Knot Massage Therapy – Trigger Point Release: A Complete Guide

As a physiotherapist, I mostly deal with patients who have muscle soreness, tightness, and knots that are extremely painful and worsen with time and activity. These knots are called trigger points.

These knots are hard to get rid of without expert knowledge and help.

If you can relate, let’s dive into the fascinating world of knot massage. I’ll share my professional insights, research-based knowledge, and real-life examples to help you understand how these techniques can benefit you.

What is A Knot Massage Therapy?

Knot massage therapy aims to release tension and alleviate the associated symptoms by applying focused pressure on these areas.

Knot massage therapy, commonly known as trigger point release therapy, targets those stubborn, tender spots in your muscles that feel like tight knots.

These knots, or trigger points, are hyperirritable spots in the muscle fibers that can cause pain, limit the range of motion, and create discomfort.

Why Knot Massage Therapy?

In layman’s terms, knot massage therapy is a game-changer for those struggling with muscle pain, tightness, and limited mobility.

If you have a sedentary lifestyle, like working all day long on a desk job or doing repetitive movements like typing on a keyboard or lifting or lowering weights, then you are more likely to have tight muscles and knots that reduce your flexibility to a greater extent.

Having trigger points also reduces your work productivity and hinders you from participating in any recreational activity because you can not go on with a stiff back or a painful neck.

Knot massage therapy can help improve flexibility, reduce muscle tension, and ultimately provide a sense of relaxation and well-being.

Some of you may have a question about chiropractor vs knot massage. The answer is simple, the knot massage is primarily meant to release the knots out of muscles whereas a chiropractor works better when you have issues with bones and joints.

Knot Massage Techniques

There are several techniques used in knot massage therapy, some of which include:

  1. Direct pressure
  2. Stripping
  3. Friction massage
  4. Myofascial release
  5. Pin and stretch

To help you better understand each technique, let’s delve deeper into the knot massage methods and provide guidance on when and where to use them.

1. Direct pressure

1. Direct pressure

As the name suggests, in this technique, the therapist applies direct pressure on the trigger point, holds it for a few seconds, and then releases it.

This technique, also called ischemic compression, refers to the ischemia or stopping of blood flow to the area under compression, which reduces the tenderness of the knots and makes them easy to break.

Direct pressure targets specific knots, especially in smaller muscle groups like the neck, shoulders, and forearms.

Sharing one of my personal experiences:

One of my clients whom I was treating for an ankle sprain, told me about her headache that was not going away with medicine. After assessing her neck I found multiple latent and active trigger points in the deep neck muscles. After treating her with the direct pressure technique for 4 sessions, her headache was relieved, and I advised her to regularly perform gentle neck stretches to prevent the knot from reoccurring.

2. Stripping

2. Stripping

With stripping, the therapist uses his thumb or fingertips to apply pressure along the length of the muscle fibers and rub on to remove the knots along the way.

The therapist starts with light pressure and gradually increases the pressure as required.

This method is particularly useful for larger muscle groups, such as the hamstrings, quadriceps, and calves. Stripping helps improve blood flow, reduce muscle tightness, and promote relaxation.

3. Friction massage

3. Friction massage

The therapist places the thumb or fingertips over the knot, applies pressure, and rubs the knot back and forth.

This technique breaks the adhesions in the muscle fibers and works well for deeper knots or those resistant to other methods.

Friction massage suits various body regions, including the shoulders, upper back, and hips. Research shows its effectiveness in treating tension-type headaches.

It can cause discomfort due to the rubbing motion; thus, the therapist must be careful while treating sensitive areas.


While applying the friction massage technique on trigger points in the neck, you should take great care of the fact that there are important blood vessels passing through your neck that supplies blood to the brain.

If by any chance the therapist compresses the arteries and stops the blood flow to the brain, it can result in unconsciousness.

One way to avoid any accidents is to not apply compression on both sides of the neck simultaneously so that the arteries on one side are freely supplying oxygenated blood to the brain while the other side is under treatment.

4. Myofascial release

4. Myofascial release

While performing a myofascial release, the therapist gently stretches the connective tissue (fascia) surrounding the muscle to improve the range of motion and decrease pain.

The therapist avoids overstretching by applying a slow and controlled stretch localized to the area being treated.

This technique can be applied to almost any body part but is especially effective for the back, chest, and hips, where the fascia is often tight.

5. Pin and stretch

5. Pin and stretch

This technique is a combination of the direct pressure and myofascial release techniques. The therapist applies pressure to the trigger point (pin) while simultaneously stretching the muscle (stretch).

This is also termed as positional release method. The therapist locates the trigger point, applies direct pressure for some time, and then slowly moves your limb in a full range of motion to lengthen the muscles being treated while keeping the direct pressure on the trigger point. 

It helps release knots and restore flexibility to the affected area. Pin and stretch are effective for various body parts, such as the neck, shoulders, and legs.


Overstretching is a hazard in this technique. During practical application, the muscle under treatment is prone to overstretch injuries. To avoid this, you must use active cueing to guide the therapist if the muscle hurt too much while stretching.

I educate my clients about this before starting therapy and we continuously engage with my clients during the session to ensure it all goes smoothly. So, be sure to communicate with your therapist about how you feel during the session.

Tools Used for Knot Massage

While fingers and hands are the most common tools for knot massage, there are other options available that can be effective, such as:

Knot Massage ToolsUsage
Massage ballsSmall, firm balls targeting specific trigger points, especially in hard-to-reach areas.
Foam rollersThese versatile rollers can help release trigger points in larger muscle groups, like the thighs and back.
Massage sticksHandy tools that allow for more controlled pressure and ease of use.
Massage gunsThese are electrical or battery-operated devices that vibrate and target deeper muscles.

How to Perform a Knot Massage?

The best option is to consult a professional massage therapist or physiotherapist for personalized advice; here’s a general guide to performing knot massage.

Step 1: Warm-up

Step 1 - Warm-up

Warming up the muscles before knot massage reduces the risk of injury because some of the techniques involved in knot massage exert intense pressure over the knots, making your muscle more prone to injury.

Gentle or dynamic stretching, effleurage, walking, and jogging pump the muscles leading to an increase in blood flow to the area, which aids in enhancing the effect of the knot massage along with preventing injury.

Step 2: Locate the trigger point

Step 2 - Locate the trigger point

The therapist feels your muscles with fingertips to locate any tender areas.

This process is called palpation, and it might be slightly uncomfortable for you, but it shouldn’t be painful.

The therapist locates and notes precisely where the knot is present.

It is best to perform muscle relaxation or effleurage technique for superficial muscle relaxation if there are trigger points in the deep layers of muscles.

Step 3: Choose the appropriate technique and tools

Step 3 - Choose the appropriate technique and tools

Depending on the size, depth, and number of trigger points, the therapist decides on a single technique or combination of techniques to perform for breaking the adhesions.

The best choices that I recommend are:

  • For superficial knots in the shoulder and neck region: Direct pressure
  • For superficial knots in the back: Myofascial release
  • For superficial knots in the thighs: Stripping
  • For deep knots in thighs, shoulders, and back: Friction massage, pin, and stretch
  • For a deep knot under the shoulder blade, a massage stick is used to apply the pressure.
  • For superficial knots in the back and thighs, a foam roller is used to apply myofascial release and stripping techniques.
  • For deeper knots in the thighs and back, a massage ball or massage gun is a better option.

Step 4: Apply pressure and perform the technique

Step 4 - Apply pressure and perform the technique

Once the therapist has located the knot and identified the right technique, the therapist applies firm and steady pressure over the knot and holds it for 30 seconds or as per the chosen technique requires.

The therapist commonly uses thumb or fingertips to apply pressure, but if the not is very deep then it is better to use a massage ball, massage gun, or massage stick.

If needed, the therapist gradually increases the pressure depending on your body’s response.

Step 5: Stretch and release

Step 5 - Stretch and release

This step is different for every individual and depends on the techniques that the therapist uses.

If using the direct pressure, stripping, or deep friction methods, the therapist will release the pressure applied in step 4 for 5 seconds and then reapply the pressure over the same spot.

If using Myofascial release, the therapist releases the pressure, followed by a gentle stretch at the end.

If using the positional release technique, the therapist applies a stretch while keeping the pressure on the knot, and then at the end of the stretch, releases the pressure for 5 seconds while holding the stretch for 15 to 30 seconds.

Step 6: Rest and recover

I would advise you to allow your muscles to rest and recover after the knot massage. You must give it time to adapt and heal before strenuous activities or additional massage sessions because knot massage is very intense.


  • Always warm up before starting a knot massage to minimize the risk of injury.
  • Use steady, controlled pressure, and avoid applying excessive force.
  • Pay attention to your body’s cues, and stop the massage if you experience sharp or intense pain.
  • Always consult a professional massage therapist or physiotherapist.

Frequency and Duration of Knot Massage

The frequency and duration of knot massage sessions can vary depending on your needs and tolerance.

A general recommendation is to perform a knot massage for 5-10 minutes on each affected area once or twice a week. However, always listen to your body and adjust the frequency and duration accordingly.

Final Thoughts:

Knot massage and trigger point release therapy can be incredibly beneficial for those struggling with muscle tension, pain, and limited mobility.

By understanding the different knot massage techniques and their respective applications, you can choose the most suitable method for addressing your specific muscle tension and discomfort.

Consult a professional massage therapist or physiotherapist for personalized guidance and tailor the techniques according to your body’s needs and responses.

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