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Myofascial Trigger Points (MTP's) are not the same as the "tender points" that occur in Fibromyalgia or acupressure points. They are extremely sore or hyperirritable areas that can develop anywhere in the body and are more common than generally thought. The red dots in Figure 1 indicates the areas affected by CMP.

They may feel like knots, nodules, hard lumps, or taut, ropy bands of fibers in the muscles. In very severe cases, muscle may feel like hardened concrete. Trigger points may be active orlatent. Active trigger points cause pain, and latent ones can be "recruited" into causing pain. While CMP is not progressive, it can appear to be since each trigger point can develop satellite and secondary trigger points, which can themselves form satellites and secondaries, and so on 1. This cascade is especially likely if perpetuating or aggravating factors are not identified and corrected.

Active or Latent

Trigger points might be "active" or "latent." An active trigger point is always sore and can prevent the full use of the muscle, leading to weakness and decreased range of motion2. A latent trigger point does not cause pain during normal activities, but is tender when touched and can be activated when the muscle is strained, fatigued, or injured. Other symptoms associated with CMP include a sensation of muscle weakness, tingling, and stiffness. The pain associated with CMP might also lead to problems sleeping.

How They Work

When a trigger point is stimulated, it refers pain to other areas of the body in specific, predictable, characteristic patterns. Stimulation of some trigger points may also cause seemingly unrelated signs and symptoms; these include:3,4,5

  • Migraines and other headaches

  • Jaw pain

  • Neck pain

  • Lower back pain

  • Earaches, Tinnitus (ringing in the ears)

  • Heartburn

  • Pseudo-heart pain

  • Extreme dizziness

  • Nausea

  • Loss of balance, staggering, clumsiness

  • Carpal tunnel syndrome-like symptoms

  • Irritable bowel syndrome

  • Bruxism (grinding of teeth)

  • Painful menstruation

  • Impotence (inability to attain or sustain an erection)

  • Painful intercourse

  • Paresthesias (A skin sensation, such as burning, prickling, itching, or tingling)

  • Sciatica (painful disorder extending from the hip down the back of the thigh and surrounding area)

  • Leg cramps

  • Buckling knees and ankles

  • Blurring of vision, double vision

  • Trouble swallowing

  • Hypoglycemic-like symptoms (abnormally low level of glucose in the blood)

  • Sweating

  • Blanching (becoming pale)

  • Lacrimation (abnormal abundance of tears)

  • Salivation (act or process of salivating)

  • Coryza (acute inflammation of the mucous membrane of the nasal cavities)

  • Sinus pain

  • Congestion

  • Decreased immunity

  • Joint pain that can be mistaken for arthritis, tendonitis, bursitis, or ligament injury may also occur

Trigger point activation may cause muscle contraction, which can pull bones out of alignment and lead to osteoarthritis. Trigger point activation may also be a contributing factor to the development of scoliosis (abnormal lateral curvature of the spine).

Misdiagnosed & Mistreated

Myofascial pain is often misdiagnosed and mistreated for one primary reason: the cause of myofascial pain is often not located in the same place where the pain is felt.6 An example is that hand and arm pain is often caused by chronically contracted muscles in the upper arm, shoulder or even the neck.

While drugs can provide short term relief, they do not address the causes of chronic myofascial pain. And they pose a risk of side effects or in some cases, drug dependency. Surgery is a higher cost, and higher risk method of pain relief, justified in many cases. However, when myofascial factors are paramount, they can be treated at much lower cost and risk.


1. Mariana Ruiz-Saez, PT, DO, a Cesar Fernandez-de-las-Penas, PT, et al. Changes In Pressure Pain Sensitivity In Latents Myofascial Trigger Points In The Upper Trapezius Muscle After A Cervical Spine Manipulation In Pain-Free Subjects. Journal of Manipulative and Physiological Therapeutics, October 2007.

2. Chronic Myofascial Pain (CMP) (Also Called 'CMP', 'Myofascial Pain Syndrome'). Health Information. The Cleveland Clinic (

3. Starlanyl D, Copeland ME. Fibromyalgia & Chronic Myofascial Pain, 2nd ed. Oakland CA: New Harbinger Publications, Inc; 2001.

4. McMakin C. "The pain from someplace else:" myofascial pain and trigger point therapy. (

5. McMakin C. Fibromyalgia. (

6. What Are Myofascial Trigger Points? MYO Seminar Series on Myofascial Trigger Point Therapy. (

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Last Modified: 12/31/69 07:00 ET