Ask the Experts: What Are the Pros and Cons of Trigger-Point Therapy?

Self treatment for a trigger point using a ball.

Patrick writes: After looking at some of the Sock-Doc’s videos on the Natural Running Center site and trying to find out how to deal with some pains on both the inside and the outside of my right knee, it appears to me that there is similarity between Dr Gangemi’s methods and Trigger-Point Therapy.  Is this accurate?  Would it be worthwhile having somebody mention the pros and/or cons of trigger-point therapy on your website?  I am using the foam roller and the stick and it seems after one week to be helping my knee.  However, at the moment there are too many variables to consider for me to confidently attribute my improvement to the massaging I’m doing of different areas on my quads and buttocks.  Of course, I hope that does explain my improvements as these are chronic problems for me.

Sock Doc replies: The trigger-point therapy (which is the term I use often in my articles and videos) is the same type of trigger-point therapy that many other therapists use. Some also call this origin-insertion technique. The benefits are primarily that it helps re-align muscle fibers so they may begin to heal, and it is also suspected that it may help with inflammation, perhaps much like compressing an injury can be of benefit. I also believe that when using trigger point therapy on an old or chronic injury that it’s also making your body aware that there is an injury present, and needs to be dealt with; it’s much like your body has compensated as to forget that there is still an injury present affecting you though there is no acute pain.  I see many patients with patterns of injuries that are not healing because their body essentially doesn’t recognize that there is a problem anymore. It’s difficult to explain, but when you’re injured certain aspects of your nervous system respond a certain way. When they don’t respond correctly, you don’t heal properly – or at all. For example, you may have injured your shoulder in the past and no longer have pain there. Now, months or years later say you have a pain in your hip due to a gait imbalance from that old shoulder injury on the opposite side of your body. This is actually very common, and the hip problem will not be resolved until you deal with the shoulder issue, perhaps via a trigger point in a muscle in that region.

The cons of trigger-point therapy? I’d say zero unless you have a therapist who doesn’t know what they’re doing and is just beating the hell out of your muscles and actually creating new injuries.

The other important factor to understand is that the trigger point is there because of some muscle imbalance. If you correct the trigger point, you may or may not correct the muscle imbalance. If you don’t, you won’t see much, or any, positive response. The muscle imbalance rarely occurs from the trigger point – it comes from some other problem related to stress. Too much physical stress (injuries, poor footwear), chemical stress (poor diet, nutrition) and emotional stress (poor sleep, work, commitments) create muscle imbalances, which in turn creates pain, injuries, and the trigger points. So working on the trigger points is part of the overall therapy in resolving the injury, but it is often not the only part of it. If you don’t correct the underlying problem, your trigger point work will provide no benefit or you’ll always feel the need to constantly be working the points out.

9 Responses to “Ask the Experts: What Are the Pros and Cons of Trigger-Point Therapy?”

  1. Patrick says:

    Dear Dr. Gangemi,

    Many thanks. This is helpful. My next challenge will be to find a good therapist. Meanwhile, I’ll keep working on this myself.


  2. Jack says:

    I have some trigger points in my left calf, it seems like in the soleus and peroneal. I am massaging them multiple times a day, and find that they are always more sensitive in the morning, or after a nap. Do you know why this might be?

  3. Sock Doc says:

    Jack, that could be from the lying down position and increased fluid build up in the area (inflammation). If you sleep with your leg elevated and they are less tender after that would give you a definitive answer. Also, as I particularly note in the last paragraph, if you have to keep working out tender areas/trigger points, you’re probably not correcting the true source of the problem, and you may even be making it worse.

  4. Lisa Valerio says:

    Hi! I’ve found many of these videos to be useful. Do you have one on trigger points for the foot? I developed super-tight calf muscles from overtraining (sigh, I didn’t know, I’m new to the racing game) and my feet hurt. I’ve been doing VFF’s for over a year, and in the past 3 months switched to Softstar moccasins (2 mm vibram sole). So, probably a combo of overtraining and transitioning shoes too quickly. My forefoot is sore on both feet, but the calves are definitely losing their soreness. The video on achilles tendonitis was especially helpful. Thank you for your advice!

    • Sock Doc says:

      Thanks Lisa. There is not a video specifically showing trigger points for the foot, though they sometimes need to be treated. The main area is right in the middle of the main arch of the foot, right where the tibialis posterior attaches and supports the arch via the navicular bone. Actually, much of the foot “tenderness” that so many get is from a fatigued tib posterior. Therefore, a lot of times the points to work out are way at the opposite end – the origin – behind the tibia and the fibula just below the knee joint. Check there!

    • MarkC says: should visit Steve. dig your thumbs in the tender points of the plantar fascia and flex and extend the toes. kind of breaks up the fibrous tissue to realign. Mark

  5. Eric Cooper says:

    YAY!!! Finally, some sanity. I am so tired of hearing runners complain about all their pains and having no understanding that almost all of their suffering is referred pain.

    I have Travell & Simons’ two volumes, Myofascial Pain and Dysfuntion. Still considered the gold standard. It explains how the pain runners feel is mostly muscle pain. Even if it feels like hard tissue pain, it is mostly caused by muscle dysfunctioin.

    Even more useful is The Trigger Point Therapy Workbook by Clair Davies. Only $15 on! It will explain all your running pains. It will not tell you how to change your running form so the pain stops. Your bare feet will do that, if you listen to them. But it will show the physical source. De-mystification of pain.

    I see such a plague of Tibialis Posterior problems in runners. That muscle, in part, is our built in pronation control. Tib Posterior dysfuntion feels like achillies pain. And all the Vastus Lateralis pains that runners misunderstand as IT band problems.

    Bravo and thank you for shining some light on Trigger Points and the pain referral they cause.
    Ever onward!

  6. This is great advice. As a therapist, I have seen amazing results with the combination of self massage – using a foam roller, soft ball, lacrosse ball, and golf ball, and professional massage treatments. I have treated painful injuries such as plantar fasciitis, runner’s knee (ITB pain), low back pain, top of foot pain, metatarsal pain, and even shoulder pains with great success. Usually within 2-4 sessions the pain cycle is broken allowing the client to be fully engaged in their recovery process.

    Here are a few more articles on self massage treatments with examples of exercises.

    Happy Running
    Jesse James Retherford

  7. Karen says:

    Good to read some common sense at last! I have been suffering from chronic psin in shoulder, arm and HAND for 3 years now – and think we have finally identified the trigger points involved (after a lot of other treatment that really didn’t work). The key point I took from this post is that working on trigger points is great – but it’s key to work on the underlying cause to get lasting results….my physio and I press on – my problem seems to stem from poor posture – which isn’t a quick fix after years of ingrained slouching……

    How much do you think self-therapy can remedy? I am concerned about doing more harm than good.

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