Clinicians Corner | Attack of the Trigger Points: When Poking Becomes a Profession

Is Myofascial Pain Syndrome a real clinical diagnosis?

Feb 25, 2025

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This post is a guide only and should not be taken as medical advice. It does not replace assessment and recommendations from a registered and regulated healthcare professional.

I missed a mild Twitter storm — more of a brief downpour — over the weekend of 22–23 Feb 2025.

This time, it was about Myofascial Pain Syndrome (MPS), but more important it was another opportunity to have a dig at Trigger Points as a concept.

Myofascial Pain Syndrome (MPS) is a term used to describe localized muscle pain and tenderness attributed to trigger points — hypersensitive spots in muscle tissue believed to cause referred pain.

To me, MPS feels like one of those conditions we hyper-focused on in the 1990s, back when we didn’t know as much about other causes of pain and dysfunction. What else did we get carried away with in the ‘90s? Pelvic realignments (adjustments, etc.), core stability as the panacea for all back pain, and a bunch of other concepts many of us have since moved on from.

A trigger warning, this blog is full of Satire and Hyperbole, uncritical minds should take the nearest exit.

The Issue with Trigger Points

Having seen countless patients for second opinions n their long-term Musculoskeletal (MSK) Pain conditions after a 100% trigger point therapy approach failed, the pattern seems to be:

It’s mostly done by those who don’t know what else to do.

and

2. …No, that’s all.

Some call it a legitimate MSK condition, citing that the World Health Organisation recognizes and defines it as a primary diagnosis.

Strong backing, right?

Yes — in ICD-9 (1979) and ICD-10 (1992).

But perhaps the biggest clue that this diagnosis should be retired? The WHO has already retired it. ICD-11 (released in 2018, implemented in 2022) no longer recognizes MPS as a distinct condition.

The Bigger Problem with MPS: Are Trigger Points actually a Thing?

No one outside of those who treat trigger points as real things uses MPS as a diagnosis. Trigger points haven’t been shown to be a real entity — just sensitive areas. I have not seen it in the legitimate regulated medical/healthcare space at all (in this country — at least).

Even the ‘experts’ in trigger points can’t reliably find them. Adam Meakins summarized studies showing that even experienced clinicians — those who claim to specialize in treating trigger points — can’t tell if a patient is pain-free or in pain just by palpating them.

Paul Ingraham (The O.G. Msk Skeptic — from PainScience.com) has an an entire index of years of critique on trigger points, for those who want do dive down a deep dark rabbit hole.

Why Else Do Trigger Points Bother Me?

Patients think ‘knots’ (another term for trigger points) are literally knots. They are knot. (Sorry… couldn’t help myself.) Biopsy studies of these so-called knots show they look exactly the same as adjacent, non-knotted tissue.

Patients fixate on them because their providers also fixate on them (and think they are literally knots) — and entire treatment models (dry needling, ischemic pressures, scraping, cupping, massage guns) revolve around them.

What do most of us Clincians actually think? They are just areas of sensitized tissue. That’s it. No magic.

Even the Guru/Trigger Point Experts don’t agree on where trigger points are if you have different experts palpate the same patient, they’ll find sore spots — but never in the same places.

Trigger point treatment can sometimes escalate like an addiction — massage is a gateway drug to ischemic digital release is a gateway drug to dry needling is a gateway drug to cupping is a gateway drug to shoving something else in that spot even harder.

Patients who’ve been poked, stabbed, needled, buzzed, scraped, cupped, and shot (by massage guns) often end up needing a bigger hit or a deeper scratch for the same relief.

When I take them off the cycle cold turkey, their symptoms usually improve once we stop focusing on them.

Don’t Throw Your Straw Men at Me!

A common counterpoint to this argument is:

“Oh, OK Wise Guy! So you’re saying manual therapy does nothing?”

Of course not! That’s a straw man fallacy. This is not a debate about Manual Therapy vs. No Manual Therapy.

Manual therapy absolutely cam help reduce pain and improve function — but for most modalities, it works via non-specific effects, not by “releasing tissues” as if using a scalpel. It provides short-term pain relief and should be seen as one tool in a much larger toolbox available to regulated healthcare professionals managing musculoskeletal injuries, pain, and discomfort.

The issue arises when healthcare providers prioritise treatments that simply “feel good” while neglecting evidence-based care. These interventions should be clearly distinguished from scientifically supported treatments. If a therapy is purely for comfort and lacks measurable clinical impact, patients deserve full transparency about its nature. There’s no harm in comfort-based care — but it should be recognized as just that, without misleading medical jargon that falsely implies deeper physiological effects.

This blog isn’t about rejecting hands-on treatment — it’s about rejecting a narrative that disempowers patients. A narrative that leads to overtreatment, over-reliance on the therapist, and shifting the locus of control into the provider’s hands rather than the patient’s. Worse still, it gives patients an unrealistic and unscientific understanding of what’s actually happening in their body.

The Simple Conversation:

This is a common script and a demonstration on how easy it is to not throw pixie dust on a horse and call it a unicorn:

📍 Patient: “This spot hurts when I poke it.”

📍 Me: “Does that spot hurt when you don’t poke it?”

📍 Patient: “Well… no.”

📍 Me: “So you don’t notice that spot at all — ever — when you don’t poke it?”

📍 Patient: (Cue the realization…) “Umm, no.”

📍 Me: “Sooooo?”

📍 Patient: “…Don’t poke it?”

📍 Me: “You got it.”

📍 Patient: “Can you feel that though?”

I feel their ‘area of sensitivity’ with their consent

📍 Patient: “Do you feel it?”

📍 Me: “Nope, but you do. It feels the same as the areas around it to me”

I then demonstrate multiple places (ITB, calf, upper trap) where they can feel soreness despite having zero pain or dysfunction when we assess those areas.

Grab a Quick Fix Deal from your nearest Fast Food Fysio

The Takeaway

Trigger points are just areas of sensitivity. They often persist even after the patient’s primary pain condition has resolved. The bigger issue? Many patients — and unfortunately, many clinicians — are stuck focusing on them instead of moving on and finding underlying causes for the patients pain, discomfort and dysfunction.

If they are silly constructs without a scientific base, and are the proposed cause of ‘Myofascial Pain Syndrome’ (a very scary label for patients…. by the way), then maybe it’s time we all retire MPS as a diagnosis, just like the WHO already did.

For a more in-depth critical dive into trigger points with a far less hyperbole and satire, check out:

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