# Myofascial trigger point

> Mediated Wiki article. Canonical URL: https://mediated.wiki/source/Myofascial_trigger_point
> Markdown URL: https://mediated.wiki/source/Myofascial_trigger_point.md
> Source: https://en.wikipedia.org/wiki/Myofascial_trigger_point
> Source revision: 1344560916
> License: Creative Commons Attribution-ShareAlike 4.0 International (https://creativecommons.org/licenses/by-sa/4.0/)

Hyperirritable spots in skeletal muscle

Not to be confused with the "tender points", used for [fibromyalgia](/source/Fibromyalgia) diagnosis.

For the alternative medicine concept, see [Myofascial release](/source/Myofascial_release).

"Trigger point" redirects here. For the film, see [Trigger Point](/source/Trigger_Point). For the British television series, see [Trigger Point (TV series)](/source/Trigger_Point_(TV_series)).

Medical condition

Myofascial Trigger Point Other names Trigger point Myofascial trigger point in the upper trapezius Specialty Rheumatology

**Myofascial trigger points** (**MTrPs**), also known as **trigger points**, are described as hyperirritable spots in the [skeletal muscle](/source/Skeletal_muscle). They are associated with palpable [nodules](/source/Nodule_(medicine)) in taut bands of [muscle fibers](/source/Muscle_fiber).[1] They are a topic of ongoing controversy, as there is limited data to inform a scientific understanding of the phenomenon.[*[clarification needed](https://en.wikipedia.org/wiki/Wikipedia:Please_clarify)*] Accordingly, a formal acceptance of myofascial "**knots**" as an identifiable source of pain is more common among [bodyworkers](/source/Bodywork_(alternative_medicine)), [physical therapists](/source/Physical_therapists), [chiropractors](/source/Chiropractors), [osteopaths](/source/Osteopaths), and [osteopathic physicians](/source/Osteopathic_physicians). Nonetheless, the concept of trigger points provides a framework that may be used to help address certain musculoskeletal pain.

The trigger point model states that unexplained pain frequently radiates from these points of local tenderness to broader areas, sometimes distant from the trigger point itself. Practitioners claim to have identified reliable [referred pain](/source/Referred_pain) patterns that associate pain in one location with trigger points elsewhere. There is variation in the methodology for [diagnosis](/source/Diagnosis) of trigger points and a dearth of theory to explain how they arise and why they produce specific patterns of referred pain.[2]

Compression of a trigger point may elicit local tenderness, referred pain, or local twitch response. The local twitch response is not the same as a [muscle spasm](/source/Muscle_spasm). This is because a muscle spasm refers to the entire muscle contracting, whereas the local twitch response also involves the entire muscle but only causes a small twitch, without any contraction.

Among [physicians](/source/Physician), various specialists might use trigger point therapy. These include [physiatrists](/source/Physiatrist) (physicians specializing in physical medicine and rehabilitation), family medicine, and orthopedics. [Osteopathic](/source/Osteopathic_medicine_in_the_United_States) (as well as chiropractic) schools also include trigger points in their training.[3] Other health professionals, such as [athletic trainers](/source/Athletic_trainer), [occupational therapists](/source/Occupational_therapist), [physiotherapists](/source/Physiotherapist), [acupuncturists](/source/Acupuncturist), [massage therapists](/source/Massage_therapist) and [structural integrators](/source/Rolfing) are also aware of these ideas and many of them make use of trigger points in their clinical work as well.[4]

## Diagnosis

A 2009 review of nine studies examining the reliability of trigger point diagnosis found that physical examination could not be recommended as reliable for the diagnosis of trigger points.[5]

### Imaging

Since the early 2000s several research studies have been conducted to determine if there was a way to visualize myofascial trigger points using tools such as ultrasound imaging and magnetic resonance elastography.[6][7][8][9] Several of these studies have been dismissed under meta-analysis.[10] Another synthetic literature review expressed more optimism about the validity of imaging for myofascial trigger points, but admitted small sample sizes of the reviewed studies.[11]

### Myofascial pain syndrome

[Myofascial pain syndrome](/source/Myofascial_pain_syndrome) is a focal hyperirritability in muscle that can strongly modulate [central nervous system](/source/Central_nervous_system) functions. Scholars distinguish this from [fibromyalgia](/source/Fibromyalgia), which is characterized by widespread pain and tenderness and is described as a central augmentation of [nociception](/source/Nociception) giving rise to deep tissue tenderness that includes muscles. Myofascial pain is associated with muscle tenderness that arises from trigger points, focal points of tenderness, a few millimeters in diameter, found at multiple sites in a muscle and the fascia of muscle tissue. Biopsy tests found that trigger points were hyperirritable and electrically active [muscle spindles](/source/Muscle_spindle) in general muscle tissue.[12]

### Misdiagnosis of pain

The misdiagnosis of pain is the most important issue taken up by Travell and Simons. Referred pain from trigger points mimics the symptoms of a very long list of common maladies. Physicians, in weighing all the possible causes for a given condition, rarely consider a myofascial source. The study of trigger points has not historically been part of medical education. Travell and Simons hold that most of the common everyday pain is caused by myofascial trigger points and that ignorance of that basic concept could inevitably lead to false diagnoses and the ultimate failure to deal effectively with pain.[13]

## Treatment

### Physical muscle treatment

Physical exercise aimed at controlling posture, stretching, and [proprioception](/source/Proprioception) has all been studied with no conclusive results. However, exercise proved beneficial to help reduce pain and the severity of symptoms that one felt. Muscular contractions that occur during exercise favor blood flow to areas that may be experiencing less than normal flow. This also causes a localized stretching effect on the fascia and may help relieve the abnormally tight fascia. Evidence that supports these exercises for treatment is scarce, but physical exercise can be beneficial in reducing the intensity of pain.[14]

Researchers of [evidence-based medicine](/source/Evidence-based_medicine) concluded as of 2001 that evidence for the usefulness of trigger points in the diagnosis of [fibromyalgia](/source/Fibromyalgia) is thin.[15] More recently, an association has been made between fibromyalgia [tender points](/source/Tender_points) and active trigger points.[16][17]

### Trigger point injection

Injections without anesthetics, or [dry needling](/source/Dry_needling), and injections including saline, [local anesthetics](/source/Local_anesthetic) such as [procaine hydrochloride](/source/Procaine_hydrochloride) (Novocain) or [articaine](/source/Articaine) without vasoconstrictors like epinephrine,[18] [steroids](/source/Steroids), and [botulinum toxin](/source/Botulinum_toxin) provide more immediate relief and can be effective when other methods fail. In regards to injections with anesthetics, a low concentration, short acting local anesthetic such as procaine 0.5% without steroids or [epinephrine](/source/Epinephrine_(medication)) is recommended. High concentrations or long acting local anesthetics as well as epinephrine can cause muscle [necrosis](/source/Necrosis), while use of steroids can cause tissue damage.[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed)*]

Despite the concerns about long-acting agents,[1] a mixture of [lidocaine](/source/Lidocaine) and [bupivacaine](/source/Bupivacaine) (Marcaine) is often used.[19] A mixture of 1 part 2% lidocaine with 3 parts 0.5% bupivacaine provides 0.5% lidocaine and 0.375% bupivacaine. This has the advantages of immediate anesthesia with lidocaine during injection to minimize injection pain while providing a longer duration of action with a lowered concentration of bupivacaine.[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed)*]

In 1979, a study by Czech physician Karl Lewit reported that dry needling had the same success rate as anesthetic injections for the treatment of trigger points. He dubbed this the 'needle effect'.[20]

Studies relevant to trigger points have been done since the 1930s, for example by [Jonas Kellgren](/source/Jonas_Kellgren) at [University College Hospital](/source/University_College_Hospital), London, Michael Gutstein in Berlin, and Michael Kelly in Australia.[21]

Health insurance companies in the US such as [Blue Cross Blue Shield Association](/source/Blue_Cross_Blue_Shield_Association), Medica, and [HealthPartners](/source/HealthPartners) began covering trigger point injections in 2005.[22]

### Risks

Treatment, whether by self or by a professional, has some inherent dangers. It may lead to damage to soft tissue and other organs. The trigger points in the upper [quadratus lumborum](/source/Quadratus_lumborum), for instance, are very close to the [kidneys](/source/Kidney), and poorly administered treatment (particularly injections) may lead to kidney damage. Likewise, treating the [masseter muscle](/source/Masseter_muscle) may damage the [salivary glands](/source/Salivary_glands) [superficial](https://en.wiktionary.org/wiki/superficial) to this muscle. Furthermore, some experts believe trigger points may develop as a protective measure against unstable [joints](/source/Joint).[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed)*]

### Efficacy

Studies have shown a moderate level of evidence for manual therapy for short-term relief in the treatment of myofascial trigger points. Dry needling and dry cupping are no more effective than a placebo. There have not been enough in-depth studies to be conclusive about the latter treatment modalities, however.[23]

Studies to date on the efficacy of dry needling for MTrPs and pain have been too small to be conclusive.[24]

## Overlap with acupuncture

In a June 2000 review, Chang-Zern Hong correlates the MTrP "tender points" to acupunctural "ah shi" ("Oh Yes!") points, and the "local twitch response" to acupuncture's "de qi" ("needle sensation"),[25] based on a 1977 paper by Melzack *et al.*[26] Peter Dorsher comments on a strong correlation between the locations of trigger points and classical [acupuncture](/source/Acupuncture) points, finding that 92% of the 255 trigger points correspond to acupuncture points, including 79.5% with similar pain indications.[27][28]

## History

In the 19th century, British physician [George William Balfour](/source/George_William_Balfour), German anatomist [Robert Froriep](/source/Robert_Froriep), and the German physician Strauss described pressure-sensitive, painful knots in muscles, sometimes called myofascial trigger points, through [retrospective diagnosis](/source/Retrospective_diagnosis).[29][30]

The concept was popularized in the US in the middle of the 20th century by the American physician [Janet G. Travell](/source/Janet_G._Travell).[29][30]

## Controversy

A review from 2015 in the journal [*Rheumatology*](/source/Rheumatology_(journal)), official journal of the British Society for Rheumatology, concluded that the concept of myofascial pain caused by trigger points was nothing but an invention without any scientific basis.[31] A rejection of this criticism appeared in the *Journal of Bodywork & Movement Therapies*, the official journal of several therapeutic societies, including The National Association of Myofascial Trigger Point Therapists USA.[32][33]

## Research

An analysis of the environment of trigger points found the pH around active trigger points going down to pH 4.3. Furthermore, the environment of trigger points (unlike healthy muscle) contained inflammatory cytokines and [CGRP](/source/Calcitonin_gene-related_peptide).[34][35] Concentrations of protons (H+), bradykinin, calcitonin gene-related peptide, substance P, tumor necrosis factor-β, interleukin 1-β, serotonin, and norepinephrine were found to be significantly higher in the active trigger point group than either of the other two groups (latent trigger points and no trigger points).[36]

## See also

- [Acupressure](/source/Acupressure)

- [Myofascial release](/source/Myofascial_release)

- [Neuromuscular therapy](/source/Neuromuscular_therapy)

- [Pressure point](/source/Pressure_point)

## References

1. ^ [***a***](#cite_ref-travell_1-0) [***b***](#cite_ref-travell_1-1) [Travell, Janet](/source/Janet_Travell); Simons David; Simons Lois (1999). *Myofascial Pain and Dysfunction: The Trigger Point Manual (2 vol. set, 2nd Ed.)*. US: Lippincott Williams & Williams. [ISBN](/source/ISBN_(identifier)) [9780683083637](https://en.wikipedia.org/wiki/Special:BookSources/9780683083637).

1. **[^](#cite_ref-variability_2-0)** Tough EA, White AR, Richards S, Campbell J (March–April 2007). "Variability of criteria used to diagnose myofascial trigger point pain syndrome—evidence from a review of the literature". *[Clin J Pain](/source/Clin_J_Pain)*. **23** (3): 278–86. [doi](/source/Doi_(identifier)):[10.1097/AJP.0b013e31802fda7c](https://doi.org/10.1097%2FAJP.0b013e31802fda7c). [PMID](/source/PMID_(identifier)) [17314589](https://pubmed.ncbi.nlm.nih.gov/17314589). [S2CID](/source/S2CID_(identifier)) [30891217](https://api.semanticscholar.org/CorpusID:30891217).

1. **[^](#cite_ref-McPartland_JM,_2004_244–49_3-0)** McPartland JM (June 2004). ["Travell trigger points--molecular and osteopathic perspectives"](https://web.archive.org/web/20160306064019/http://jaoa.org/cgi/content/full/104/6/244). *Journal of the American Osteopathic Association*. **104** (6): 244–49. [PMID](/source/PMID_(identifier)) [15233331](https://pubmed.ncbi.nlm.nih.gov/15233331). Archived from [the original](http://www.jaoa.org/cgi/content/full/104/6/244) on 2016-03-06. Retrieved 2011-08-30.

1. **[^](#cite_ref-Alvarez_DJ,_Rockwell_PG_2002_653–60_4-0)** Alvarez DJ, Rockwell PG (February 2002). ["Trigger points: diagnosis and management"](https://web.archive.org/web/20080513202228/http://www.aafp.org/afp/20020215/653.html). *Am Fam Physician*. **65** (4): 653–60. [PMID](/source/PMID_(identifier)) [11871683](https://pubmed.ncbi.nlm.nih.gov/11871683). Archived from [the original](http://www.aafp.org/afp/20020215/653.html) on 2008-05-13. Retrieved 2006-07-07.

1. **[^](#cite_ref-5)** Lucas N, Macaskill P, Irwig L, Moran R, Bogduk N (January 2009). "Reliability of physical examination for diagnosis of myofascial trigger points: a systematic review of the literature". *Clin J Pain*. **25** (1): 80–9. [doi](/source/Doi_(identifier)):[10.1097/AJP.0b013e31817e13b6](https://doi.org/10.1097%2FAJP.0b013e31817e13b6). [PMID](/source/PMID_(identifier)) [19158550](https://pubmed.ncbi.nlm.nih.gov/19158550). [S2CID](/source/S2CID_(identifier)) [11603020](https://api.semanticscholar.org/CorpusID:11603020).

1. **[^](#cite_ref-pmid18047882_6-0)** Chen Q, Bensamoun S, Basford JR, Thompson JM, An KN (December 2007). ["Identification and quantification of myofascial taut bands with magnetic resonance elastography"](https://doi.org/10.1016%2Fj.apmr.2007.07.020). *Archives of Physical Medicine and Rehabilitation*. **88** (12): 1658–61. [doi](/source/Doi_(identifier)):[10.1016/j.apmr.2007.07.020](https://doi.org/10.1016%2Fj.apmr.2007.07.020). [PMID](/source/PMID_(identifier)) [18047882](https://pubmed.ncbi.nlm.nih.gov/18047882).

1. **[^](#cite_ref-PubMed.gov_7-0)** Myburgh, C; Larsen AH; Hartvigsen J. (2008). ["A systematic, critical review of manual palpation for identifying myofascial trigger points: evidence and clinical significance"](https://doi.org/10.1016%2Fj.apmr.2007.12.033). *[Arch Phys Med Rehabil](/source/Arch_Phys_Med_Rehabil)*. **89** (6): 1169–76. [doi](/source/Doi_(identifier)):[10.1016/j.apmr.2007.12.033](https://doi.org/10.1016%2Fj.apmr.2007.12.033). [PMID](/source/PMID_(identifier)) [18503816](https://pubmed.ncbi.nlm.nih.gov/18503816).

1. **[^](#cite_ref-pmid18164325_8-0)** Shah JP, Danoff JV, Desai MJ, et al. (2008). "Biochemicals associated with pain and inflammation are elevated in sites near to and remote from active myofascial trigger points". *Archives of Physical Medicine and Rehabilitation*. **89** (1): 16–23. [doi](/source/Doi_(identifier)):[10.1016/j.apmr.2007.10.018](https://doi.org/10.1016%2Fj.apmr.2007.10.018). [PMID](/source/PMID_(identifier)) [18164325](https://pubmed.ncbi.nlm.nih.gov/18164325).

1. **[^](#cite_ref-pmid18164347_9-0)** Simons DG (2008). "New views of myofascial trigger points: etiology and diagnosis". *Archives of Physical Medicine and Rehabilitation*. **89** (1): 157–9. [doi](/source/Doi_(identifier)):[10.1016/j.apmr.2007.11.016](https://doi.org/10.1016%2Fj.apmr.2007.11.016). [PMID](/source/PMID_(identifier)) [18164347](https://pubmed.ncbi.nlm.nih.gov/18164347).

1. **[^](#cite_ref-10)** Lucas, Nicolas; Macaskill, Petra; Irwig, Lee; Moran, Robert; Bogduk, Nikolai (January 2009). "Reliability of Physical Examination for Diagnosis of Myofascial Trigger Points: A System Review of the Literation". *The Clinical Journal of Pain*. **25** (1): 80–9. [doi](/source/Doi_(identifier)):[10.1097/AJP.0b013e31817e13b6](https://doi.org/10.1097%2FAJP.0b013e31817e13b6). [PMID](/source/PMID_(identifier)) [19158550](https://pubmed.ncbi.nlm.nih.gov/19158550). [S2CID](/source/S2CID_(identifier)) [11603020](https://api.semanticscholar.org/CorpusID:11603020).

1. **[^](#cite_ref-11)** Kumbhare, D; Elzibak, A; Noseworthy, M (2016). "Assessment of myofascial trigger points using ultrasound". *Am J Phys Med Rehabil*. **95** (1): 72–80. [doi](/source/Doi_(identifier)):[10.1097/PHM.0000000000000376](https://doi.org/10.1097%2FPHM.0000000000000376). [PMID](/source/PMID_(identifier)) [26334421](https://pubmed.ncbi.nlm.nih.gov/26334421). [S2CID](/source/S2CID_(identifier)) [27284692](https://api.semanticscholar.org/CorpusID:27284692).

1. **[^](#cite_ref-12)** Jantos M (June 2007). ["Understanding chronic pelvic pain"](https://web.archive.org/web/20190213021015/http://www.pelviperineology.org/practical/chronic_pelvic_pain.html). *Pelviperineology*. **26** (2). [ISSN](/source/ISSN_(identifier)) [1973-4913](https://search.worldcat.org/issn/1973-4913). [OCLC](/source/OCLC_(identifier)) [263367710](https://search.worldcat.org/oclc/263367710). Archived from [the original](http://www.pelviperineology.org/practical/chronic_pelvic_pain.html) on 2019-02-13. Retrieved 2007-08-08. Full open-access article

1. **[^](#cite_ref-Davies_13-0)** Davies Clair; Davies Amber (2004). *The trigger point therapy workbook: your self-treatment guide for pain relief* (2nd ed.). Oakland, California: New Harbinger Publications. p. 323. [ISBN](/source/ISBN_(identifier)) [978-1-57224-375-0](https://en.wikipedia.org/wiki/Special:BookSources/978-1-57224-375-0).

1. **[^](#cite_ref-14)** Guzmán-Pavón, María José; Cavero-Redondo, Iván; Martínez-Vizcaíno, Vicente; Fernández-Rodríguez, Rubén; Reina-Gutierrez, Sara; Álvarez-Bueno, Celia (2020-11-01). "Effect of Physical Exercise Programs on Myofascial Trigger Points-Related Dysfunctions: A Systematic Review and Meta-analysis". *Pain Medicine (Malden, Mass.)*. **21** (11): 2986–2996. [doi](/source/Doi_(identifier)):[10.1093/pm/pnaa253](https://doi.org/10.1093%2Fpm%2Fpnaa253). [ISSN](/source/ISSN_(identifier)) [1526-4637](https://search.worldcat.org/issn/1526-4637). [PMID](/source/PMID_(identifier)) [33011790](https://pubmed.ncbi.nlm.nih.gov/33011790).

1. **[^](#cite_ref-15)** ["Fibromyalgia: diagnosis and treatment"](https://web.archive.org/web/20160304023824/http://www.medicine.ox.ac.uk/bandolier/band90/b90-2.html). *Bandolier* (90). August 2001. [ISSN](/source/ISSN_(identifier)) [1353-9906](https://search.worldcat.org/issn/1353-9906). Archived from [the original](http://www.medicine.ox.ac.uk/bandolier/band90/b90-2.html) on 2016-03-04. Retrieved 2009-07-20.

1. **[^](#cite_ref-16)** Ge HY, Nie H, Madeleine P, Danneskiold-Samsøe B, Graven-Nielsen T, Arendt-Nielsen L (2009-12-15). "Contribution of the local and referred pain from active myofascial trigger points in fibromyalgia syndrome". *Pain*. **147** (1–3): 233–40. [doi](/source/Doi_(identifier)):[10.1016/j.pain.2009.09.019](https://doi.org/10.1016%2Fj.pain.2009.09.019). [PMID](/source/PMID_(identifier)) [19819074](https://pubmed.ncbi.nlm.nih.gov/19819074). [S2CID](/source/S2CID_(identifier)) [22098443](https://api.semanticscholar.org/CorpusID:22098443).

1. **[^](#cite_ref-17)** Brezinschek HP (December 2008). "Mechanismen des Muskelschmerzes" [Mechanisms of muscle pain : significance of trigger points and tender points]. *Zeitschrift für Rheumatologie* (in German). **67** (8): 653–4, 656–7. [doi](/source/Doi_(identifier)):[10.1007/s00393-008-0353-y](https://doi.org/10.1007%2Fs00393-008-0353-y). [PMID](/source/PMID_(identifier)) [19015861](https://pubmed.ncbi.nlm.nih.gov/19015861). [S2CID](/source/S2CID_(identifier)) [115732018](https://api.semanticscholar.org/CorpusID:115732018).

1. **[^](#cite_ref-18)** Raab D: Craniomandibular disorders simulating odontalgia and Eustachian tube -disorders – a case report. [Durch craniomandibuläre Dysfunktionen vorgetäuschte Zahnschmerzen und Tubenfunktionsstörungen – ein Fallbericht.] Wehrmedizinische Monatsschrift 2015: 59(12); 396-401. [http://www.wehrmed.de/article/2738-durch-craniomandibulaere-dysfunktionen-vorgetaeuschte-zahnschmerzen-tubenfunktionsstoerungen-ein-fallbericht.html](http://www.wehrmed.de/article/2738-durch-craniomandibulaere-dysfunktionen-vorgetaeuschte-zahnschmerzen-tubenfunktionsstoerungen-ein-fallbericht.html)

1. **[^](#cite_ref-lowback_19-0)** ["Trigger point injection"](https://web.archive.org/web/20061026111155/http://www.lowbackpain.com/trigger.html). Non-Surgical Orthopaedic & Spine Center. October 2006. Archived from [the original](http://www.lowbackpain.com/trigger.html) on 2006-10-26. Retrieved 2007-04-07.

1. **[^](#cite_ref-20)** Lewit K (1979). "The needle effect in the relief of myofascial pain". *Pain*. **6** (1): 83–90. [doi](/source/Doi_(identifier)):[10.1016/0304-3959(79)90142-8](https://doi.org/10.1016%2F0304-3959%2879%2990142-8). [PMID](/source/PMID_(identifier)) [424236](https://pubmed.ncbi.nlm.nih.gov/424236). [S2CID](/source/S2CID_(identifier)) [35930507](https://api.semanticscholar.org/CorpusID:35930507).

1. **[^](#cite_ref-21)** Wilson VP (2003). ["Janet G. Travell, MD: A Daughter's Recollection"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC152828). *Tex Heart Inst J*. **30** (1): 8–12. [PMC](/source/PMC_(identifier)) [152828](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC152828). [PMID](/source/PMID_(identifier)) [12638664](https://pubmed.ncbi.nlm.nih.gov/12638664).

1. **[^](#cite_ref-22)** ["Who Administers Trigger Point Injections?"](https://medlineplus247.com/who-administers-trigger-point-injections/). *Med Line Plus*. 2017-11-07. Retrieved 2017-12-04.

1. **[^](#cite_ref-23)** Charles D, Hudgins T, MacNaughton J, Newman E, Tan J, Wigger M. ["A systematic review of manual therapy techniques, dry cupping and dry needling in the reduction of myofascial pain and myofascial trigger points"](https://www.bodyworkmovementtherapies.com/article/S1360-8592(19)30114-7/fulltext). *J Bodyw Mov Ther.* 2019 Jul;23(3):539–546. [doi](/source/Doi_(identifier)):[10.1016/j.jbmt.2019.04.001](https://doi.org/10.1016%2Fj.jbmt.2019.04.001). Epub 2019 Apr 4. PMID 31563367.

1. **[^](#cite_ref-24)** Tough EA, White AR, Cummings TM, Richards SH, Campbell JL (January 2009). "Acupuncture and dry needling in the management of myofascial trigger point pain: a systematic review and meta-analysis of randomised controlled trials". *European Journal of Pain*. **13** (1): 3–10. [doi](/source/Doi_(identifier)):[10.1016/j.ejpain.2008.02.006](https://doi.org/10.1016%2Fj.ejpain.2008.02.006). [PMID](/source/PMID_(identifier)) [18395479](https://pubmed.ncbi.nlm.nih.gov/18395479). [S2CID](/source/S2CID_(identifier)) [23087439](https://api.semanticscholar.org/CorpusID:23087439).

1. **[^](#cite_ref-25)** Hong CZ (June 2000). ["Myofascial trigger points: pathophysiology and correlation with acupuncture points"](https://doi.org/10.1136%2Faim.18.1.41). *Acupunct Med*. **18** (1): 41–47. [doi](/source/Doi_(identifier)):[10.1136/aim.18.1.41](https://doi.org/10.1136%2Faim.18.1.41). [S2CID](/source/S2CID_(identifier)) [54688332](https://api.semanticscholar.org/CorpusID:54688332).

1. **[^](#cite_ref-26)** Melzack R, Stillwell DM, Fox EJ (February 1977). ["Trigger points and acupuncture points for pain: correlations and implications"](http://www.medaku.com/images/TRIGGERPOINTS_MELZACK.pdf) (PDF). *Pain*. **3** (1): 3–23. [doi](/source/Doi_(identifier)):[10.1016/0304-3959(77)90032-X](https://doi.org/10.1016%2F0304-3959%2877%2990032-X). [PMID](/source/PMID_(identifier)) [69288](https://pubmed.ncbi.nlm.nih.gov/69288). [S2CID](/source/S2CID_(identifier)) [38467256](https://api.semanticscholar.org/CorpusID:38467256).

1. **[^](#cite_ref-27)** Dorsher PT (May 2006). ["Trigger points and acupuncture points: anatomic and clinical correlations"](https://web.archive.org/web/20090515023947/http://www.medicalacupuncture.org/aama_marf/journal/vol17_3/article_3.html). *Medical Acupuncture*. **17** (3). Archived from [the original](http://www.medicalacupuncture.org/aama_marf/journal/vol17_3/article_3.html) on 2009-05-15. Retrieved 2009-11-28.

1. **[^](#cite_ref-28)** Dorsher PT (July 2009). ["Myofascial referred-pain data provide physiologic evidence of acupuncture meridians"](https://doi.org/10.1016%2Fj.jpain.2008.12.010). *J Pain*. **10** (7): 723–31. [doi](/source/Doi_(identifier)):[10.1016/j.jpain.2008.12.010](https://doi.org/10.1016%2Fj.jpain.2008.12.010). [PMID](/source/PMID_(identifier)) [19409857](https://pubmed.ncbi.nlm.nih.gov/19409857).

1. ^ [***a***](#cite_ref-Thieme_29-0) [***b***](#cite_ref-Thieme_29-1) Gautschi, Roland (2019). [*Manual Trigger Point Therapy: Recognizing, Understanding, and Treating Myofascial Pain and Dysfunction*](https://books.google.com/books?id=GJmRDwAAQBAJ&pg=PT46). Thieme. [ISBN](/source/ISBN_(identifier)) [978-3132203112](https://en.wikipedia.org/wiki/Special:BookSources/978-3132203112). Retrieved 19 Jan 2020.

1. ^ [***a***](#cite_ref-:1_30-0) [***b***](#cite_ref-:1_30-1) Reilich, Peter; Gröbli, Christian; Dommerholt, Jan (2018-07-22). [*Myofasziale Schmerzen und Triggerpunkte: Diagnostik und evidenzbasierte Therapie. Die Top-30-Muskeln*](https://books.google.com/books?id=XP9lDwAAQBAJ&pg=PA2) (in German). Elsevier Health Sciences. pp. 2–3. [ISBN](/source/ISBN_(identifier)) [9783437293467](https://en.wikipedia.org/wiki/Special:BookSources/9783437293467).

1. **[^](#cite_ref-pmid25477053_31-0)** Quintner JL, Bove GM, Cohen ML (2015). ["A critical evaluation of the trigger point phenomenon"](https://doi.org/10.1093%2Frheumatology%2Fkeu471). *Rheumatology (Oxford)*. **54** (3): 392–399. [CiteSeerX](/source/CiteSeerX_(identifier)) [10.1.1.872.7808](https://citeseerx.ist.psu.edu/viewdoc/summary?doi=10.1.1.872.7808). [doi](/source/Doi_(identifier)):[10.1093/rheumatology/keu471](https://doi.org/10.1093%2Frheumatology%2Fkeu471). [PMID](/source/PMID_(identifier)) [25477053](https://pubmed.ncbi.nlm.nih.gov/25477053).{{[cite journal](https://en.wikipedia.org/wiki/Template:Cite_journal)}}: CS1 maint: multiple names: authors list ([link](https://en.wikipedia.org/wiki/Category:CS1_maint:_multiple_names:_authors_list))

1. **[^](#cite_ref-32)** [Presentation of the journal by the publisher](https://www.journals.elsevier.com/journal-of-bodywork-and-movement-therapies)

1. **[^](#cite_ref-pmid25892372_33-0)** Dommerholt J, Gerwin RD (2015). ["A critical evaluation of Quintner et al: missing the point"](http://avt-osteopathie.de/assets/downloads/5ace2cea/tp_2.pdf) (PDF). *J Bodyw Mov Ther*. **19** (2): 193–204. [doi](/source/Doi_(identifier)):[10.1016/j.jbmt.2015.01.009](https://doi.org/10.1016%2Fj.jbmt.2015.01.009). [PMID](/source/PMID_(identifier)) [25892372](https://pubmed.ncbi.nlm.nih.gov/25892372).

1. **[^](#cite_ref-34)** Shah, Jay P.; Danoff, Jerome V.; et al. (January 2008). "Biochemicals associated with pain and inflammation are elevated in sites near to and remote from active myofascial trigger points". *Archives of Physical Medicine and Rehabilitation*. **89** (1): 16–23. [doi](/source/Doi_(identifier)):[10.1016/j.apmr.2007.10.018](https://doi.org/10.1016%2Fj.apmr.2007.10.018). [ISSN](/source/ISSN_(identifier)) [1532-821X](https://search.worldcat.org/issn/1532-821X). [PMID](/source/PMID_(identifier)) [18164325](https://pubmed.ncbi.nlm.nih.gov/18164325).

1. **[^](#cite_ref-35)** Shah, Jay P.; Phillips, Terry M.; et al. (November 2005). ["An in vivo microanalytical technique for measuring the local biochemical milieu of human skeletal muscle"](https://journals.physiology.org/doi/prev/20171106-aop/abs/10.1152/japplphysiol.00419.2005). *Journal of Applied Physiology*. **99** (5): 1977–1984. [doi](/source/Doi_(identifier)):[10.1152/japplphysiol.00419.2005](https://doi.org/10.1152%2Fjapplphysiol.00419.2005). [ISSN](/source/ISSN_(identifier)) [8750-7587](https://search.worldcat.org/issn/8750-7587). [PMID](/source/PMID_(identifier)) [16037403](https://pubmed.ncbi.nlm.nih.gov/16037403). Retrieved 24 September 2023.

1. **[^](#cite_ref-36)** Simons, David G. (2006). ["Review of Microanalytical in vivo study of biochemical milieu of myofascial trigger points"](https://www.sciencedirect.com/science/article/abs/pii/S136085920500094X). *Journal of Bodywork and Movement Therapies*. **10** (1): 10–11. [doi](/source/Doi_(identifier)):[10.1016/j.jbmt.2005.09.004](https://doi.org/10.1016%2Fj.jbmt.2005.09.004). Retrieved 24 September 2023.

Classification D ICD-10: M62.8 MeSH: D061028

Authority control databases GND

---
Adapted from the Wikipedia article [Myofascial trigger point](https://en.wikipedia.org/wiki/Myofascial_trigger_point) by Wikipedia contributors ([contributor history](https://en.wikipedia.org/wiki/Myofascial_trigger_point?action=history)). Available under [Creative Commons Attribution-ShareAlike 4.0 International](https://creativecommons.org/licenses/by-sa/4.0/). Changes may have been made.