Have you ever felt a tight, painful "knot" somewhere in your neck or shoulders — one that, when you press on it, sends pain somewhere else entirely? That familiar sensation has a name: trigger points, and they are at the heart of Myofascial Pain Syndrome.
This is one of the most common — and frequently overlooked — causes of chronic musculoskeletal pain. The good news: in most cases it responds very well to conservative treatment, without medication or surgery.
What Are Trigger Points?
Trigger points are small, hypersensitive areas within a muscle where muscle fibres remain in a state of continuous contraction. You may feel them as hard "knots" or cord-like bands beneath the skin.
There are two main categories:
- Active trigger points: They cause pain even at rest or during movement, and often "refer" a characteristic pain to another area (referred pain).
- Latent trigger points: They do not hurt spontaneously, but are tender to pressure and may restrict movement.
A classic example: a trigger point in the trapezius muscle that "refers" pain towards the temple, producing what many people experience as a headache — a phenomenon closely related to cervicogenic headache.
Why Do They Develop?
Trigger points rarely appear "by chance". There is usually an underlying contributing factor:
- Repetitive movements or prolonged static postures (e.g. office work, remote working)
- Poor ergonomics — the neck held in an awkward position in front of a screen
- Trauma or sudden movement (e.g. whiplash, sports injury)
- Stress and psychological tension, which increases muscle tone
- Weakness or muscle imbalance — some muscles "overwork" to compensate for others that are not functioning properly
- Poor sleep quality or chronic fatigue
In clinical practice, many patients with neck pain or low back pain also present with active trigger points that worsen their symptoms.
Where Do They Most Commonly Occur?
Trigger points can develop in any muscle in the body, but certain areas are more common:
- Trapezius and neck muscles: Pain in the neck, shoulders, and head
- Lumbar muscles: Chronic low back pain that extends into the buttocks
- Gluteal muscles and piriformis: Pain that resembles sciatica
- Chest muscles (pectorals): A sense of tightness, difficulty taking a deep breath
- Calf muscles: Night cramps, stiffness
In many cases, the pain the patient feels is NOT located at the same site as the trigger point — this is one of the reasons the syndrome is often misdiagnosed.
How Is It Assessed?
There is no blood test or imaging method that can "see" trigger points. Diagnosis is clinical — carried out by the hands of a specialist physiotherapist or chiropractor.
During the assessment, the therapist:
- Palpates the muscle, searching for taut bands and areas of hypersensitivity
- Reproduces the characteristic referred pain with gentle pressure
- Evaluates posture, range of movement, and muscle balance
- Takes into account the patient's history, work habits, and stress levels
This holistic approach is essential — because trigger points almost never appear in isolation, but as part of a broader picture.
What Physiotherapy Techniques Are Used?
The management of myofascial pain is multi-faceted and tailored to each individual patient. Some of the most commonly used techniques include:
- Ischemic compression: Gradual, sustained pressure on the trigger point that "breaks" the cycle of contraction
- Dry needling: Insertion of a fine needle precisely into the trigger point to provoke a local response and promote relaxation
- Myofascial release: Techniques that free the fascia and improve circulation
- Thermotherapy / TECAR: Deep energy that reduces muscle tension and promotes tissue healing
- Postural correction and therapeutic exercise: To address the cause, not just the symptoms
In Clinical Pilates, activating the deep muscle corset plays an important role, as it helps to balance muscles that are being disproportionately overloaded and are feeding the trigger points.
Can Treatment Be Carried Out at Home?
Yes — and this is one of the significant advantages for patients who find it difficult to travel. Home physiotherapy allows the therapist to assess the workspace, sleeping position, and daily habits at the same time as providing treatment — information that is often lost in a clinical setting.
Konstantinos Danalis offers trigger point assessment and treatment at home in Voula, Vouliagmeni, Vari, Glyfada, and Alimos, tailoring the programme to each patient's real-life circumstances.
It is worth noting that part of the treatment always includes self-care: simple self-massage techniques, stretches, and exercises that your therapist teaches you to perform on your own — so that progress is maintained between sessions.
When Should You Seek Help?
If you recognise the following, an assessment by a physiotherapist is recommended:
- Pain or stiffness that has persisted for more than 2–3 weeks
- A sensation of a "knot" that keeps returning even when you stretch
- Pain that "moves" or appears in different locations
- Headaches associated with tension in the neck or shoulders
- Reduced range of movement with no apparent cause
Please note: this article is for informational purposes only and does not replace a personalised assessment by a healthcare professional. Every case is different and requires its own treatment plan.
If you would like to get started, you are welcome to get in touch so we can arrange an initial assessment.
Can It Be Prevented?
It is not always possible to avoid trigger points entirely — particularly in demanding jobs or during periods of stress. However, certain habits can significantly reduce the risk:
- Regular short breaks during work (every 45–60 minutes)
- Ergonomic adjustment of your workspace
- Regular physical activity that strengthens muscle balance
- Adequate sleep and stress management
- Hydration — dehydrated muscles are more prone to spasm
- Therapeutic exercise (such as Clinical Pilates) to activate the stabilising muscles