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Soft tissue sore spots of an unknown origin
  1. Adam Meakins
  1. Correspondence to Dr Adam Meakins, Department of Physiotherapy, Spire Bushey Hospital, Heathbourne Road, Bushey, Herts WD23 1RD, UK; adammeakins{at}

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Trigger points are common clinical diagnoses in the musculoskeletal profession. However, questions have been raised about what they are and how they are treated.1 Trigger points were first described by Travell and Simons as tender, painful areas found in myofascial tissue when palpated. These are often described as muscle ‘knots’ or taut bands, and are considered to be areas of adverse sustained muscular contraction caused either from direct trauma to myofascial tissue or through repeated microtrauma from postural or activity-related stresses/strains. This is believed to cause a crisis at the motor end plates, creating a sustained adverse muscular contraction that is then felt as pain either locally or referred elsewhere.

However, despite widespread acceptance of this theory, and a large and diverse industry built around the treatment of trigger points, including various deep tissue massage and acupressure techniques and more recently, the growing popularity of dry needling, the theory of adverse muscle knots and taut bands as a cause of soft tissue pain has never been adequately explained.

So what are they?

More and more clinicians …

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