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Sock Doc WorkshopsI use trigger point therapy a lot while treating patients in my office – it’s one of the many tools used to get a person well. Trigger point therapy is very effective for a variety of problems, often structural but even sometimes visceral (organ related). Since I discuss trigger points in articles throughout the Sock Doc site and especially in my videos, I thought it would be helpful to go deeper (no pun intended) into trigger points – why you get them and will want to correct them, and how to go about doing just that – safely and effectively.
What is a Trigger Point?
Trigger points are termed as hyper-irritable points in the muscle and fascial matrix, which can alter nervous system function. They are also often created by nervous system stress, which I’ll talk about more in a bit. Tiny parts of the muscle called sarcomeres are unable to release from their interlocked state and this creates poor blood flow, inflammation, and pain in the area. Trigger points can be anywhere in the body, and can result from a local injury or from one distant from where the injury is perceived to be. They are described as hard nodules, tight bands of fiber, or “knots” in the muscle or fascia. Actually, many trigger points refer pain to a distant area – common examples are a trigger point in the calf muscle causing ankle or foot pain or a trigger point in the upper trapezius causing jaw or headache-type pain.
The concept behind trigger points is nothing new. In 1942, medical physician Dr. Janet Travell coined the term based upon what she described as myofascial pain syndromes. This basically means pain derived from muscle, fascia, or both. Fascia is the thick type of connective tissue that surrounds pretty much everything in your body, from muscles to blood vessels to organs. Fascia is like a spider-web matrix of tissue and it makes it plausible that everything is in some way connected to everything inside you. That means that muscles in your foot are connected to muscles in your neck, and even to your liver – obviously not directly, but definitely amazing (at least to me).
In the 1960s, chiropractic physician Dr. George Goodheart used a similar type of trigger point therapy in his office to correct muscle imbalances. He called his therapy “origin-insertion technique” and observed that when manually treating a “knot” in the muscle or fascia that not only was the patient’s pain lessened or eliminated, but muscle strength, posture, and range of motion improved too. This type of work, which is used by many doctors, including myself, who practice applied kinesiology techniques and various forms of manual muscle testing, also allows them to figure out precisely where the trigger points are as changes in muscle function can be detected immediately upon palpation (slight pressure) of the trigger point. This also allows these practitioners to understand abnormal patterns (such as gait imbalances) that have developed from the trigger points and the order in which they are best corrected. As discussed in other articles, stretching will not change a muscle that is neurologically facilitated (in spasm); exercise of any type will not benefit a muscle that is neurologically inhibited (weak) more than temporarily. Many hold onto this belief that either type of therapy provides healing benefits. Trigger point therapy, however, has the ability to correct these muscle imbalances and restore function, often very quickly.
How Do You Treat a Trigger Point?
Ideally when you treat a trigger point you’re pressing on it just hard enough but not too hard – you sorta have to get a feel for it. This can sometimes be difficult to do on yourself. You can hold a trigger point, or rub it in a circular motion (either direction), or work the trigger point in a back-and-forth direction. One method may provide a better result than another on a case-by-case basis. Apply pressure or rub out the trigger point for at least 10-15 seconds. If the pain is improving as you treat the point then continue until there is no further relief. Sometimes you can actually feel the trigger point “wash away” beneath your fingers and disappear.
Some practitioners use modalities and tools such as wooden or metal spoon-shaped devices and other hand-held appliances, mechanical vibration, laser therapy, electro-stimulation, dry-needling, or injection to treat a trigger point. Although some of these can be beneficial, my personal preference is to use my hands as much as possible – it allows me to feel the area I’m working on and often the dissipation or release of the trigger point can be felt. Using a hands-on approach also reduces the chances of pressing too hard and creating further damage or bruising, as well as not pressing hard enough or long enough resulting in inadequate results. If your hands are not strong enough or you’re unable to reach a suspected trigger point, then tools such as a foam roller, tennis or golf ball, Thera Cane, or The Stick, may be beneficial.
Why Treat a Trigger Point?
One main benefit for treating a trigger point is that it helps correct neurological muscle imbalances. Other therapies such as acupuncture, chiropractic and cranial-sacral adjustments, nutritional and lifestyle interventions, and biofeedback programs can also correct muscle imbalances which is vital to injury prevention and treatment. As mentioned previously, stretching and exercise-therapies cannot correct muscle imbalances; they can only alter its function for a very short period (often less than one minute). Once the neurological muscle imbalances are corrected, then rehabilitation via exercise is definitely recommended; (static) stretching – definitely not. By addressing the trigger points as described, muscle fibers and connective tissue (including scar tissue) can re-align so they may begin to heal and the injured area may remove waste through improved blood flow. It is also suspected that it may help with inflammation, perhaps much like compressing an injury can be beneficial.
I also believe that when using trigger point therapy on an old or chronic injury that it’s also making your body aware that there is an injury still present and needs to be dealt with; it’s much like your body has compensated as to forget that there is still an injury affecting you though there is no acute pain. I see many patients with patterns of injuries that are not healing because their body essentially doesn’t recognize that there is a problem anymore. It’s difficult to explain, but when you’re injured certain aspects of your nervous system respond a certain way. When they don’t respond correctly, you don’t heal properly – or at all. For example, you may have injured your shoulder in the past and no longer have pain there (that you realize anyway). Now, months or years later you have a pain in your hip due to a gait imbalance caused from that old shoulder injury. This is actually very common, and the hip problem will not be resolved until you deal with the shoulder issue, perhaps via a trigger point in a muscle in that region.
Why Do You Have Trigger Points? (Are You Addressing the Problem?)
If you suddenly become injured – say you are running and you fall in a hole and twist your ankle, then you’re going to have trigger points in several areas throughout that injured area. It’s a local issue in a problem like this. If not properly treated (which often is the case) then continuing to walk on the injured ankle will cause gait imbalances and soon you may develop trigger points (from muscle imbalances) in your knee, and/or elsewhere. So it’s important to address the trigger points very early in an injury. If you’re self-treating and not a professional (therapist or doctor) and you are unsure of what you’re doing, you should be very careful as obviously you don’t want to cause more harm than good – such as inflaming and already inflamed area. You also don’t want to not address a more serious problem such as a fracture, tendon tear, or blood clot. So, be smart about it.
Often trigger points develop from problems in another area so it makes them much harder to find. One example would be if you’re wearing footwear that isn’t right for you. You may develop trigger points in your calf muscles or lower back until you resolve the footwear problem. So if this is the case, you’ll be treating the trigger points all day long and see little, if any, lasting results.
I often like to remind patients that, “the cause of their problem is often distant from where it is felt.” This means that a problem in the thigh can be causing their foot pain, or a problem in the foot may be causing a knee, low back, or even neck pain. This has a lot to do with the fascial connections throughout the body as well as our kinetic chain (how we move) – the foot affecting the knee – the knee affecting the hip – the hip affecting the spine. But the statement also means that muscles are affected by much more than just the muscles themselves. They’re highly influenced by visceral organs, nutrition, hormones, stress, emotions, the environment – pretty much everything and anything. Let’s take an example that is easy to understand. Say you eat something and you get very bloated – your belly distends. The abdomen distention is going to put pressure on your low back and this may cause you to have some low back or hip pain. Now you have a muscle imbalance between the front and back of your body as a result of diet. Trigger points are going to be present in the lower back in various places as well as probably deep in the abdomen in the psoas muscles, and treating these will most likely provide relief. But the problem is really deep within the gut and this will continue to affect the trigger points until, well, you pass what you shouldn’t have eaten and the belly distention goes down.
Remember, muscle imbalances can come from everything and anything – and most often these are a result of too much stress, (including exercise training), and a poor diet. So consuming too much
refined sugar or inflammatory-type fats will result in muscle imbalances and therefore trigger points (and in essence, an injury). Training too hard (anaerobic) or inadequate recovery (or poor sleep) will also cause various muscle imbalances, common in the knee, lower leg, ankle, and foot, and result in injuries and trigger points due to the relationship of these areas with the adrenal glands where you make adrenalin, cortisol, mineral-balancing and sex hormones. So yes the trigger points need to be addressed but it is as important, if not more, to address why they’re there. These are concepts that traditional medicine does not recognize or understand.
I think this is a vital point because so many people, including “fit athletes” eat poorly, are under substantial stress, and train improperly. So what happens? Well, they get injured. Then they themselves, their doctor, or therapist looks only where the injury is felt. Although this is necessary to some degree depending on the injury, you have to address the WHY, more than the WHERE. Also, the longer the injury is present, or has gone unresolved, (such as the injury you perhaps had for months that just slowly went away on its own), the greater chance that you’ll have a lot of trigger points present that you don’t even realize. That old ankle injury can easily create shoulder problems, and most docs won’t even consider linking the two together.
Remember – trigger points can correct muscle imbalances and that’s how you can effectively treat an injury or prevent one from occurring. One area might respond to a trigger point whereas another area might not. If an area doesn’t respond it’s either because you’re on the wrong trigger point, you aren’t treating it correctly, (too much or too little pressure or time), or most often, that trigger point needs its source addressed – dietary, lifestyle, training, footwear change perhaps, or maybe a different therapy such as acupuncture, chiropractic, or another effective type of bodywork. It’s okay to treat a trigger point a few times a day if you’re improving each time, but don’t think more is necessarily better. If you’re sore the next day then don’t continue, give it a rest.
One final point, which I discuss often in the videos – is that usually you don’t want to be treating exactly where the pain is felt, but the area around it, usually further proximal (up) or distal (down) on the muscle from where the pain is occurring. This is especially true for tendon pain – such as ITB problems and Achilles tendon pain – look deep in the muscle and not on those already tender muscle insertions. Think outside the box!
A little bit more and a short demo here:
Dr. Stephen Gangemi "Sock Doc"
I'm a board-certified chiropractic physician and clinical nutritionist with a passion for true natural health care. I implement dietary & nutritional therapies, exercise & movement practices, and lifestyle changes along with manual therapy techniques to help the body heal and prevent illness and injuries.
Furney says
Again great information, always enjoy your articles.
Patric says
You should develop a course and teach prople in this subject. I’d go for sure. But then again i live in sweden and you probably don’t come here that often, but if you do, let me know!
Debby says
I stopped doing what other sites were recommending to relieve heel pain and followed your advice. Thanks…it worked!
Rob says
Was pleasantly surprised to see your video on treating plantar fasciitis, in which you described the use of trigger point therapy. I always concentrate on the calf first….sometimes do not go near the foot to relieve plantar fascitis.Definitely agree with treating the gastrocnemius and soleus (calf) trigger points, not only do they refer pain could also play a major role in reduced ankle dorsiflexion, which could lead to compensatory pronation…..increased stretch on the plantar fascia with resultantant symptoms. Linked to the foot, common to get trigger points in abductor hallucis in the medial longitudinal arch…..deactivating the MTRPs often does the trick. Orthotics not always needed.
Sandi says
What does your last paragraph mean? Not a doc, just someone whose been dealing with plantar fasciitis. Pain in normal spot between heal and arch, but tendons that run down the middle of the bottom of my foot are extremely tender. Bottom of feet feel like they are ononer pts
Sock Doc says
As I say in most of my videos – you rarely want to treat exactly where you feel the pain. So if your Achilles is a problem then you don’t treat that sore spot, but look for the trigger points around it, in the calf.
PhilipV says
Could you speak a bit more on your position on trigger point injections? Why are they unhealthy and unnecessary?
Sock Doc says
You run the risk of hitting a nerve or causing tissue damage and some people react to the numbing agent or hormone (usually corticosteroids) in the injection. I say they’re unnecessary because if you have a knowledgeable therapist with skillful hands then there’s no need to get injected.
John Calarco says
Hey sock doc i have kind of a random question regarding the alignment of feet. Some individuals are “pigeon toed” with the feet turned inward and some the opposite with the feet turned out almost like a duck. Do you think it is ideal for a persons feet to be pointing straight ahead? is it possible or even necessary for a person to try to correct the way their feet are pointing? Alot of times i hear that the feet arent straight because of some imbalance in the hip whether they are internally rotated outward or inward. I know this is kind of a weird question but I am very curious about this.
Sock Doc says
It depends where the problem is stemming from. If you developed that way then you may never be able to correct it as your body has adapted. I grew up with my right hip “flaring out” so when I stand my foot points about 45 degrees outwards. I have no problems walking, running, cycling. Though I’m healthy and balanced (of course!).
Joanna says
Hi
Thanks for the article.
How exactly does poor nutrition create muscle imbalances and trigger points? Can you refer me to any research that substantiates your claim? Also I would love to see references to research that underpins your statement that treating trigger points corrects muscle imbalances. Thanks.
Sock Doc says
You can read my articles on gait (2 parts) as well as many other areas here on SD to help you understand this. Is it “peer reviewed research”? No. If you want research to back up everything I write here you won’t see it. Not only are many of these techniques, ideas, and therapies not thoroughly studied, (such as barefoot running), but I don’t have the time or desire to find research to back up all my information. Plus, it’s not too hard to find research to debunk research cited, which is often what skeptics of new and different ideas do anyway.
BTW – finding research on trigger points isn’t all that difficult. You can do a pubmed search and get more than enough.
DL says
While I commend you for educating people about TP Therapy, I have a slight issue with the industry that you’re marketing. Personal Trainers should not be performing TP Therapy on clients. I am an LMT and put a lot of hard work into my education and how I practice. I workout in a small independently owned fitness center that is very big on TP Therapy. The problem is that the people performing this are not LMT’s. They are trainers. The state I’m in requires certification and licensing for therapeutic work as do many states now. I’m required to take 24 CEU’s every 2 years in order to keep my license.
Sock Doc says
Really? Where do I recommend personal trainers to perform Trigger Point Therapy? I’m actually helping the average person/athlete to assess their problem and find some of these trigger points on themselves and hopefully help their problems when nobody else can or is able. I’m constantly recommend people to find a chiropractor, physical therapist, rolfer, or LMT, or even a non-conventional MD. So I’m not quite sure what you’re reading. Though in defense of personal trainers I know a lot of them who are a lot smarter than those “licensed” practitioners. From your comment it sounds like you’re working with trainers who do TP therapy in the fitness center you work in so you should deal with that issue there, not on my site.
andrew says
Hi – Firstly, can i just say thank you for giving people such a fantastic online resource as the sockdoc website – if only there were more people out there with the knowledge (and altruistic nature) that were willing to share it without wanting large amounts of money for it, the world be be all the better for it. Secondly, apologies for all of the words below, i’m sure i could have been more succinct and thanks very much for taking the time to read this.
Anyway, as someone who can no longer afford healthcare, it has been an invaluable resource to me over the past couple of weeks while starting to get a grip (pun kind of intended) of self tpt to treat a mild case of plantar fasciitis/osis.
Maybe it’s societal conditioning but i almost feel guilty for being able to ask these questions without having to hand mover some money but i’m going to ask anyway and if you get back to me, then that will be much appreciated. If i can make a small contribution to you (or a charity/deserving organisation that you support, please let me know).
As i seemed to be improving quickly (all be it slightly overdoing the tpt on the inner right gastroc), i did a “third world squat” (very slowly and without additional weight – i weigh 190lbs at 6ft 2) and believe that while doing so, i have lightly “strained” (caused minor trauma to) the tibialis posterior where it starts to wrap from under the ankle to under the foot – the feeling is not pain, just as if i had “overstretched” (still trying to remember the terms you would use for this, many years of listening to these terms i’m afraid) and i am simply afraid that walking around on this will not help with healing – like i say, it’s not pain, it’s as if it’s just letting me know that it’s tender right now.
Obviously i would rather avoid taping unless you feel necessary (hard to know without an actual exam i know but i live a long way away) and i always go barefoot around the house walk (going to go towards more minimal outdoors too once i feel “strong” enough to start up “normal” activities again – very wary of recurrence through pushing too hard too soon again – scared to even walk normally right now as i spend 8 hours a day on my feet at work and can’t afford another week off – last one was 24 years ago when i was playing 30-35 hours of sport a week as a teenager!). Sorry for waffling, I suppose the question is that if pain is not present and i can walk on it without pain (just that sensation that says, “hey you, take it easy on me or you could hurt me”), should i be ok to do so? – Is mild eercise the right path along with tpt or should i get complete rest and get the weight off it – in old terms have a completely neutral left foot/arch and my right foot does “over supinate” – tpt to the right inner gastroc, outer left leg gastroc and soleus and various spots on the quads – a small amount on the rectus femoris and vastus medialis as well as along the it band of both legs (along with some basic movements similar to sun salutations in yoga) seem to be helping considerably but i am still a bit concerned about recovery as this muscle/tendon bears so much weight, even with my feet being fairly “strong”.
Now here’s the nice short one:
Should you ever look for/work on trigger points on the feet themselves?
Apologies again for all the words.
all the best
andrew
N.B. Thanks for bringing MovNat to my (and i’m sure many others) attention – i for one will doing everything possible to get on one of those courses. Anyway, that’s enough, thanks again.
Submitted on 2012/07/24 at 7:08 am
i should have pointed out that mild eercise is a new form of “exercise” but is way more beneficial – i invented it and it’s real easy to do 😉
I have also come across many myofascial therapists say that fascia can be “stretched and molded” due to it not only being elastic but having a plastic nature too – is this really possible or are you just tearing it down and rebuilding it the same way body builders do with muscle fibre?
Sock Doc says
Hi Andrew, few comments back to you:
1) Thanks for the offer on making a small contribution. Many don’t realize that I spend several hundred$$ of my own money per month (and a lot of time) to keep this site going and I make zero in return. I’ve thought of a donation for the free advice but nothing yet.
2) Check out the new First Aid Part II that is just up – talks about active rest. So yes, if no pain then get moving. 🙂
3) Taping is okay if done for a very short time (like a few days at most) if you leave it on longer then often it will further weaken muscles, just like a brace will.
4) Yes you can look for the trigger points in the feet and I show this in the feet video. More often the points are in the lower leg though.
5) I’m not sure if the correct word for the fascia repair is remolding or rebuilding. I’d say a maybe both but not 100% sure.
andrew says
Thanks again and i’m sure there are many that truly appreciate what you do – i will keep an eye out for the donation button (or link to a suitable beneficiary).
Still wondering about the remolding bit too – if it can be “stretched”/lengthened when in the healing process, is there not a little sense in having it repair in a slightly elongated position to help avoid a recurrence? or does this just cause imbalance as while having a slightly elongated fascia may help to not tear it again, it will not provide the same control as it doesn’t have the same “tension” on it? – sorry for my lingo not being medically perfect ;), been thinking about this subject a lot lately.
Sock Doc says
That would depend on if the fascia is actually shortened. Lengthening is okay, but that doesn’t necessarily mean “stretching.”
andrew says
So, just to get this straight before i leave you in peace, i was thinking about getting a strassburg sock as the idea made sense at the time (when i was first diagnosed with mild pf iitis/osis), to have the fascia repair whilst in an elongated position as this would help somewhat with avoiding future pulls/tears/whatever. Then, reading about not stretching and in the comments bit of one of your articles you (not quoting exactly word for word here) replied to someone that the fibres are trying to re-engage/join back together and that by stretching you are making it tougher for that to happen. That made a lot of sense to me but now if we are saying that the fascia can be stretched/re-molded, why wouldn’t you do just that (that sock and the “stretched” position) as surely a tiny bit of “slack” will get taken up by the fascia as it runs around the body?
I really do appreciate this, i’m just trying to understand – How can you tell if the fascia has been slightly shortened during the initial tear/re-attachment and healing process and is this generally the case?
Sock Doc says
Well this kinda gets into “stretching” – which I don’t like (static, and for injury treatment), and “elongating” – they don’t mean the same physiologically. You don’t want tissue or fibers to be tight – but that doesn’t mean you “stretch” them. You want them naturally elongated – naturally flexible and mobile you might say – but not “stretched”. Know what I mean? If you strip down the fascia to break up adhesions and help the fibers repair then some may say you’re “stretching” them but I wouldn’t call it that – I’d say you’re elongating them naturally to where they should be. So that sock (which is really bad) stretches, and that’s all wrong as I say in the Stop Stretching! post.
andrew says
Thanks and yes, i think i get what you mean – it’s ones of those things that for me to truly understand i would have to study fascia to a much higher level, something that this experience (both the injury and the learning process) has inspired me to do. I’ll have to get back up to scratch on my anatomy first, it’s been 20 years since i taught in a gym – we still held great value in plyometrics back then! (and it would seem people are re-discovering the value of that type of exercise). Anyway, thanks again, will keep reading the site, donate where possible and wish you all the best.
One last thing though (still scared of causing damage and this thing coming back) – am i causing any damage to the “tender” spots on under the arch or am i really safe to gently work on these trigger points? (in the area you talk about in the foot video, near where the peroneus longus attaches) – Obviously i am working on the tib pos, tib ant (tib ant and peroneus longus are getting a lot of work!), soleus etc etc as well but having found points at the same spot on both feet (mainly the right), i’d like to work with those as well providing it is safe to do so (i understand you can’t guarantee anything, i’d rather come and visit for a session but i’m in ireland so no go i’m afraid!)
anyway, thanks again, all the best and keep up the fantastic work.
Sock Doc says
Yes you can work out the trigger points on the bottom of the foot (that’s why I show them in the video!). I go deep on them sometime too.
andrew says
Thanks, just wanted to double check as i want to avoid further damage at all costs.
Susan says
Are you familiar with Trigger Point Performance Therapy products? Are they good products to use?
Sock Doc says
Sure I think they’re fine but you can get by with just a golf or tennis ball in most cases, as well as your own hands.
Susan says
Thanks. I have the quadballer and the foot and lower leg kit already. I got them at a running store for my leg and foot problems when I tried running last year. I will start using them again. Thank you so much for all the wonderful information you have on your site and for taking the time to answer questions! I have other health problems (hormone imbalances, insomnia, adrenal fatigue) that you have mentioned on your site; sure wish you I was closer to you so I could come in for an appointment!
Rex says
I’ve been diagnosed with plantar fibromas in the arch of both of my feet (I see you talk about plantar fasciitis in other articles but that seems to be different). Should I approach that the same as a trigger point even though it’s usually referred to as scar tissue buildup? I’ve tried some but it seems to inflame it more than giving it relief so before I continue I was wondering what you have to say.
thank you in advance.
Sock Doc says
Yes, same things to try for the fibromas. Make sure you read this which explains if/why the trigger points are helping. https://sock-doc.com/2012/04/trigger-point-therapy/
And here, especially Parts III and IV, for inflammation: https://sock-doc.com/sock-doc-first-aid-for-injuries/
Rex says
Can you expand a little on how to work the scar tissue? I read the articles and understand the basics of trigger points (have used it on a few with success) and of working things too hard and causing inflammation (from reading and experience of doing too much) as well as paying attention to my diet. But since this isn’t going to simply disappear from pressure like a typical trigger point, I’d like some advice on technique, etc. I saw a video on the web of surgery removing the fibroma scar tissue – which I definitely don’t want to have surgery – so I saw what it looks like and it feels exactly what it looks like which helps with the imagery of what I’m trying to do underneath the skin.
Should I simply press on it or use more of a press and squish it around motion? In the center or work from the edges as it squishes around (great medical term, eh, I can feel it squish around when I take an edge and push it outward but not when I work the center)? As it breaks up, where does it go and how does my body get rid of it? How long of a time frame should I thinking to work on this (about the size of a quarter, half to full centimeter thick or so, each foot is a little different)? The time frame will help with balancing realistic results vs. over expectations (NOW, not later type of thing). Any specific trickiness you can suggest for working the scar tissue parts would be appreciated.
And finally, should I consider the non-invasive injections that cause it to atrophy (not the typical cortisone type shot, but a mixture of hyaluronidase, triamcinolone acetonide directly into the lesion which will cause it to involute/atrophy)? I know you aren’t a fan of those types of things unless it’s necessary, I ask because everything I’ve read says it will never go away on it’s own and it needs attention. It’s causing quite a bit of pain so I’m trying to weigh what degree of attention I need to give it, short of surgery, to get results and I highly value your input.
Thanks again…Rex
Sock Doc says
So you have a scar that is locally causing you pain – or a fibroma on the bottom of both feet? Exactly where?
The point of working scar tissue via trigger point therapy is to address the fascia issues that may still be associated with the injury – you’re not actually looking to resolve the scar (though you may reduce it – depends on how long you’ve had it).
So the treatment is the same as any other TGPT. As it breaks up, your lymph system will carry away the waste products and your body will repair it with new tissue.
Rex says
fibroma, in the arch of both feet. I use the term scar tissue because what I’ve read calls it that vs. a tumor, growth, cancer, etc. (specifically says it’s not those). I can feel it under the surface, reminds me of grissle in some steaks I’ve eaten. it seems lumped around the muscle and some nerve because it seems to radiate out from there towards my 2nd & 3rd toe causing a pulling sensation (in the nighttime when I’m laying down especially) and some electric shock type pain randomly, sometimes more than others.
Sock Doc says
Okay…just wanted to make sure – yes scar tissue, but not an actual scar (as if you stepped on something and it healed up). I’d still focus on the areas around the problem, and not actually on breaking up that tissue bundle itself. So that depends where it is. You can’t post a photo on the comments here – but you can in the forum. If you do that then I can show you where to look for the TGPTs.
janet5130 says
Great info! Thank you!
Kari says
I came across your site last night it seems to have the solutions to some of my issues. I was treating PF with various shoe inserts, padded-arched shoes, and a velcro arch strap. All of which diminished the heel pain but caused unbearable knee pain a few weeks later. I have been freaking out about what the knee issues could be, and after reading your articles I’m pretty sure the foot products threw off my natural gait. I ditched the foot products as of last night and have been walking around my apartment barefoot. I tried the trigger point massage both for knee and for the PF, and 24 hours later feel so much better, better than I’ve felt in 2 weeks. Am pretty amazed! One question though, I’m just a little unsure of how frequently to use the trigger point methods. I’m doing it myself and I definitely want to keep healing the problem, I just don’t know if I should do this a few times a day, once a day, a few times a week? As of now I did last night and this morning. The points feel a bit tender now from the pressure I put on them, so should I wait and give them time to recover?
Sock Doc says
Yes, give it a bit of time to recover, or look for another point away from the tender area.
Kari says
Thank you! And I realized nowhere in my lengthy comment did I mention how much I appreciate what you’ve shared online here. I just can’t get over how thanks to a few minutes of the trigger point techniques my PF seems GONE after 2 months of pain, 3 orthopedist/podiatrist appointments, and a number of products that all produced no results except pain elsewhere. I was scheduled to have an injection and am glad to say I can cancel that now. Thank you so much for providing such valuable and helpful information. You rock, sock doc 🙂
Sock Doc says
Thanks Kari!
Renee says
This is amazing. I have worked out many bumps and lumps from my quads, hips, calves, and even my heels……these must have been there for years just sitting there causing tightness, and ultimately plantar fascitis! Why didn’t the podiatrist think beyond the foot? I am grateful for this information you have been so kind to share. Today, was the first morning I woke up and was able to walk normal, after a weekend of working on the trigger points. It definitely takes patience and perseverence but so worth it. So, after a run, do you substitute stretching with this?
Sock Doc says
Only substitute if you feel like you need it. Ideally you shouldn’t and after you run you go about your normal “non-stretching” daily life.
Andrew says
Hi!
I would appreciate it if you would clarify your position on training to strengthen muscles which are affected by trigger points.
You state that:
“exercise of any type will not benefit a muscle that is neurologically inhibited (weak) more than temporarily”
From this statement, I think that you are saying that trying to strengthen a muscle with a trigger point in it will not help resolve the trigger??
If so, what is your position on strengthening the affected muscle(s) and other associated muscles (agonist / antagonists) during rehabilitation, once the trigger is gone to prevent the problem coming back? At what point should you start to do this?
I completely ‘get’ everything else that you have said but i’m not 100% clear on this issue
Thanks for all the great info
Sock Doc says
Yes, a weak (inhibited) muscle is often the one with the trigger point(s) and you can’t exercise that out. Therefore, since it is often the weak muscle, strengthening the antagonist won’t help either.
When do you start exercise (rehab)? Once the muscle/joint is functioning normally again, usually indicated by less pain, increased ROM, and more natural flexibility/movement. In my office I figure this out by using specific muscle testing procedures of each individual muscle and under various loads, but of course not everybody (or many) have this available.
Mara Adams says
Running about 35 miles a week and have been having issues in my lower leg for about a week – some shin pain, tight calf and just aching from the knee down. I have a trigger point in my upper calf on the inside. Could that be the issue? I’ve been working on it for a couple of days and still having pain. Trying not to run through the pain this week but anxious to get back at training. Thanks!
Sock Doc says
Sure it could be or could just be part of it. You’ll never know until you treat it and see what it leads to.
Mara says
If I have pain in the middle of my upper calf – where should I look for a trigger point? Nothing above or below that I can find. Came on during my long run and I have a race this weekend. :-/ Rest day and massage helped but then returned today while running and sore/tight to walk.
Sock Doc says
Please read this; thanks!
https://sock-doc.com/sock-doc-questions-comments/
hara says
Hi Soc Doc, thanks for the great article
I recently bought a foam roller and sort of on the side of my calves (both feet) i feel a bump in my muscles when im foam rolling over that area. is that a trigger point/knot or is it like the area where 2 muscles connect which is why i feel bumps? the bump quickly slides side to side if i move the foam roller forward or backward, and is a bit hard and painful to keep the foam roller static pressing over the bump because the bump slides.
(I’m a sprinter)
Sock Doc says
Most likely that is what you’d call a trigger point.
Bob Merritt says
Hi- can you recommend a good do it yourself trigger point book/ reference guide?
Thanks and we just found your site. It’s great!
Sock Doc says
Trigger Point Therapy Workbook by Clair Davies is good and so is Anatomy Trains by Thomas Myers.
Brenda says
Wow… what a read and site you have. I am a 51 yr old female. Have suffered with PF on and off for over 15 years in both feet. Have never heard any of this info. I am overweight (about 215 5’7) and have been for years. Sugar addict and carbs but eat basically healthy otherwise. About 6 months ago I had a calf step on the top of my left foot… it began hurting and now has developed into a hammertoe.. I have weird feet anyway always wide but never pain anywhere before besides the PF. Now after limping on the foot for a while I developed what I think is bursitis in my R knee. Has been the worst pain I’ve ever felt for the past 3 weeks. I now know I’ve made it worse by stretching to much. So now my question is I had decided to go in for foot surgery for my bunion and hammertoe (doc said I have nerve damage under my second metatarsil?) and since such pain for months I’ve got to do something. I am so confused if I should go thru with the surgery though I don’t think the hammertoe will ever go away. I am hopeful with your help the PF can be controlled by weaning myself off the orthodics (always wore over the counter and the birkenstock brand) thought helped the most. Now though with my knee pain and also hip pain I’m feeling awful!! I’ve been active, worked hard my whole life, never a avid exerciser though tried to do moderate 3x per week. I’d really like to do a phone consult with you. I tried clicking on the link but didn’t work? (mac computer) Anyway my calves have many tender spots up and down the whole area you showed! I actually had a very tender muscle on my left leg prior to getting the severe bursitis thought I pulled something but now think it may have been a huge trigger point! Anyway… hope you can help me or let me contact you thru phone appointment. Thank you!! (ps I have never ever had surgery and never take much meds) Am taking Apple cider vinegar thou the past 2 days! seems to be helping the bursitis? THANKS
Sock Doc says
Please read this; thanks! And consult info can be found from this link too.
https://sock-doc.com/sock-doc-questions-comments/
Kacy says
Hello, I just stumbled across your site by recommendation from Runner’s World, and I’m so glad you’re an advocate against stretching! I used to have persistent knee trouble until I stopped stretching, but I digress. I’m a 22 year old distance runner and 4 months ago began having Achilles trouble that became bad enough for me to stop running completely. Where the tendon meets the calf is where the pain was. I noticed what felt like torn fibers beneath the skin as well as painful bumps around the area. After resting for 4 months the swelling has gone away, though my tendon seems a bit thicker. I do have full range of motion with only a bit of stiffness sometimes. I can still feel scar tissue, so what I wonder is, should I be doing Trigger Point Therapy to get rid of the scar tissue and can I begin running again in conjunction with the TPT?
Sock Doc says
Please read this; thanks!
https://sock-doc.com/sock-doc-questions-comments/
Elizabeth says
I have been struggling off and on with PF for over a year. I have never been a runner but spend a lot of time outdoors hiking — or rather, did until the last couple of years when I haven’t been able to walk more than 3 or so miles without PF flaring back up, especially in my left foot. Have tried many inserts, lots of stretching, etc. and gotten temporary relief but still hitting up against that distance limit. I found your website after a recent trip to the mountains tempted me way beyond 3 miles per day and I was in agony by the end of the weekend (even with all the ibuprofen and temporary relief from stretching — and yes I have read your opinions on both now!).
After watching this video I discovered the entire interior side of my left tibia was dotted with trigger points – yikes! – as well as some deep in the back of my calf. Working on them has definitely been helping and although I already walked around the house barefoot a lot, something feels different in how I am walking/standing when I am barefoot now — hard to describe, like I am more settled into my heels or something.
A few questions about the trigger point therapy:
1. Do I need to worry at all about too much of a good thing? I find myself wanting to work on the trigger points throughout the day — for example I am often on the phone for work several times a day for a half hour or so at a time which would be perfect for digging around in there…I am hopeful the need to do this will lessen as I strengthen/use better shoes, but in the meantime, if the points are there is it ok to work on them or should I limit it to a couple of times a day or for a certain amount of time total?
2. On a related note (too much of a good thing), in one spot to the side of my tibia it now feels less like a triggery nodule and more like a spread-out bruise, though there’s no visible bruising…could this be a normal dissipation of the yuck in there or did I likely go at it too hard?
3. Any advice about when to work on trigger points? i.e., before getting out of bed vs. after a workout, or does it not really seem to matter?
Thank you so much for all of the work you have put into this website. It gives me hope that I may get back on the trail for longer distances again someday.
Sock Doc says
Please read this; thanks!
https://sock-doc.com/sock-doc-questions-comments/
Jeniffer says
I have been struggling for shin splints (for got the correct name for this) on the tibialis posterior side for 6 years now, and had fasciatomy operation for them last year. The oparation helped to get rid of the chronic pain, and this year I was able to get back on running. I have also been focusing a lot to the cause of the pain which was mainly on the incorrect running technique in addition of increasing the distance too fast and even though the pain in the posterior tibialis area has reoccured only very rarely and I have been able to control the pain by treating the trigger points, but the trigger points just keep coming back and I can’t figure out a cause for them. My running technique is good now, mainly running with barefoot/minimalist shoes now and the transition has been very slowly and still sometimes wear supported running shoes, I have healthy diet and there is nothing wrong on my position according to doctors and physios.
One thing I was able to point out on my posture is while sleeping, as I tend to point with my toes so my ankle is higher than my toes so, this would then cause my achilles tendon and calves not being in rest during the night, am I correct?
On the previous comments you mentioned about the Strassburg sock that it wouldn’t be good as it provides statistic streching but could it be beneficial if the idea is to correct the position?
Thank you
Jeniffer says
I have also been trying to do loads of strenghtening exercises for tibialis posterior as I thought that is weak compared to the anterior and this imbalance would be causing the pain. I tried to avoid strenghtening the anterior side because there has never really been pain- was this completely wrong and I should have done more strenghtening exercises for the anterior side? and the pain in the posterior side would be due to weak anterior muscles instead of vice versa like I thought
Sock Doc says
Please read this; thanks!
https://sock-doc.com/sock-doc-questions-comments/
Alan says
How would you deal with sesamoiditis (terrible pain right by the 1st metatarsal) can’t run, barely walk efficiently, and bending the toe or walking barefoot puts pressure on it and it feels like its gonna tear of the bone. Any thoughts? Would you try orthotics in this case, metatarsal pads? Anything? Im doing the trigger point stuff along and under the tibia, calf too.
Thanks, Great SITE!!
Sock Doc says
Please read this; thanks!
https://sock-doc.com/sock-doc-questions-comments/
Jamie says
In December I had issues with the edge of my heel. It felt bruised but I didn’t pay much attention and at the time I was looking for new sneakers as well. Wore these Nike fly knit that I hated because the toe curves up so every time I had to do a run for my workout class it would push my heel all the way back. So I ditched those shoes. Bought some strike movement minimal shoes and wore them as well. Maybe my transition was too quick I’m not sure but my heel still bothered me and it’s not directly under it. It’s all the edge. So I finally saw a chiropractor in March and we did ART but we worked on my elbow which I had problems with and other issues. We didn’t work much on my foot/calves. But it finally went away in June and maybe I jumped right into my Nike class too fast and it was high impact so my heel bothered me again so I went to see podiatrist and he told me i had slight tear in my Achilles’ tendon. We did X-rays and it looked okay except my ankle flexibility isn’t that great. But when I wake up in the morning after I reinjured it somehow the back of my heel core was stiff every morning. So he sent me to physical therapy a month ago and of course I have a bunch of strength workouts to do at home and STRETCHING. ever since I was told to stretch my calf (the bad one) 5 times a day. It’s been feeling super sore. At this time I’m also seeing a massage therapist and she does myofacial release which helped a lot but I feel like going once a month isn’t enough so I find your website and saw the vid. So I’m palpating and looking for tender spots in my calf and after I worked on it I feel a bit of relieved in my heel and I hope that it gets better. I kinda stop stretching. But I’m doing all the exercises I’m being told to do and I have 2 more weeks of therapy. It has helped my Achilles to be honest but it did not solve the root of the problem and I think maybe it is my calf that’s the problem. I’m not sure how all this happen. Maybe poor body mechanics or wearing those stupid Nike fly knits or transitioning into minimals too soon and I worked out just as hard when I wore those. But anyways sorry it’s so long. I hope working on trigger points will help resolve this issue that nobody seem to know what it is!! Thank you for the vids and all the info!!!
Jamie says
Oh and all the tender spots are on the sides (inner and outer) of my calves. Sometimes I feel that my good strong side is doing the same. Hopefully working on these tender spots will help and eventually I won’t have to work on it so much anymore and I hope I can go back to high intensity workouts soon. I really miss it.
Karen says
Hey Doc
Must say I was very impressed when running across your video on elbow pain .my pain just below my elbow in the area or position you describe where you get the pain was suprenator or brachiradiatus pain I think .my pain commenced with shoulder rotator cuff injury .I am getting an ultrasound to check for tears but can you advise where you think the problem area might be if I raise my arm up in front and then reach over across mr body to other side of my body as soon as arm is just past mid way I start to get pain in front of shoulder top of arm at start of bicep also have the usual limitations to range of motions with rotator cuff injury.i was hoping you might be able to give me any ideas on trigger point release
Stefanie Dean Brown says
Hey there- My name is Stefanie. I was wondering your position on a surgery called SMPL (Selective percutaneous myofascial lengthening ) It is basically a way of making pinpricks in the myo fascia to release spasticity. I believe the fascia to be living and I think this would cause more spasticity down the road and perhaps injury-short term gain long term loss. I was reading your comments of the fascia on this page from 2012. But I would really like your opinion on the idea.
Sock Doc says
I’m not familiar with that procedure but it doesn’t sound like something I’d recommend. Check out the new 4 part series on Stretching, especially Part II. https://sock-doc.com/move-with-a-purpose-stop-mindless-stretching/
Tracy says
Hey Barefoot Doc! 😉
I just ran a half marathon a few days ago and I had some sharp pain on the outside of my left knee – so IT issues. Lately, I’ve had two physiotherapists tell me to foam roll it – a couple times a day even. Do you suggest skipping this all together and search out the trigger points etc. instead as you suggested in your video or do it as well?
Your thoughts would be greatly appreciated!!!
Dr. Stephen Gangemi "Sock Doc" says
Foam rolling is not going to correct that. Yes I suggest you check out my advice in the knee video as well as the ITB video!
Amy says
Three months ago, I started doing jumping jacks (25-50), lunges, squats, etc, barefooted in my living room at night. Though I always go ‘barefoot’ at home (minimal soft slippers only) my feet were not ready for that. (I am 53; 4 or 5 lbs over-weight.). After about a month of doing that every evening (and some days during work) I developed plantar fasciitis in the right heel and a post-tibial tendon pain in the left. Two months of orthotics and lots of stretching (3-5 times a day) and NSAIDS ordered by the Podiatrist, Physical Therapist, and Physician, made it worse and worse, and nearly crippled me, until I learned about Trigger points on this site and others. Huge relief in the plantar fasciitis from a major painful point at the top inside calf which I fixed, but can’t seem to get relief for the occasional searing pain under the inside ankle bone in the left. I eat Primal, (grass fed, pasture raised, low sugar, etc), prioritize sleep and sleep very well. I will look for trigger points near the post-tib muscle/tendon like your video shows. I can re-create the pain just by pushing there. Thanks for your helpful articles, any any other suggestions are much appreciated.
Kylie Dotts says
I didn’t know that treating a trigger point could help correct neurological muscle imbalances. To be totally honest, I didn’t even know there were neurological muscle imbalances! My husband has been complaining for some time about some pain in his back so maybe we should take him to see someone who specializes in this kind of therapy that might be able to help him get rid of some of that unwanted pain.
Frankie says
Hey Doc,
I’m currently getting Graston therapy for built up scar tissue.It’s working,but it isn’t cheap either.$300 for 6 treatments.Are there any other methods that I can use instead that are as effective?Was gonna start to use a golf/lacrosse ball.Thanks.
Dr. Stephen Gangemi "Sock Doc" says
It depends on the exact issue. I have patients use a tennis ball to help with adhesions.
Frankie says
I have a torn labrum,miss doing my chin ups and pull ups.As of right now I’m just doing push ups.Will I further aggravate the labrum tear if I do the chin/pull ups?
Dr. Stephen Gangemi "Sock Doc" says
The depends always on the severity of the injury, the surrounding muscles, and your technique. Sorry it’s too much to say yes or no without seeing you.