Trigger points coming back? Here's why it's happening!

Trigger points coming back? Here’s why and how to prevent it

trigger point

Are your trigger points coming back often? If so, you’ll need to work on many things. Trigger points come back for a variety of reasons – and you can take steps to help stop them returning.

Things you need to look out for are:- bad posture,  stress breathing, repetitive movements. For example, if you work every day at a computer, you need to examine very carefully your workplace setup.

If your workplace setup is causing tension in your muscles, then no matter how much you release your triggers, they’ll keep returning.

Stress breathing occurs when you use the muscles in your shoulders and upper chest for breathing, rather than your abdominal and diaphragm muscles. These muscles are less efficient, and if you use them all day long, this can create trigger points that keep coming back.

Bad posture means that you’re continually holding tension. Constant tension will stress muscles, which then leads to trigger points – almost as a defensive mechanism. If you want to see excellent sitting posture – look at how a baby sits.

Babies have to sit with perfect posture – their posture muscles are still weak and their heads are heavy. They sit with their head perfectly balanced on their shoulders. That’s the kind of effortless posture you need to help trigger points stay away.

For improving posture and never having trigger points coming back again, the Alexander Technique is also very useful.

Below is an excerpt from an interview I did on how to stop triggers coming back. (The full interview in on my membership site.)

Click on the triangle below to listen.

PS. to go deeper into these techniques you may want to have a look at a course I’ve made that teaches self-treatment of trigger points.

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(31) comments

KAREN HANNAFORD November 17, 2009

Hi there, after listening to the speach on trigger points, I’m afraid in my case , it is a whole different ball game!!
Ihave had Fibromyalgia and chronic myofascial pain for over 20 years. I exercise through the pain as much as I can , but I am at the end of my tether, and wondered if you can help me. I have tried ABSOLUTELY every treatment to try and stop my trigger points and muscles going into spasm, but as soon as I have my most sucsessful treatment (MYOFASCIAL RELEASE) and relax, after a few days, I need another one! It’s relentless, and driving me up the wall. I suffer flare ups , then recover. I try and pace myself, but I don’t want to live at ‘SNAILS pace’ and not do anything. Why can’t I stay out of spasm?

    Jonathan November 30, 2009

    Hi Karen

    Fibromyalgia complicates the clinical picture considerably. This is now thought to be a centrally mediated pain condition. This means that many of the signals arising from your body become amplified in the central nervous system [ ie the spinal cord and brain]. This means that you may feel pain from areas in your body where there is literally nothing wrong and any painful areas will be more sore.
    Therefore you need to treat the Fibromyalgia together with trigger points. There are many treatments for Fibromyalgia- and only some work in each individual. This is a huge and complex topic.
    Once your Fibro is quieter, then treatment of trigger points will be more successful

    Jonathan Kuttner

jagadish December 14, 2009

dear sir,

i am mainly suffering from muscle pain in back muscle wile doing work & i can’t sit properly for 5 min. en while breathing the muscle cauching………. please give me a good suggestion to it early as possible

thanking u


    Jonathan December 15, 2009

    Hi Jagadish,

    I can’t really diagnose this sort of problem over the internet. You need to have a competent health practitioner examine your back to see where this pain is coming from.

    Best wishes,

tom orbell February 27, 2010

yeh go and see a trigger point therapist. i feel my back pain more when taking a deep breath. i find that massage to the rib muscles and abdominals help my pain but id go and see a proffessional before self massaging the area

Ruth May 19, 2010

Hi Jonathon,
I have been suffering from chronic low back pain for 7 years and now between the shoulders blades on a regular basis. Have been diagnosed with some L4-L5 stenosis, and facet arthritis with grade 1 spondylolisthesis. I have tried every modality out there to get relief including acupuncture, massage, trigger point board with pegs, rolling on balls, injections, active release, rolfing, and herbs and enzyme supplements. Even if I get some relief it is short lived. I have been an active hairstylist now for 15 yrs and do a lot of repetitive movements with arms up and out, and a lot of twisting side to side. I try to be conscious of correct posture but my job makes it tough. I am thinking of getting a breast reduction because I feel the extra weight is pulling my center of gravity forward and perpetuating the return of trigger points all over. Have you ever heard of this being a viable reason for constant muscle tension?
Thank you,

    Jonathan June 10, 2010

    hello Ruth

    I have looked after a number of woman who had chronic neck, shoulder and thoracic spine pain and also had a large bust. They had a similar experience to you, where all other treatment had either been partially effective or ineffective. They went forward for a breast reduction and all reported a significant improvement not only in a pain but also in their quality of life. They all reported feeling so much lighter and more free plus they also felt better about themselves.


Rose Robertson August 18, 2010

Hello Jonathan
I seem to have persistent trigger points (TP’s from now on!) in the back and front of my thighs (hamstrings and glutes), on both sides of the body – also TP’s in the bands of muscles which go down the thigh on both sides of the body (ITB).
Currently I’m attending a pre-hip replacement clinic and doing exercises there to improve mainly the ‘stand up, sit down muscles’ because I have reported I can’t get my right leg in particular over anything ( I’m talking about bike crossbar or stiles, that kind of thing).
The X-rays don’t tell why the right leg – both hip joints show a thinning of the cartilage and lipping on both hip joints. But I have much more muscular pain very definitely on one side. The other one doesn’t bother me!
The hospital has physiotherapists who are fine on exercise but other therapies are never mentioned, let alone suggested (though one physio wanted to know about the collapsing knee TP I spoke of, so I sent him your website details as he was obviously interested).
My question is: Where should I search for the primary TP to treat frequently. Am not expecting to cure the muscular pain but to limit it. Would it be likely to be in the glutes or the hamstrings? Come to think of it, I also have TP’s in the backs and fronts of my legs below the knees. As I say this I’m thinking that the nearer the source of my discomfort, probably the more likely to be the first to treat?

    Jonathan September 14, 2010

    hello Rose

    is very difficult for me to say exactly where your triggers are without examining you. However trigger points in the gluteal muscles and the hamstrings are very common and can be gratifying to treat. There are also quite common trigger points in the muscles of the lower leg (tibialis anterior, gastrocnemius etc). These are also amenable to treatment.

    If the triggers or secondary to the arthritis in your hip and then treating them will only give temporary relief. However often they can be a primary problem, if this is the case then treating them will give long-lasting relief.

    if you wish to learn how to diagnose, find and treat the specific trigger points in the muscles that are causing your pain, you can follow the following link:

    in this course you can choose of the area of the body that you wish to treat and purchase just that section

    Kind regards

tom August 18, 2010

Hi Ruth

Have you tried trigger point therapy to the psoas muscle?

In relation to back pain….psoas reffered pain usually is a very deep pain and its hard to localise to one spot

It can easily be self massaged by lying on your back and dropping your knees to the side (a better description can be found in the trigger point therapy workbook.)

If the self massage helps then i would look into seeing a competent medical acupuncturist…they can really get at the psoas by directing the needle through the transverse process L1-5.

After suffering from low back pain for 5 years…i have had 3 sessions of this deep acupuncture and am well on the road to recovery.

cathy August 25, 2010

While I realize you can self treat some trigger points, it is almost impossible to treat all your trigger points. This is like a double edged sword i.e. you get some temporary relief from the area you massaged, but the trigger points are widespread which means you have many other areas that are painful. How is it possible to treat widespread myofascial pain syndrome? p.s. and when and if you do get some relief from a certain trigger point, the relief is only so very temporary. This leads to alot of frustration and anxiety

    Jonathan September 14, 2010

    hello Cathy

    There are is essentially two broad types of trigger points.

    The first is a peripheral problem — there is a localised group of trigger points in an area of the body which is either primary (there is nothing driving them) or secondary (reacting to a painful joints etc). Treatment of these is usually gratifying and ineffective. Often you can get long-lasting relief from accurate treatment of the trigger points.

    the second is that the trigger points are part of a central pain problem — here there is often an underlying pain system malfunction, as you would find in fibromyalgia. Often trigger points will be multiple and widespread in many parts of your body. treatment of these trigger points can often be unsatisfactory and temporary. This is because they are a peripheral manifestation of the central neural processing disorder. in general this is more difficult and you’ll treatment needs to involve recognition of this problem. Often centrally acting neuromodulating medications (amitriptyline, nortriptyline, gabapentin etc) can be really helpful as part of an overall strategy

    kind regards

tom September 4, 2010

Hi Cathy,

I can understand your frustration and is sounds like your trigger point therapy is short lived.

There are different types of trigger points and understanding them is important. First there are latent or active trps. The latent ones only hurt when pressed but do not actively refer pain. (these latent trps cause stiffness but no pain) The active ones are the the ones which cause pain.

Secondly, to treat your condition effectively you need to understand the difference between Primary, secondary and attachment trigger points.

Primary trigger points are the ones to go after….these can usually be found midway along the belly of the muscle….they will most likely be the most painful trps to palpate. The idea is that once these are treated the secondary trps will go away once the primary has been deactivated. Secondary trigger points are caused by muscles compensating from the primary muscle that is in trouble.

This is how widespread myofascial pain starts….one trigger point leading to another and another and so on.

When your trps have been in place for sometime you may develop trps in the muscle attachments. Like with secondary trps these are likely dissapear after the primary has been treated or may need some treatment.

It si important to remember that trigger points may be made worse by certain repetive postures….. For example…lets say that you sit on one side of your glutes all day long… it is likely that your primary trp is in your glutes but you may develop secondary trps in your QL.

Other possibilites : Nutritional deficiencies…B vitamins are common

i hope this helps


    Jonathan September 14, 2010

    thanks Tom for your informative an accurate answer. I really appreciate your assistance

    Kind regards

Vicky September 13, 2010

To Rose

Hi, I just read your post and it sounds very much like my own problem. I thought I treated all areas involved, following the charts, but to no permanent relief for months. Finally I’ve found a big tender ‘lump’ and a cluster of other TPs on the back of my upper thigh and upper ITB, which feels like treatment there might be more successful. I only found these yesterday so don’t know the final answer, but it might be worth your try. These don’t appear on any charts or books I’ve seen, so might need to do your own exploration.

Best of luck

Dawn Olsen October 20, 2010


I have been having problems with dizziness and sore neck muscles for almost a year now. It started when I quit smoking and I had so much tension in my upper body I thought I was going to have a heart attack. I have been to the doctor many times and have had no help from any of them. My shoulder muscles and neck muscles are so tight and I can feel knots in them everywhere. Any suggestions?

Katherine October 31, 2010

I just was out of work for entire week due to my flare up. I have multiple concerns:

1) biltateral compartment syndrome(calves) I had a release in 2006 but is still bothers me when I work out or even walk!

2) Multi level DJD spine, concentrating in L4, L5, S1, bulging discs- I have had injections but they don’t work for long. Walking even bothers me.
Sometimes it affects my bladder.
I don’t sleep more than 3-4 hrs a night because of the pain

3) Severe arthritis in R knee and meniscus tears.. had two knee surgeries, it keeps going out on me.. they don’t want to do a knee replacement until I am 65. I am 55 now.
I can hardly walk. My foot spasms alot, feet are often a dusky color.

I have been in physical therapy for years, I know all the core exercises known to man and I do them as able.

I used to be very active my entire life up until 5 years ago, Now I can’t do anything.

Katherine October 31, 2010

i have to add more 😉
I have golfer’s elbow and the facet joint pain in back and hips… pain radiates down my leg.

tom November 3, 2010

@ Jagadish

I have been reding through travell and simons manual and would like to share with you some problem trigger points which cause increased pain during breathing:

Multifidus/Roataorez – These are very deep, short muscles which attach to the vertebra and assist extension & rotation of the spine. To treat them, lie on the floor and use compression technique with a hard rubber ball. Hold for 30 secs- 2 min and repeated until required relief is achieved.

IllioPsoas – This is the big pretender comprising psoas minor/major and illiacus and causes a diffuse kind of back pain which is difficult to localise. The pain is usually felt parralell to the spine and also at the top of hips. The psoas attaches at the 12th rib, all vertebra L1-5, to the lesser trochanter of the femur. To treat psoas lie on your back, drop both knees to one side to allow intenstines to move out of the way, and use short deep strokes starting 2 inches to the side of the belly button. (This is usually the primary trigger point) If your psoas is tight and afflicted with trps it will feel like a hard thin sausage

Breathing exercises may improve your symptoms – Lie on the floor and Take deep breaths in allowing your belly to expand (not your chest) Complete 20-30 deep breaths, take a minutes rest and repeat

    CRYSTAL July 2, 2015

    Hi tom,

    For about 3 years now I have been dealing with a dull aching pain in my middle or lower trapezius muscle it bothers me all the time. I have noticed it has only gotten worse it is on my right side it seems as though it is a trigger point when I take deep breathes I can feel the exact location of the pressure from it my whole right side is out of whack! It irritates all the muscles around it up into the right side of my neck down my right side towards the kidney area I have even noticed a difference in muscle compared to my left side, my right side also drops lower than the left and I just noticed I have a winged scapula! This has become so horrible I am just going crazy I wanted to know if you have so much muscle tension in this area if intact it can effect your breathing and if it is in the trigger point if you can feel the area when you deep breathe? I have terrible posture it began about 8 years ago when I had a fall from a 3 story window I landed on my feet where I endured a hairline compression fracture to my l1 and fractured my right leg I believe my right side got the brunt of the trauma and that is why it may be shorter and caused a muscle imbalance I noticed this issue start in my upper back (trapezius muscle) after I had my son 3 years ago I had gained a lot of weight in which the chest bared a lot of it they were beyond gigantic I had bad posture already and that just unbelievably made it worse I carried all the weight in my chest and caused an extreme slouch in my posture. I also checked and I have forward head posture when I leaned against a wall I noticed I had a lot of space from my shoulders and head from the wall! I just wanted some professional input as to wether all this could be connected and if you can feel so much on one side from a pulled muscle! I use my right side all the time I even lean in that direction when I sit I also lay on my stomach with my head turned towards the left which pulls my right neck muscles! I know it is so much but this is effecting my life tremendously my PCP told me it is musculoskeletal/myofacial when I turn my shoulders I feel the location as if something is there it is the one spot directly in my trap it is a dull pain can this be a trigger point? can it effect my breathing can it cause scapula winging and cause pain on the side of my ribs into my chest? Please respond as soon as possible I really need some input! Thank you very much

tom November 3, 2010

@ Katherine

For L4-5 pain – try the compression technique listed above

For S1 – Try a tenniss ball against the wall on glute medius (side of glute) and Tensor Fascia Lata (This muscle can cause excessive lumbar curve in the spine and aggravate the SI joint)

For your knee pain – start gently working on rectus femoris (top of knee pain), IT pain for outside knee pain, sartorius for inside knee pain and popliteus (a small muscle at the back of the knee) for back of knee pain.

For bladder pain… Lower abdominal trigger points (they will usually be below the belly button). Use short deep strokes and dont overdo the area…. 8-10 strokes per trp iconstitutes a treatment

For pain radiating down your leg the muscle to go after is piriformis. Its primary purpose is to externally roatate the hip but is very well known for causing sciatica like symptoms.

I hope this helps

Andrew Stewart May 22, 2011

Hello Jonathan,
I’m looking forward to working my way through the full course. I’ve already had a lot of success in treating a trigger point using the techniques described in your free course (for which I shall be eternally grateful). The frequency with which it returns has diminished considerably, and the burning sensation that I had for some time in my right buttock is far less intense now, though not completely absent. I’m not very familiar with anatomy but I think the muscle involved is the piriformis. In addition to the inflammation in the right buttock I get nerve pain affecting the right knee and shin. Most of the time it’s so mild that ‘pain’ is not the right word, irritation would be closer, though occasionally it becomes a momentary stabbing pain.

I don’t expect to banish all my mobility problems resulting from an arthritic right hip and/or disc degeneration in the back (two orthopaedists disagree about the main cause). The key findings of a lumber MRI were “degenerative bulging discs, more severe at levelL2-3, L3-4,L4-5, with mild indenting the thecal sac” and “moderate neural foraminal narrowing at level right T10-T11, bilateral L2-3, L3-4 and mild narrowing at Level L4-5 without compression exiting nerve root”. What I am looking for is some way of combating the worst aspect of my condition, which is this:

After sitting for more than about ten minutes, when I stand and start to walk I experience acute pain in the right buttock, some nerve pain at various points in the right leg, and a general muscular stiffness. It induces a pronounced limp and at times can be so bad that I need a walking-stick for support for the first ten paces or so. After that I can dispense with the stick. The only thing that I can do to minimise the pain is to bend down and touch my toes, holding that position for about 30 seconds, but that’s not always practical in public places (leaving a restaurant, for example). I do try keep some movement going when I’m sitting, such as flexing the ankle and changing the angle of my legs. I’ve also discovered that it can be helpful to lift my right leg so that the thigh is horizontal (which induces pain in the groin), hold it until the pain subsides, then lift it higher and hold it again. This is something I’ve only just discovered for myself. I’m always experimenting.

So far these are the exercises that I’ve found beneficial:
1: swimming. I swim between 300 and 500 metres every day, mainly breast stroke but some back stroke as well and occasionally front crawl. The benefit of this can be illustrated by an occasion when I could hardly walk at all when I got up in the morning; after staggering downstairs with much difficulty I plunged in the pool, swam 320 metres and was able to walk normally back up three flights of stairs.

2 : walking, provided I’m not in too much pain to start with.

3: stretching exercises of various kinds. I also do your core muscle-strengthening exercises every morning .

I’ve had some success with physio-therapy, but the woman who achieved the best results has left my area. Incidentally I live in Thailand, so English is not the first language, which can make discussing things in detail with professionals a bit difficult, even when their command of English is reasonably good.

I’d be grateful for any comments or further suggestions from you or others, particularly how best to strengthen the hip muscles. One thing I haven’t yet tried is an exercise bicycle, but sitting astride anything usually induces groin pain.

Sorry for the length of this and many thanks for all you’ve offered so far.

Andy May 31, 2011

I started to suffer from upper back pain that sometimes turns into neck pain after I moved to a new country two and a half years ago; through you I learned that my upper trapezius is constantly tight so is my sternocleidomastoid…. this gives me occasional headaches and almost a constant dull tension on my upper back.

It’s been like a rollercoaster for me…. I noticed that if I move a lot and become active and my mind becomes busy the pain sort of eases and I can actually feel 100% normal….. but when I used my computer a lot and don’t move around the pain sets in with a burning feeling between my shoulder blades…. Also if I drive because my arms are extended the burning sets in.

I had an MRI done of my spine and they told me my spine, including my cervical spine is absolutely fine….. nothing wrong with it except for a tiny bulging disc on my neck which is very normal for a person my age (I am 33) and that is most likely NOT the cause of my chronic upper back pain.

I admit I used computers A LOT for the last ten years…. could that be the cause of my pain????? I also changed mattress from a soft one where I felt perfectly fine without any back pain 3 years ago to a hard one which I’ve had since I moved here…. in fact is so hard that I would wake up at night with shoulder pain as I am a side sleeper…. so had to put some type of cushioning on it to make it softer!!!!

I am starting to think my mattress and the computer use is to blame for most of this pain…. what do you think from your professional point of view?

Andy Stewart June 2, 2011

Response to Andy, above: I am not a professional, just a fellow sufferer. There is a difference between a firm mattress and a hard one. I have a firm mattress (so-called orthpoedic) made by a reputable company and it’s fine for me. I have just spent a night in a hotel where the bed was fitted with an unyielding hard mattress and I woke with a sore shoulder like you. A decent, firm mattress that supports the back well should not lead to a sore shoulder.

As for the computer, I’m convinced my problems stem from years of sitting immobile in front of a computer for hours on end.

bajram September 25, 2011

Dear Dr.Jonatan!
I am honored by your assessment of how easily it passed that I have the chest pain of rheumatism. Together with your methodsthat you send by e-mail, I started to do exercises and to do self massage by some video from Youtube by Boris, Rich,, etc..
Thank you for your care and assure you that the steps taken so farare promising and I felt relief in the chest, especially the use ofmassage techniques. Were very soothing stretching exercises I’vedone for hernien disc, affect cervical, and walking distance 3-5 kmper day, according to the daily health status.
In case of ambiguity in communication, because we translate vocabulary through computer, please for your understanding.
I express my gratitude for the help so far.
Sincerely Bajram Dautaj.
Tirana, Albania, September 25, 2011

Joe April 17, 2012


I have a nest of trigger points in my lower abdomen that refer pain to the pelvic region. I apply ischemic pressure every other day, which provides symptom relief, but the trigger points remain after 7 monts of this protocol. What else might I do?

Jane September 2, 2012

Trigger points that keep comimg back can be an indicator of serious internal trouble.
After working on trigger points in my feet and calves for 3 months I came to realize
that my core problem was in my digestive tract. A stuck ileocecal valve was my problem.
Don’t invest your energy in a limiting self diagnosis. Look further than trigger points
which are a symptom only.

ella September 20, 2012

Does mayofascial pain syndrome come and go through out a life time?

Jane September 24, 2012

karen and katherine,
Been diagnosed wth fibromyalgia for 10 yrs after 3 back surgeries only made my condition worse.
Recently found my ileocecal valve was stuck closed. After abdominal massage (see Utube) much improved. I had NO negative digestive issue to point to this.
Before self massage my bladder was painful and spastic.
So much of our pain begins from the gut.
Also check if you may be gluten intolerant.

Bert August 13, 2013

I have a neuromuscular junction disease resulting from degenerative disc disease confirmed by MRI that caused a peripheral neuropathy in my feet and ankles. The muscular problem is, it results in cramping in my calves when I sleep which used to wake me until I started taking Soma at bedtime a CNS muscle relaxer and gabapentin which gets me through the night. I have also been doing trigger point therapy which seemed to also help my cramping problem. My neurologist doesn’t believe the cramping has anything to do with the peripheral neuropathy but I a am convinced that using trigger point therapy has also relieved the cramping. My question is, if I continue using trigger point therapy for a CNS problem could I ever expect permanent relief from the muscle cramping in my calves when I sleep?


True. I also think that lack of electrolytes, such as magnesium, and other dietary factors can cause and perpetuate trigger points. Also, some hormones can promote faulty trigger point formation such as low estrogen or low thyroid.

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