How to eliminate trigger points on your back

No matter if you perform strenuous physical work or sit at a desk for eight hours a day, the risk of developing trigger points on your back affects everyone. These painful spots appear when muscle fibers are unable to relax. They are often found in the trapezius muscle, a large muscle that stretches from the base of the skull down to the back and extends across both shoulders. You can try some techniques to relieve the pain on your own, or seek medical treatment.

Find the trigger point location. Most trigger points occur in the upper back and shoulder region. When you touch them, you'll feel tightness compared to the surrounding muscles, similar to a knot in a rope. Although trigger points usually feel tight when touched, sometimes they may not feel tight but still cause significant pain. Focus on the sensation of pain when pressing, rather than looking for a 'tight' knot.

• When you press on a trigger point, the pain may radiate outwards. This is a sign of a trigger point. This 'tender point' usually doesn't cause pain in other parts of the body.

Massage by rubbing your fingers along the trigger point. Gently massage the trigger point in a circular motion using your fingertips. Apply light pressure, avoiding using too much force to prevent additional pain. Massage can help relax the tight muscle fibers.

• You may find that simply pressing on the point helps alleviate the pain. Press your fingers firmly on the trigger point and hold for about a minute.
• If the location of the trigger point makes it hard or impossible for you to massage it yourself, ask someone else to help.

Use a tennis ball. Use a massage ball for your back by leaning against a wall or lying on the floor. Position the ball between your back and a hard surface. Roll the ball to the spot where you feel the most pressure. At first, it may feel uncomfortable, but this sensation will lessen as you continue to apply pressure with the ball.

• Press the ball between the trigger point and the hard surface until the pain disappears. Take breaks if necessary. Initially, you may only be able to hold the ball for a few seconds, but as you practice, you'll be able to hold it longer.
• You can use different types of balls, but firmer ones like a wall tennis ball may create more pressure, at least in the beginning.

Use a foam roller. The foam roller works on the same principle as the tennis ball, but it covers a wider area. It can help loosen up tight muscles. Foam rollers are usually a few inches long and look like a pool float.

• Start slowly. Focusing too long on one trigger point could lead to further muscle damage, especially if you're not used to the foam rolling technique. You should roll for about 15-30 seconds on each spot.
• Place the foam roller horizontally on the floor. Lie on it at a perpendicular angle. Find the painful area and slowly roll over it. Do not use the foam roller for more than three minutes per session.
• Avoid using the foam roller on your lower back as it could damage your nerves.
• Most importantly, never lie directly on the foam roller on your back. This motion can overextend your lower back, causing pain and joint damage.

Use a reaching tool. A curved-handled umbrella or a specially designed massaging tool like the 'Body Back Buddy' can help you massage hard-to-reach areas.

• If you have a trigger point on the top of your shoulder, simply place the tip of the umbrella handle on it. Then press down and hold. Like the tennis ball method, hold the umbrella handle until the pain subsides.
• To target these trigger points without using your hands and avoid straining your arm muscles, you can use products that don’t require hand use, such as the 'Muscle Wizard.'

Perform stretching exercises. Stretching won't eliminate trigger points, but it can ease the pain and certainly prevent other trigger points from forming. You can practice the following exercises.

Shrug your shoulders. This exercise helps release tension in the neck and shoulder area, a common place for trigger points on the back.

• Sit upright on a chair, preferably one with a straight back. You can also sit on the floor or stand, but maintain proper posture.
• Shrug your shoulders up to your ears. Push your shoulders forward and then down in a clockwise motion.
• Repeat the exercise in the opposite direction: up, backward, down (counterclockwise).
• Perform 2-4 repetitions multiple times a day.

Stretch your shoulders by moving your elbows. This movement encourages blood circulation to the shoulder blades, where trigger points often form.

• Start by placing your palms flat on your shoulders. The right hand should rest on the right shoulder and the left hand on the left shoulder.
• Bring your elbows together while keeping your hands on your shoulders. You will feel a gentle stretch in your shoulders and upper back.
• Hold this position for 3-5 seconds, breathing evenly and deeply. Then relax. Perform this exercise several times throughout the day.

Pinch your shoulder blades together. This exercise can help loosen up tight muscles in the upper back and shoulder region.

• Sit or stand with your arms hanging loosely by your sides. Squeeze your shoulder blades together. Hold this position for a few seconds, then relax. Repeat several times throughout the day.
• Imagine a string pulling your shoulder blades back and downward, not just stretching your chest muscles forward.

Stretch your shoulders using the opposite arm. This exercise helps to stretch and release tension in the shoulders.

• Cross your left arm over your chest. Reach your arm as far as possible across your chest.
• Use your right arm to hold your left arm at the elbow.
• Hold the stretch for 30 seconds, then release.
• Repeat the movement with the opposite arm.

"Legs Together and Roll" Exercise. This exercise stretches the lower back, although it is not as effective for the upper back and shoulders.

• Sit on the floor with your knees pulled towards your chest.
• Wrap your arms around your legs and gently roll back and forth to stretch your lower back.

Knee-to-Chest Stretch. This move helps relieve tension in the lower back. If you feel more pain in your back, avoid doing this exercise.

• Lie on your back on the floor. A yoga mat can help make this more comfortable.
• Flex your knees and place your feet flat on the floor.
• Place both hands behind one knee and pull it toward your chest, keeping your lower back pressed into the floor. Hold this position for 15-30 seconds, then relax.
• Repeat on the other side. Perform 2-4 reps per leg.

Use Pilates Moves. Pilates exercises can help stretch tight muscles in the back, which are often the cause of trigger points. A sequence from the Prayer Position to Cat Pose and then to Camel Pose can effectively relax your muscles.

• Start on your hands and knees. Inhale and, as you exhale, move your body back onto your heels. Stretch your arms forward and lower your head to the floor. This is the Prayer Position, and you will feel a stretch in your lower back.
• Move back into the starting position. Inhale as you move. Arch your back upward, tucking your chin and engaging your core. This is the Cat Pose, and you will feel a stretch in your back muscles.
• Exhale and arch your back downward, lifting your hips and chin toward the ceiling. This is the Camel Pose, and you will feel a stretch in your upper back.
• Return to the Prayer Position. Repeat this sequence five times.

Interlace your hands and stretch them in front of you. Keep your elbows straight and arch your back. Turn your palms outward, then rotate them inward toward your body. Hold this position for 20-30 seconds.

Neck Stretch. Bring your ear towards one shoulder. Gently use the hand on the same side to hold your head in place. You should feel a gentle stretch, not pain. Hold for 30 seconds, then relax. Repeat on the other side.

• Tuck your chin to your chest. Hold for 20-30 seconds in the position where you feel the stretch.

Apply cold compress to the affected area. If the pain is caused by an injury, you should apply cold compress first. Wrap an ice pack in a towel or cloth and apply it to the painful area for 15-20 minutes, at least three times a day. Use cold compress for the first 2 or 3 days after an injury.

• You can make an ice pack with 3 cups of water and 1 cup of rubbing alcohol. Mix them well and pour the mixture into a sealable bag. Remember to remove all air before freezing the bag.
• You can also use frozen pea bags. Choose small, even-sized peas or corn kernels. Note that after using frozen food for an ice pack, you should not eat them again (do not refreeze thawed food).

Apply heat to relax the muscles. For frequent or chronic pain, heat works better than cold. Use a heated wrap, soak in a hot bath, or take a hot shower.

• Do not apply heat for longer than 15-20 minutes at a time, three times a day.
• If you prefer moist heat, you can heat a damp towel for 30 seconds in the microwave. Be careful not to make it too hot to avoid burns when applying. Pay special attention to steam, as it can cause severe burns.

Monitor your posture. Poor posture, especially when sitting for long periods, can cause back pain and trigger pain points. Pay attention to your slumped shoulders, as this places constant pressure on the same muscle group.

• If you work at a desk, make sure to take breaks to walk around (and stretch) after about every hour.
• Avoid slouching your head forward while standing or sitting. Slumping your head can create pressure on the shoulders and back, contributing to painful trigger points.
• When lifting heavy objects, ensure you maintain good posture. Lowering heavy items too quickly can cause muscle contractions and strain.

Practice yoga. Yoga is one of the best exercises to improve back health, relieve back pain, strengthen muscles, and increase flexibility. Here are some poses to try:

• Downward Dog Pose is beneficial for the lower back. It targets the posterior chain muscles—the muscles that help you stand and lift objects. Start on all fours. Keep your knees directly below your hips, and place your hands slightly in front of your shoulders. As you exhale, lift your knees off the floor and stretch your legs. Push your heels toward the floor. Keep your legs straight without locking your knees. Your body should form an inverted 'V'.
• Child’s Pose helps lengthen the back muscles. Start in a kneeling position. Sit back until your hips touch your heels. Stretch your arms forward and lower your head to the floor.
• Pigeon Pose stretches the hip rotators and flexors. Sometimes we forget that the entire body is interconnected—a misaligned hip can wreak havoc on a healthy back. Lie on your back with knees bent. Cross your left ankle over your right thigh. Place your hands around the back of your right thigh and pull your right knee toward your chest. Relax your upper body as you hold the pose. Repeat on the other side.
• Triangle Pose strengthens the back and legs, stretches the sides of the body and hips. Stand on your yoga mat with feet about one meter apart. Turn your right foot outward so it aligns with the long edge of the mat. Align your heels in one straight line. Stretch both arms to the sides to form a “T” shape. Bend toward your right side, reaching your right hand down to touch your right foot. Hold the position as long as comfortable. Repeat on the other side.

Engage in aerobic exercises. Regular moderate-intensity aerobic exercise can prevent trigger points from forming. You can try activities like swimming, cycling on a stationary bike, or simply jumping jacks to engage both your arms and legs.

• Engage in moderate aerobic activity for about 30 minutes every day.

Take over-the-counter pain relievers. Acetaminophen (Tylenol) is the best first choice, as it has fewer side effects than other pain relievers. If it’s ineffective, you may opt for NSAIDs (non-steroidal anti-inflammatory drugs). Common NSAIDs include ibuprofen (Advil), naproxen (Aleve), or aspirin.

• Never exceed the recommended dosage on the packaging. NSAIDs and acetaminophen can cause serious side effects if misused.
• You should see a doctor if your back pain persists after taking over-the-counter medication for a week. Most over-the-counter pain relievers are not safe for long-term use. Your doctor might need to prescribe stronger medication.

Consult your doctor about chronic back pain. If back pain persists for weeks or regularly disrupts daily life, it’s time to consult with your doctor. You may need stronger medications for treatment.

• Physical therapy is usually recommended first. A physical therapist will suggest exercises and techniques to alleviate pain and strengthen the back. Some therapists are trained in methods like dry needling, which stimulates trigger points to treat back pain.
• Your doctor might prescribe muscle relaxants if the pain persists or doesn’t improve. These medications can be addictive, so only take them as directed by your doctor.
• Injections are typically a last resort and used only when the pain radiates to other areas of the body. Your doctor may inject cortisone into the epidural space (around the spinal cord). The effects of this injection usually last a few months.
• If the back pain is not related to trigger points but to a more serious condition, your doctor may consider surgery as an option.

Seek emergency treatment when necessary. Sometimes back pain can be a symptom of a more serious medical condition that requires urgent care. Call emergency services or visit a healthcare facility if you experience any of the following symptoms:

• Back pain accompanied by other symptoms like chest pain, shortness of breath, or sweating, which may indicate a heart attack.
• Back pain following a severe impact, such as a car accident, high fall, or sports injury.
• Back pain combined with difficulty in bowel movements or urination.
• Back pain accompanied by fever and/or night sweats.

• Perform stretching and massage exercises 3-5 times a day. Consistency is key to reaping the benefits!

• Avoid placing direct pressure on the spine!
• Do not move in any direction that causes sharp pain. Stretching is great, but if a movement causes discomfort, you should refrain from doing it.