach, maintain as neutral as possible a treatment position and look upward often during sessions.




Do you feel pain in the back, near the sacrum? Pain into the cheek or lower jaw? Pain into the calf? All this pain could be caused by a pesky and elusive referral pattern by the soleus muscle in the calf.

As massage therapists, we spend lots of time on our feet, sometimes up on our tippy toes to get a good push-off for long, gliding strokes. All too often, massage therapists don’t make the best footwear choices, and these things can lead to the development of trigger points in the soleus muscle.

Prevention: Change shoes often during the week. Wear a supportive shoe with a good grip on the floor to support your long, lunging strokes. If you wear high heels on special occasions, be sure to practice wearing these types of shoes long before the event.



Trigger points in the suboccipitals can cause wrap-around headaches like a vise grip on the skull, as well as restriction in head flexion or extension in the uppermost cervical area. Chronically leaning forward over treatment tables leads massage therapists to be particularly susceptible to dysfunction in these muscles.

Prevention: Be sure to work, sleep, text and drive in as neutral as possible a head-and-neck position. Avoid looking downward at a phone or keyboard. During your workday, tilt, tip and rotate your head in all possible directions to ensure full range of motion in the suboccipital region.


Mary Biancalana, L.M.T.About the Author

Mary Biancalana, L.M.T., is a board-certified myofascial trigger-point therapist and president of the National Association of Myofascial Trigger Point Therapists. She is founder and owner of the Chicago Center for Myofascial Pain Relief, Advanced Trigger Point Seminars and Trigger Point Sports Performance. She is proud to be a dynamic continuing education provider, as well as an author of books, articles and digital media teaching materials. She wrote “Self-Massage: 6 Steps to Pain Relief” for the March 2016 issue of MASSAGE Magazine.