Banner for blog about therapeutic percussion for massage therapists. Image of an LMT using a massage gun

Therapeutic percussion has evolved from traditional manual techniques to modern tools like massage guns, and it can effectively augment trigger point therapy when used correctly. However, understanding the mechanism of pain referral and treating the true source of pain rather than just the symptomatic areas is crucial for achieving lasting relief.

Key Takeaways

  • Effective pain relief requires treating myofascial trigger points, which often refer pain to other areas, rather than just the painful spot
  • Therapeutic percussion works by micro-stretching muscle fibers and providing neurological distraction, helping to reduce tension and dissolve trigger points
  • Lasting relief comes from addressing all muscles in pain referral networks and their functional antagonists, not just the symptomatic area

The use of therapeutic percussion/vibration to address pain and limitation has a long history, from manual percussion in traditional modalities like Thai or Shiatsu to more recent use of massage guns by manual therapists. 

I began incorporating therapeutic percussion into our Coaching The Body® modality several years ago as an experiment to determine how it could augment our approach to trigger point therapy. While we were impressed with its ability to speed treatment, we were not happy with the tools available at the time, and ended up developing our own, the Muscle Liberator™. 

Since that time, extensive clinical experience has convinced us that properly used, percussion tools can powerfully augment bodywork and self-care. That being said, there are a lot of misconceptions about what the actual mechanism is by which vibration facilitates  recovery from pain.

The typical non-specific, “meat tenderizer” use of percussion in areas where the pain is felt  may provide symptomatic relief for a time, but will not create lasting change. I would like to offer some ideas here that will help you use this powerful modality much more effectively to address pain in yourself and others. 

Finding The True Source

Myofascial trigger points, not injury or disease, have been shown to be responsible for the majority of pain in several formal and informal studies. 1 Even in cases in which tissue damage or inflammation is present, trigger points are a productive target for treatment due to their role as a peripheral nociceptive input to the central nervous system, fostering upregulation and protective muscle splinting.

Many practitioners make the mistake of identifying hard, taut bands in muscle as “scar tissue” or adhesions. In most cases, these areas are actually taut fibers containing trigger points. This is easy to verify in practice – scar tissue can’t be softened in minutes, but taut fibers can be released quickly via the use of appropriate techniques. 

Trigger point theory has shown us that if you are looking to relieve pain in a lasting way, it’s generally a mistake to “rub where it hurts”, because the vast majority of muscles with trigger points refer pain to an area removed from the location of the trigger point.  

For example, pain in the anterior deltoid is a very common complaint. While it’s tempting use a massage gun in the front of your shoulder, you will probably find that the benefit is short-lived if that’s where you stop. 

There are 13 muscles that refer pain to the front of the shoulder, including local referral from the anterior deltoid itself. However, the deltoid, even in the presence of painful taut bands, is not the most likely origin of this sort of pain, which often occurs without a history of undue stress on the muscle.

The Hidden Referral Network

So why then would the deltoid develop taut fibers and tenderness if it isn’t under unusual stress? To understand this, you have to be familiar with satellite referral

When a muscle’s fibers sit under the referral zone of another muscle, it can develop dysfunction itself, in a kind of chain reaction. This phenomenon was explored incompletely in several muscles by Travell and Simons, but in their decades-long effort to establish the foundation of trigger point ideas they were never able to fully flesh it out, and sadly, in the most current 1-volume revision by other authors, satellite referral has been relegated to the dustbin, lumped in with other “associated muscles”. 

In our development of the Coaching The Body® modality, we have found that satellite referral plays a much greater role than its marginal coverage would suggest. Satellite referral chains occur consistently throughout the body, and set up a confusing, hidden network of causality that few practitioners are aware of. We have found it to be a reliable model that reveals the true source of many common pain patterns. 

In the anterior shoulder example, there are several commonly involved muscles that refer over the anterior deltoid and could set it up with taut fibers and tenderness. The scalenes, infraspinatus, clavicular pectoralis major and pectoralis minor are all frequent sources of inbound referral. 

The satellite referral chain often extends beyond a single step. For example, infraspinatus can be a target of satellite referral from low trapezius and serratus anterior, both important scapular stabilizers.

Treating Functional Units

There is an additional dimension that must be considered in the quest to get to the source. Functionally opposed muscles tend to become dysfunctional together. There is a particularly problematic case of this with subscapularis and infraspinatus, which are not only functional antagonists, but supraspinatus also refers directly over infraspinatus. Their close functional relationship alone makes them likely to propagate dysfunction in each other, but this is greatly amplified by satellite referral. 

A complex web of referral and functional relationships exists in the shoulder and other parts of the body, making the task of finding the true source of shoulder pain far more nuanced than the simplistic trigger point idea that “Muscle A causes Pain B”. We want our practitioners to have a high rate of success. So we have developed regional pain protocols for both bodywork and self-care to ensure that you visit all of the muscles that are likely contributors in a fruitful order. 

Our core shoulder pain protocol first establishes balance between the functionally opposed muscles that stabilize the scapula. Normalizing position at rest, for example eliminating excess protraction and restoring proper scapular rotation, lowers chronic stresses due to abnormal resting lengths on these muscles which tend to cause regional myofascial pain syndromes. When muscles develop extensive trigger points, embedded taut fibers will tend to keep certain muscles in a shortened position. As Leon Chaitow suggested, the central nervous system can actually exploit this property of trigger points to add extra stability in a joint that has chronically disturbed position or range.

Therapeutic Vibration Mechanisms of Action

As opposed to blindly using percussion where pain is felt, therapeutic percussion is an excellent treatment modality for unraveling the neurological protection that develops in these areas. It is mistaken to assume that the benefit percussion provides is mechanical disruption of scar tissue and adhesions. There are two different mechanisms by which percussion can reduce taut fibers, dissolve trigger points and restore normal muscle length and range. 

The first mechanism is micro-stretch of local fibers. We use custom-designed silicone heads with a narrow but elastic point of contact so that individual fiber bundles can be targeted without excessive discomfort or possibility of damage to delicate bones and tissues. This causes a rapid micro-stretch each time the head contacts compromised muscle fibers, which happens so fast that it defeats the normal myotatic stretch response that will cause muscle fibers to protectively engage to resist stretch. In addition, stretching trigger points at slower speeds will tend to invoke the muscle’s referred pain patterns, sending the CNS a nociceptive stream and further encouraging a protective resistance to stretch. The lightning speed of each percussive strike when using a tool avoids this barrier. 

Secondly, vibration tools are excellent sources of neurological distraction. The vibration causes a flood of regional sensation across groups of muscles, overwhelming the CNS with input and defeating the pain referral mechanism. This causes the CNS to allow muscles to release much more easily.

We often use therapeutic percussion while a muscle is under stretch, usually as part of a contract/relax cycle. The combination of micro- and macro-stretch along with powerful neurological distraction dramatically accelerates progress in comparison to other techniques involving simple stretch or compression. 

How To Make Better Use of Therapeutic Vibration

Here are some general suggestions for using therapeutic percussion more effectively for self-care in any part of the body (the principles apply equally to manual therapy):

  1. Starting with the area where pain is felt, work backward with a referral chart to establish muscles that might be causing direct referral to the area. 
  2. For each of those muscles, determine the muscles likely to be causing satellite referral over their fibers. While it’s helpful to have experience to know which are most likely, a simple visual assessment is useful.
  3. Starting at the beginning of the chain, use a repeated treatment cycle to treat each muscle with therapeutic vibration – first in a shortened position and then gradually moving into stretch. For example, to treat serratus anterior, begin applying vibration with the scapula passively protracted. Use contract/relax by engaging the muscle for 5-30 seconds while holding an inhale, and on exhale gently begin retracting the scapula along with vibration. 
  4. Ensure that you include the functional antagonists for each muscle in your plan. Often the body will not allow a muscle to release if its antagonists cause discomfort when shortened. Painful contraction on the shortening side is often a more significant neurological block to stretch than any resistance from the lengthening fibers. 

Even the fanciest tools are only effective if they are supported by an informed analysis and used on the right muscles at the right time.  Any effort that you can make to learn more about referral networks and functional relationships will reward you with improved results as work with therapeutic vibration.

About the Author

Headshot of Chuck Duff

Chuck Duff has spent the last 20 years developing and training therapists in Coaching The Body®, which integrates a new understanding of MTrP theory and practice with modern neuroscience and techniques from Thai bodywork. His new book, “Ending Pain,” is a number-one Amazon Bestseller. He can be reached at


  1. Duff, Charles. 2023. “Misdiagnosis of Trigger Points Contributes to Our Pain Problem.” MASSAGE Magazine, May 22, 2023.

Latest Posts