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[[File:GraysSoleusTrigger.jpg|right|thumb|250px|The Soleus trigger point that can cause pain in the Achilles tendon<ref name="TPManual"/>. Note that the calf has two main muscles, the Gastrocnemius and the Soleus. The Soleus is under the Gastrocnemius which has been removed from this diagram.]]It is common for muscles to develop 'trigger points', also called 'muscle knots'. These trigger points can be felt as small, hard lumps in the muscle that can be painful when pressed<ref name="TPManual"/>. These Trigger points may give rise to characteristic patterns of referred pain, including tendon pain, and often result in a restricted Range Of Motion<ref name="TPManual"/>.  =Treating Trigger Points=Trigger points can be treated in a variety of ways:* '''Massage.''' A number of studies have shown that massage is an effective treatment for trigger points<ref name="TPMassHou"/><ref name="TPMassHanten"/><ref name="TPMassCesar"/>. [[Massage]] seems to be the most common and the easiest to perform at home. * '''Laser.''' The use of a low power laser on trigger points has been shown to produce pain reduction for 3 months<ref name="TPGaLaser"/><ref name="TPFDiodeLaser"/>. Another study showed improvements from laser treatment, but the effect had disappeared by 6 months<ref name="TPFLaser6m"/>. * '''TENS.''' Transcutaneous Electrical Nerve Stimulation, or TENS, uses a mild electric current to reduce pain. TENS has been shown to reduce the pain associated with trigger points, but it does not improve the Range Of Motion, suggesting it reduces the pain but not the underlying problem<ref name="TPTensEms"/>. * '''EMS.''' [[Electrical Muscle Stimulation]] does not reduce the pain as much as TENS, but it does improve the Range Of Motion, suggesting it is improving the underlying muscle functioning<ref name="TPTensEms"/>. * '''Needles. '''The use of directly inserting a needle into a trigger point appears to be effective, but there was no difference found between dry needling (no injection) and the injecting of drugs or saline and there is a concern that the needling may be no more effective than a placebo<ref name="TPNeedle"/>.* '''Ultrasound.''' A study comparing Ultrasound plus massage and exercise, just massage and exercise, or a control group indicated that the Ultrasound did not improve the gains from massage and exercise<ref name="TPUltra"/>. * '''Magnets. '''The preliminary research suggests that magnet therapy may be effective, but more studies are required<ref name="TPReview"/>. My personal experience is that trigger points can cause the muscle to be under continuous contraction, putting stress on the associated tendon. My experience is that many tendon problems are actually due to trigger points in the muscle. It is counterintuitive to work on a muscle that does not hurt to fix a tendon that is causing pain, but this approach has worked for me and others I know, but I have found no research to support or refute this belief.  =Locating Trigger Points=The original manuals on trigger point theory are expensive ($100 each), but the web site [http://www.triggerpoints.net/ triggerpoints.net] is a useful online guide. I also like the [http://itunes.apple.com/us/app/muscle-trigger-points are best treated with /id348867501?mt=8 iPhone/iPad app] shown below, which is reasonably cheap and convenient. [[massageFile:TriggerPointiPadApp.jpg|none|thumb|500px|Screen shot of the iPad version of the trigger point application. All the information is available freely online, but this is a nice presentation for $3.]]. =References=See Also<references><ref name="TPReview">The effectiveness of non-invasive treatments for active myofascial trigger point pain: A systematic review of the literature http://www.journalofosteopathicmedicine.com/article/S1746-0689%2806%2900095-2/abstract </ref><ref name="TPGaLaser">Efficacy of 904 nm gallium arsenide low leve... [Lasers Surg Med. 2004] - PubMed - NCBI http://www.ncbi.nlm.nih.gov/pubmed/15389743 </ref>* <ref name="TPFDiodeLaser">Diode laser in cervical myofascial pain: a doubl... [Clin J Pain. 1989] - PubMed - NCBI http://enwww.ncbi.nlm.wikipedianih.orggov/pubmed/wiki2520419 </Trigger_pointref>* <ref name="TPFLaser6m">Comparison of laser, dry needling, and p... [Photomed Laser Surg. 2004] - PubMed - NCBI http://www.ncbi.nlm.nih.gov/pubmed/15345173 </ref><ref name="TPTensEms">The immediate effectiveness of... [Massage]Am J Phys Med Rehabil. 1997 Nov-Dec]- PubMed - NCBI http://www.ncbi.nlm.nih.gov/pubmed/9431265 </ref>* <ref name="TPUltra">Treatment of myofascial trigger-points with ultrasound ... [[Injury prevention using 'The Stick'|The Stick]Pain. 1998]- PubMed - NCBI http://www.ncbi.nlm.nih.gov/pubmed/9755021 </ref>* <ref name="TPMassHou">Immediate effects of various physical ... [[Foam Roller]Arch Phys Med Rehabil. 2002]- PubMed - NCBI http://www.ncbi.nlm.nih.gov/pubmed/12370877 </ref>* <ref name="TPMassHanten">Effectiveness of a home program of ischemic pressu... [[Thumper]Phys Ther. 2000]- PubMed - NCBI http://www.ncbi.nlm.nih.gov/pubmed/11002435 </ref><ref name="TPMassCesar"> http://www.sciencedirect.com/science/article/pii/S1360859205000690 </ref>* <ref name="TPNeedle">Needling therapies in the management o... [[Teeter Inversion Table]Arch Phys Med Rehabil. 2001]- PubMed - NCBI http://www.ncbi.nlm.nih.gov/pubmed/11441390 </ref><ref name="TPManual">D.G. Simons, J.G. Travell, L.S. Simons Travell & Simons' myofascial pain and dysfunction: the trigger point manual (2nd ed.), vol. 1Williams & Wilkins, Baltimore (1999)</ref></references>