Massage Therapy For Bruxism, TMJ Syndrome

Massage Therapy for Bruxism, TMJ Syndrome
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Massage Therapy for Bruxism, Jaw Clenching, and TMJ Syndrome

Perfect Spot No. 7, the masseter muscle of the jaw
Trigger points (TrPs), or muscle knots, are a common cause of stubborn and strange aches and pains, and yet they are underdiagnosed. The 13 Perfect Spots are trigger points that are common and yet fairly easy to massage yourself the most satisfying and useful places to apply pressure to muscle. For tough cases, see the advanced treatment guide.
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Your masseter muscle is your primary chewing muscle not the only one,1 but the main one and it covers the sides of the jaw just behind the cheeks. Its also the main muscle that clenches your jaw and grinds your teeth, unfortunately, and its one of the most common locations for trigger points in the entire human body.2 It is probably an accomplice in most cases of bruxism (thats latin for grinding your teeth) and temporomandibular joint syndrome (a painful condition of the jaw joint), plus other unexplained painful problems in the area.3
The masseter muscle is strong (and special)

Not only does the masseter muscle probably harbour the most common trigger points in the human body, the masseter is also the strongest muscle in the human body (pound for pound), although many variables make this is difficult to be sure of.4 Together with the temporalis muscle and a few other smaller muscles, most people can generate at least 150 pounds of force (lbf) between their teeth. For contrast and amusement, the world record for human bite strength is 975 lbf. 975!5 More than six times
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normal. A human shark! Muscles might all seem similar, but its amazing how specialized they can be. The masseter gets extraordinary strength from a multipennate arrangement of fibres thats like a complex feather fibres converging diagonally on several internal tendons.6 This feathered arrangement favours torque over speed, making the masseter a very low gear muscle, slow but powerful and efficient, lots of chewing bang for your masseter buck. The physics details are a bit mind-bendy.7
Why is the masseter muscle a Perfect Spot for massage?

Its easy enough to imagine why this muscle might enjoy the occasional massage. Whose jaw isnt a bit tense? But the masseters potential to wreak havoc and its need for therapy is often underestimated by the public and health care professionals alike (although Im pleased to see a surprisingly strong interest in the subject amongst dental specialists). When irritated, masseter muscle knots can cause and/or aggravate several problems: Headaches, of course this makes strong intuitive sense to most people. There seems to be a pretty strong connection between tension headaches and jaw clenching. This is partly due to the temporalis muscle, which is reflexively massaged by everyone with a headache. But the masseter is often neglected, even though it is by far the more powerful jaw muscle. They really both need some attention massaging above and below the cheekbone. I actually considered defining Spot No. 7 as the temple and the masseter.8 Earaches and toothaches which are much less obvious. A masseter trigger point can radiate pain directly into a tooth. Travell and Simons quip, This can lead to disastrous results for an innocent tooth.9 I once suffered a dramatic case of a toothache that was completely relieved by a massage therapist the day before an emergency appointment with the dentist: a particularly vivid experience, which originally got me interested in trigger points. Tinnitus (ringing in the ears) and dizziness. Both can be serious and complex problems, and are definitely not necessarily caused by masseter trigger points. There are many other potential contributing factors and causes of these conditions but the masseter is one of the possible causes that should be considered.10
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Bruxism, or grinding and cracking of molars. Temporomandibular joint syndrome, which is a slow, painful failure of jaw joint function. As you can see, masseter problems are not to be taken lightly.
How do you massage the masseter muscle?

Fortunately, its easy really easy to massage and soothe your own masseter muscle, which is what makes it such a particularly perfect Perfect Spot. It has both great needs and its unusually easy and satisfying to self-massage. The masseter muscle hangs from the underside of the cheekbone on the side of the face. The bottom of the muscle attaches to a broad area on the side of the jawbone. Perfect Spot No. 7 is conveniently located in a notch in the cheekbone, about one inch in front of your ears. The notch is on the underside of the cheekbone, its easy to find, and your thumb or fingertip will fit into it nicely, unless you have freakishly large hands. If you press firmly inward and upwards with your thumb in the cheekbone notch, you will usually be rewarded with a sweet ache. The rest of the masseter muscle, however, tends to feel like not much, or unpleasantly tender. Although the entire muscle can be rubbed gently, most people will find that the Perfect Spot is definitely limited to the upper edge of the muscle. Spot 7 is a sturdy piece of anatomy, so dont be afraid to work steadily up to hard pressure if thats what you feel like you want. Either constant pressure or small, kneading circles are both appropriate. Since this spot is so tough, another good trick is to use a knuckle for extra pressure. A useful tool in this location is Pressure Positives Knobble productshow its easy to lie down on your side and let the weight of your head apply a steady, firm pressure, with the tip fitting nicely into the cheekbone notch.
Two tricks for learning to relax your jaw

Does anyone go to the dentist anymore and not get a prescription for a mouth guard? Judging by the inevitable prescriptions, apparently everyone has some kind of jawclenching problem. I do not know if this is actually the case, and sometimes I feel sushttp://saveyourself.ca/articles/perfect-spots/spot-07-masseter.php Page 3 of 39
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picious that the problem is greatly over-diagnosed (because selling mouth appliances is probably profitable). Then again, many people (including my wife) have actual cracks in their molars from clenching so hard and its kind of hard to argue that there isnt a problem there! This article is mostly about massaging Perfect Spot 7 in the masseter, but its obviously potentially extremely helpful for temporomandibular joint syndrome, bruxism, clenching, and grinding if you can also figure out how to relax your jaw. But this is not easy. A nice massage (or any other relaxing experience) is a helpful start, but it doesnt do much for long.11 And simply willing yourself to stop clenching seems almost completely ineffective. Ive known many Simply willing yourself to stop clenching seems to be people who have tried to get serious about re- almost completely ineffective minding themselves to stop clenching, using egg timers and so on with rather underwhelming results. So what can you do? How can you possibly learn to clench less? Here are two ideas that I think work better than simply trying hard not to clench: Slur your speech as though you are so sleepy that you can hardly form words. You know that lovely feeling when youre waking up slowly, in no hurry, and youre conscious yet not even remotely ready to move or speak yet? That floaty, delicious feeling of happy paralysis? Of complete contentment to just lie there? Dont just visualize that feeling, actually act like you feel that way, in your mouth. Try to say, softly but out loud, Im so relaxed I can hardly talk. But slur your words. Literally slur them. Slur them like your mouth is so relaxed you are having trouble making words! You will find that this is quick and effortless way to relax your jaw. It wont necessarily last, but it is a most helpful way to quickly get back to the state you want. I use this technique even when there are people around. I find that I can easily just mouth the words I can hardly talk, making no noise, and immediately access the sensory experience of jaw relaxation, with no one around me having a clue about what Im to. Spend long periods of time with your jaw wide open. Hold your mouth open at least wide enough to fit a finger between your teeth for one full hour. Not just open, but open wide the exaggerated reversal from clenched to wide open helps to break the habit of clenching much more quickly. Every time during the hour that you catch yourself with your teeth together, simply calmly stretch your mouth open again. After
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an hour of this, clenching starts to feel abnormal, and you will find it much easier to keep your jaw relaxed for some time afterwards. You may also find it helpful to actually prop your mouth open with something durable and spit-proof. Most people will salivate too much to keep this up for an entire long session, but it can be a useful way to help you focus on the challenge for a few minutes at a time. Some people may find it practical for longer. This intensive approach is generally a much Excellent. more effective method of breaking the clenching Now, dont move. habit than scattered self-reminders to stop clenching, which just never really take. If you are really determined, spend an hour a day doing this if you put in the time, you really cant fail. I estimate that most people need 510 hours of practice in a week to put a good dent in a clenching habit. Of course, life is likely to regenerate the problem back sooner or later but you will know what to do when that happens. Good luck!
Notes
1. The other major one is the temporalis muscle, which covers more of the side of the head than most people realize: the entire temple, of course, but quite a bit more above and behind that. BACK TO TEXT 2. Travell et al. Myofascial Pain and Dysfunction. 1999. amazon.com p330. Several studies are discussed that conclude that myofascial trigger points in the superficial masseter muscle are either the most common, or the second most common, of all the trigger points studied. Its a hard thing to nail down for sure, but it seems pretty clear that its an extremely prominent Perfect Spot! BACK TO TEXT 3. Thats actually an exaggeration, but its a fair one. In fact, there are almost certainly people who have those problems and no masseter trigger points but the vast majority would still have some kind of dysfunction of the masseter and other jaw muscles. For instance, with or without trigger points on a given day, the
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4.
5.
6.
7.
8.
9.
masseter would probably still be tight (high toned) in these patients. BACK TO TEXT The tongue is also popularly claimed to be the most powerful muscle, but thats really hard to substantiate. The tongue isnt one muscle, but a muscle group, and it cant apply force in a way that can be compared meaningfully to other muscles. How, exactly, do you test tongue strength? Tongue push-ups? BACK TO TEXT According to the 1992 Guinness Book of Records, in 1986 Richard Hofmann of Lake City, Florida achieved a bite strength of 975 lbs. for two seconds. BACK TO TEXT Pennate just means like a feather, with diagonal fibres converging on a line a tendon. In a multi pennate muscle, there are multiple and dividing central tendons. The result is a very complex, densely packed feathering of fibres. There are only a few multipennate muscles in the body, like the deltoid on the shoulder, and most of the small muscles in the hands and feet. But the masseter is the king of pennatedness. BACK TO TEXT Pennate muscle power is a winch: powerful but slow, and you need more cable to pull shorter distances. Pennate muscles exploit the pulley effect by pulling on the sides of tendons that run all the way through the muscle, converging on them at angles. Imagine a tug-of-war team with ropes tied to the main rope you could have at least twice as many pullers! More fibres pulling on a tendon means that pennate muscles are found in the tight spaces in the body where power is needed without a lot of mass. In contrast, muscles with parallel fibres, like the biceps, pull directly on their target bone, and so they can pull faster and farther, but they are also weaker pound-for-pound and take up a lot of room. If you converted pennated muscles to a parallel fibre structure, they would have to be roughly twice as big! Imagine doubling the size of your masseters. Chipmunk! BACK TO TEXT I decided against it because the two halves of the spot are so different in character. The temporalis is much thinner, massage there needs to be generally more delicate and superficial, and it feels more like massage of the surface of the head than the jaw. Only about a centimetre away, just on the other side of the cheekbone, the top of the masseter is sturdy and thick, and tolerates strong pressure which feels more much more penetrating and much more relevant to jaw tension. BACK TO TEXT Travell et al. Myofascial Pain and Dysfunction. 1999. amazon.com p339 BACK TO
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TEXT 10. Rocha et al. Myofascial trigger points: another way of modulating tinnitus. Prog Brain Res. 2007. In 2007, these researchers found that in 56% of patients with tinnitus and MTPs, the tinnitus could be modulated by applying digital compression of such points, mainly those of the masseter muscle. And how many people with tinnitus had trigger points? Quite a few. The researchers found a strong correlation between tinnitus and the presence of MTPs in head, neck and shoulder girdle. BACK TO TEXT 11. This is one of the classic problems with massage. Although massage does appear to be very helpful for some people, some of the time, the results are a bit underwhelming on average and the benefits are notoriously brief. This is discussed in much more detail in both my advanced trigger points tutorial, and also my general massage review, Does Massage Therapy Work?. BACK TO TEXT
Appendix A: Is trigger point therapy too good to be true?

Trigger point therapy isnt too good to be true: its just ordinary good. It can probably relieve some pain cheaply and safely in many cases. Good bang for buck, and little risk. In the world of pain treatments, thats a good mix. But pain is difficult and complex, no treatment is perfect, and there is legitimate controversy about the science of trigger points. The phenomenon of sensitive spots on the body is undeniable but their nature remains somewhat puzzling, and the classic image of a tightly contracted patch of muscle could just be wrong. On the one hand, you can measure their electrical activity, take samples of their highly acidic tissue chemistry, and now a new MRI-like technology can now show them as well. On the other hand, some of that may be wrong, and all of it could essentially just be side effects of a more basic problem. No one really knows. What we do know is that people hurt. Muscle pain is clinically significant, but medically obscure. As Dr. David Simons wrote, Muscle is an orphan organ. No medical speciality claims it. Many patients can benefit from educating themselves. The Perfect Spots are based on a decade of my own clinical experience as a massage therapist, and years of extensive science journalism on the topic. Want to know more?
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This is the tip of the iceberg. Ive written a whole book about it ZOOM Not too good to be true. Just ordinary good. Trigger point therapy isnt a miracle cure, but it is a valuable life skill. Practically anyone can benefit at least a little, and many will experience significant relief from stubborn aches and pains. The first several sections are free.
Appendix B: Quick Reference Guide to the Perfect Spots

1Perfect Spot No. 1 Massage Therapy for Tension Headaches Under the back of the skull must be the single most pleasing and popular target for massage in the human body. No other patch of muscle gets such rave reviews. It has everything: deeply relaxing and satisfying sensations, and a dramatic therapeutic relevance to one of the most common of all human pains, the common tension headache. And no wonder: without these muscles, your head would fall off. They feel just as important as they are. Read more.
for pain: almost anywhere in the head, face and neck, but especially the side of the head, behind the ear, the temples and forehead muscle(s): suboccipital muscles (recti capitis posteriores major and minor, obliqui inferior and superior)
related to: headache, neck pain, migraine
2Perfect Spot No. 2 Massage Therapy for Low Back Pain This Perfect Spot lives in the thoracolumbar corner, a nook between your lowest rib and your spine right where the stability of the rib cage gives way to the relative instability of the lumbar spine. Muscle tends to bunch up around this joint between the last of the thoracic vertebrae and the first of the lumbar. The sweet spot consists of trigger points in the upper-central corner of the quadratus (square) lumborum muscle and in the thick column of muscle that braces the spine. Read more.
for pain: anywhere in the low back, tailbone, lower buttock, abdomen, groin, side of the hip related to: low back pain, herniated disc muscle(s): quadratus lumborum, erector spinae
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3Perfect Spot No. 3 Massage Therapy for Shin Splints Perfect Spot No. 3 is in your shins seemingly an unlikely place for muscle knots! But there is meat there, and if youve ever had shin splints then you know just how vulnerable that meat can be. Even if youve never suffered so painfully, your shins probably still suffer in silence latent trigger points in the upper third of the shin that dont cause symptoms, but are plenty sensitive if you press on them. Read more.
for pain: in the shin, top of the foot, and the big toe related to: shin splints, drop foot, anterior compartment muscle(s): tibialis anterior syndrome, medial tibial stress syndrome
4Perfect Spot No. 4 Massage Therapy for Neck Pain, Chest Pain, Arm Pain, and Upper Back Pain Deep within the Anatomical Bermuda Triangle, a triangular region on the side of the neck, is the cantankerous scalene muscle group. Massage therapists have vanished while working in this mysterious area, never to be seen again. The region and its muscles are complex and peculiar, and many lesser-trained massage therapists have low confidence working with them. Read more.
for pain: in the upper back (especially inner edge of the shoulder blade), neck, side of the face, upper chest, shoulder, arm, hand related to: thoracic outlet syndrome, lump in the throat, hoarseness, TMJ syndrome muscle(s): the scalenes (anterior, middle, posterior)
5Perfect Spot No. 5 Massage Therapy for Tennis Elbow and Wrist Pain Just beyond your elbow, all the muscles on the back of your forearm converge into a single thick tendon, the common extensor tendon. At the point where the muscles converge, in the muscles that extend the wrist and fingers, lies one of the most inevitable myofascial TrPs in modern civilization: Perfect Spot No. 5. It is constantly and greatly aggravated both by computer usage today and by the use of a pen in simpler times and by the occasional tennis match, then and now. Read more.
related to: carpal tunnel syndrome, tennis elbow (lateral epicondylitis), for pain: in the elbow, arm, wrist, and golfers elbow (medial hand epicondylitis), thoracic outlet syndrome, and
muscle(s): extensor muscles of the forearm, mobile wad (brachioradialis, extensor carpi radialis longus and brevis), extensor digitorum,
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several more
extensor carpi ulnaris
6Perfect Spot No. 6 Massage Therapy for Back Pain, Hip Pain, and Sciatica When you have back pain, buttock pain, hip pain, or leg pain, much or even all of your trouble may well be caused by trigger points in the obscure gluteus medius and minimus muscles, a pair of pizza-slice shaped muscles a little forward of your hip pocket. Other muscles in the region are usually involved as well, such as the gluteus maximus, piriformis, and the lumbar paraspinal muscles. However, the gluteus medius and minimus are a bit special: their contribution to pain in this area is particularly significant, and yet people who have buttock and leg pain rarely suspect that much of it is coming from muscle knots so high and far out on the side of the hip. Read more.
for pain: in the low back, hip, related to: sciatica, buttocks (especially immediately trochanteric bursitis, low under the buttocks), side of the thigh, back pain hamstrings muscle(s): gluteus medius and minimus
7THIS PAGE (Perfect Spot No. 7 Massage Therapy for Bruxism, Jaw Clenching, and TMJ Syndrome) 8Perfect Spot No. 8 Massage Therapy for Your Quads A lot of quadriceps aching, stiffness and fatigue emanates from an epicentre of knotted muscle in the lower third of the thigh, in the vastus lateralis, a huge muscle one of your biggest that dominates the lateral part of the leg. Stretching it is effectively impossible, but massage is an option: although often shockingly sensitive, Perfect Spot No. 8 can also be quite satisfying. Its also often complicates or contributes to other problems in the area, especially runners knee (iliotibial band syndrome). Read more.
for pain: in the lower half of the thigh, knee related to: iliotibial band syndrome, patellofemoral pain syndrome muscle(s): quadriceps (vastus lateralis, vastus lateralis, vastus medialis, rectus femoris)
9Perfect Spot No. 9 Massage Therapy for Your Pectorals
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The pecs are popular muscles. Of the 700+ muscles in the human body, the pectoralis major is one of the dozen or so that most people can name and point to. It also harbours one of the most commonly-encountered and significant yet little known trigger points in the human body, and can produce pain much like a heart attack in both quality and intensity. Read more.
for pain: anywhere in the chest, upper arm related to: heart attack, respiratory dysfunction muscle(s): pectoralis major
11Perfect Spot No. 11 Massage Therapy for Upper Back Pain This spot is too large to really be called a spot its more of an area. The thick columns of muscle beside the spine are routinely littered with muscle knots from top to bottom. Nevertheless, there is one section of the group where massage is particularly appreciated: from the thick muscle at the base of the neck, down through the region between the shoulder blades, tapering off around their lower tips. There is no doubt that this part of a back massage feels even better than the rest even the low back, despite its own quite perfect spots, cannot compete. Read more.
for pain: anywhere in the upper back, related to: scoliosis mainly between the shoulder blades muscle(s): erector spinae muscle group
12Perfect Spot No. 12 Massage Therapy for Low Back Pain (So Low That Its Not In the Back) At the top of the gluteal muscles lies a Perfect Spot among Perfect Spots: a sneaky but trouble-making brute of a TrP that commonly forms in the roots of the gluteus maximus muscle, just below the pit of the low back, but experienced as low back pain. This is the kind of spot that the Perfect Spots concept is really all about not only does it tend to produce a profound and sweet ache when massaged, but the extent of the pain that spreads out around it is almost always a surprise. Read more.
related to: low back pain, for pain: in the lower back, buttocks, sciatica, sacroiliac joint hip, hamstrings dysfunction muscle(s): gluteus maximus
13Perfect Spot No. 13 Massage Therapy for Low Back Pain (Again) Some of the Perfect Spots are perfect because they are surprising they arent
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where you thought theyd be, and its delightful to discover the real source of pain. Others are perfect because they are exactly where you expect them to be and what a relief it is to be able to treat them. Perfect Spot No. 13 is perhaps the ultimate, the quintessential right where I thought it was trigger point: right at the very bottom of the thick columns of muscle, in the pit of the low back. Read more.
for pain: in the low back, buttocks, hamstrings related to: low back pain, sciatica, sacroiliac joint dysfunction muscle(s): erector spinae muscle group at L5
Perfect Spot No. 8, another one for runners, the distal vastus lateralis of the quadriceps group
Trigger points (TrPs), or muscle knots, are a common cause of stubborn and strange aches and pains, and yet they are under-diagnosed. The 13 Perfect Spots are trigger points that are common and yet fairly easy to massage yourself the most satisfying and useful places to apply pressure to muscle. For tough cases, see the advanced treatment guide.
Your quads are muscles that people think they know everyone knows where the quadriceps are, what theyre about, and how to stretch them right? Actually, they often dont. The most common misunderstanding concerns stretching. Did you know that its actually anatomically impossible to stretch most of the quadriceps?1 Ill bet you didnt! Read on to find out why. A lot of quadriceps aching, stiffness and fatigue emanates from an epicentre of knotted muscle in the lower third of the thigh, in the vastus lateralis, a huge muscle one of your biggest that dominates the lateral part of the leg. Stretching it is effectively impossible, but massage is an option: although often shockingly sensitive, Perfect Spot No. 8 can also be quite satisfying. Its also often complicates or contributes to other problems in the area, especially runners knee (iliotibial band syndrome).
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The quadriceps are a huge muscle group. The blue circle marks Perfect Spot 8.
A little quadriceps anatomy

Your quadriceps muscle is actually a group of three large muscles and one smaller one that merge just above the knee. They are: 1. vastus lateralis on the outside of the thigh 2. vastus medialis on the inside 3. the relatively skinny and insubstantial rectus femoris lying on top, right at the front of the thigh (it is drawn a little too thick and beefy in the diagram here) 4. vastus intermedius in the center (hidden underneath the rectus femoris) The smaller rectus femoris is the only one of the group that crosses both the hip joint and the knee. It powers both of those big joints, whereas the larger three members of the group the three vasti only cross the knee and therefore they can only move the knee. One of the most important implications of this (and also one of the best ways to visualize it) is that there is a problem with stretching your quadriceps.
The surprising quadriceps stretching debacle

The traditional quadriceps stretch, which people often call the runners stretch,
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stretches only the smaller rectus femoris part of the quadriceps, because thats the only part of the quadriceps that crosses the hip, which represents roughly 10% of the muscle tissue in the group. Yep, thats right: probably the most familiar and popular of all stretches is simply missing 90% of the quadriceps muscle mass! The big underlying trio of vasti muscles is anatomically impossible to stretch strongly, because they elongate only with knee flexion, and knee flexion is strictly limited you can only flex your knee so far, because the hamstrings are in the way. When you flex your knee, the vasti obviously do elongate but they dont elongate much. You will never feel anything like a strong stretch in your thigh by bending your knee unless you add hip extension into the mix. But when you add hip extension, you have absolutely no effect whatsoever zip, zero, zilch on the vasti, because they simply do not cross the hip, and cannot therefore be affected in the slightest way by hip movements. However, the rectus femoris does cross the hip, and it is already stretched out a bit if your knee is flexed. So, when you extend the hip as you do in the classic runners quads stretch now you feel a stretch, but the only thing youre feeling is the rectus femoris.
The bigger quadriceps muscles, with 90% of the quadriceps muscle mass, remain exactly as they were before you added hip extension: they stay modestly elongated by knee flexion, prevented by stretching any further by the collision of your calf with your hamstrings. There is no getting around this! There is no better quadriceps
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stretch that can somehow elongate those vasti muscles. Its just simple biomechanics there is simply no such thing as a strong quadriceps stretch. This quirk of anatomy (which hardly anyone knows about) is just one more reason why I think generic stretching is generally over-rated as a form of exercise. There are too many misconceptions of this type out there!
Where is the perfect quadriceps spot?

Due to its size, the quadriceps group seems to be able to take a licking and keep on ticking. Even when significantly polluted by trigger points,2 the quadriceps muscles often still feel mostly fine and functional, and perform as well as needed by the average person, or even by most athletes. This is only true relative to other muscles. Dont get me wrong the quadriceps can still be laid low. But seemingly less easily than smaller muscles. Even when they are polluted by trigger points, the quadriceps muscle often still feel mostly fine and functional. Even when they keep on ticking, a surprising amount of sensitivity to pressure can be lurking in those thick tissues, particularly in the big vastus lateralis muscle. There is a common trigger point there. One of the things that makes Spot No. 8 perfect is the tendency it has to be strongly latent that is, to hide in your tissue, unbeknownst to you, until you press on it. Perfect Spot No. 8 is somewhere in the bottom half of the vastus lateralis muscle, a few inches from the knee. Its not on the side of the thigh and not on the top, but between the two facing forward and out. In that location, the vastus lateralis can be pressed against the bone underneath. While pressure at virtually any location in the vastus lateralis is likely to feel potent, Perfect Spot No. 8 is a sure thing: with anything more than mild pressure, it is virtually guaranteed to generate that classic sweet ache that makes us seek out massage. Since it isnt actually possible to stimulate most of the quadriceps muscle group with any kind of stretch, massage is a bit more important.
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Does Spot #8 have anything to do with knee problems like IT band syndrome and patellar pain?
The clinical connections between quadriceps trigger points and the big two runners knee injures iliotibial band syndrome (ITBS) and patellofemoral pain syndrome (PFPS) are probably limited. Those conditions are primarily caused by tissue fatigue at the location of pain. When the tissues are irritated, everything bothers them. When they arent inflamed, they can put up with practically anything. In short, biomechanical factors like grumpy and dysfunctional quadriceps muscles are undoubtedly a factor in these conditions, but they are almost certainly not a major factor. However, thats not the conventional wisdom. The conventional wisdom is pretty sure of itself, and it will tell you that trigger points in the quadriceps matter a lot when it comes to your knee problems. It will tell you that your vastus lateralis is too tight and pulling your kneecap out of whack. And it will tell you that your ITB is too tight and needs to be loosened, and somehow quadriceps massage is going to do that which is particularly odd, because the quadriceps have no mechanical connection whatsoever to the IT band, so how, exactly, does quadriceps massage loosen the IT band? Hmmm. Congratulations if you detect a note of exasperation in my voice youre very perceptive! All of this conventional wisdom pretty much ignores the last decade of scientific research. No, double that it ignores at least 20 years of science. There is a lot of recent (up to 20 years old) evidence that all of this conventional wisdom is either wrong or at the least debatable and oversimplified. For instance, researchers have found that people with ITBS dont have tighter IT bands than anyone else,3 and that therapists and doctors cant reliably diagnose the existence of a socalled patellar tracking syndrome, let alone reliably treat it by any method.4 Researchers have found that people with ITBS dont have tighter IT bands than anyone else. So, I really wouldnt make too much of the clinical importance of trigger points when it comes to knee problems. Massage this Perfect Spot (and the rest of your quadriceps)
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for other reasons because it feels good, because it relieves a feeling of tension and fatigue in the region, and because you can impress your friends with your innovative use of an otherwise neglected kitchen utensil. And, hey, the conventional wisdom might not be completely wrong. Gentle pounding with your fists the classic Swedish massage technique of tapotement is also a pretty great way of working this big, meaty muscle group.
Further Reading
In SY Quite a Stretch Stretching research clearly shows that a stretching habit isnt good for much of anything that people think it is, I go into much more depth about the confusion around stretching. SY The Unstretchables Eleven major muscles you cant stretch, no matter how hard you try SY Save Yourself from IT Band Syndrome! All your treatment options for Iliotibial Band Syndrome reviewed in great detail, with clear explanations of recent scientific research supporting every key point.

Trigger point therapy isnt too good to be true: its just ordinary good. It can probably relieve some pain cheaply and safely in many cases. Good bang for buck, and little risk. In the world of pain treatments, thats a good mix. But pain is difficult and complex, no treatment is perfect, and there is legitimate controversy about the science of trigger points. The phenomenon of sensitive spots on the body is undeniable but their nature remains somewhat puzzling, and the classic image of a tightly contracted patch of muscle could just be wrong. On the one hand, you can measure their electrical activity, take samples of their highly acidic tissue chemistry, and now a new MRI-like technology can now show them as well. On the other hand, some of that may be wrong, and all of it could essentially just be side effects of a more basic problem. No one really knows. What we do know is that people hurt. Muscle pain is clinically significant, but medically obscure. As Dr. David Simons wrote, Muscle is an orphan organ. No medical speciality claims it. Many patients can benefit from educating themselves. The Perfect Spots are based on a decade of my own clinical experience as a massage
5/16/13 1:09 PM
therapist, and years of extensive science journalism on the topic. Want to know more? This is the tip of the iceberg. Ive written a whole book about it
Not too good to be true. Just ordinary good. Trigger point therapy isnt a miracle cure, but it is a valuable life skill. Practically anyone can benefit at least a little, and many will experience significant relief from stubborn aches and pains. The first several sections are free.

2Perfect Spot No. 2 Massage Therapy for Low Back Pain This Perfect Spot lives in the thoracolumbar corner, a nook between your lowest rib and your spine right where the stability of the rib cage gives way to the relative inhttp://saveyourself.ca/articles/perfect-spots/spot-07-masseter.php Page 18 of 39
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stability of the lumbar spine. Muscle tends to bunch up around this joint between the last of the thoracic vertebrae and the first of the lumbar. The sweet spot consists of trigger points in the upper-central corner of the quadratus (square) lumborum muscle and in the thick column of muscle that braces the spine. Read more.
5Perfect Spot No. 5 Massage Therapy for Tennis Elbow and Wrist Pain Just beyond your elbow, all the muscles on the back of your forearm converge into a single thick tendon, the common extensor tendon. At the point where the muscles converge, in the muscles that extend the wrist and fingers, lies one of the most inhttp://saveyourself.ca/articles/perfect-spots/spot-07-masseter.php Page 19 of 39
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evitable myofascial TrPs in modern civilization: Perfect Spot No. 5. It is constantly and greatly aggravated both by computer usage today and by the use of a pen in simpler times and by the occasional tennis match, then and now. Read more.
related to: carpal tunnel syndrome, tennis elbow for pain: in the elbow, arm, wrist, and (lateral epicondylitis), golfers elbow (medial hand epicondylitis), thoracic outlet syndrome, and several more muscle(s): extensor muscles of the forearm, mobile wad (brachioradialis, extensor carpi radialis longus and brevis), extensor digitorum, extensor carpi ulnaris
7Perfect Spot No. 7 Massage Therapy for Bruxism, Jaw Clenching, and TMJ Syndrome Your masseter muscle is your primary chewing muscle not the only one, but the main one and it covers the sides of the jaw just behind the cheeks. Its also the main muscle that clenches your jaw and grinds your teeth, unfortunately, and its one of the most common locations for trigger points in the entire human body. It is probably an accomplice in most cases of bruxism (thats latin for grinding your teeth) and temporomandibular joint syndrome (a painful condition of the jaw joint), plus other unexplained painful problems in the area. Read more.
related to: bruxism,
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for pain: in the side of the face, jaw, teeth (rarely)
headache, jaw clenching, TMJ syndrome, toothache, tinnitus
muscle(s): masseter
8THIS PAGE (Perfect Spot No. 8 Massage Therapy for Your Quads) 9Perfect Spot No. 9 Massage Therapy for Your Pectorals The pecs are popular muscles. Of the 700+ muscles in the human body, the pectoralis major is one of the dozen or so that most people can name and point to. It also harbours one of the most commonly-encountered and significant yet little known trigger points in the human body, and can produce pain much like a heart attack in both quality and intensity. Read more.
11Perfect Spot No. 11 Massage Therapy for Upper Back Pain This spot is too large to really be called a spot its more of an area. The thick columns of muscle beside the spine are routinely littered with muscle knots from top to bottom. Nevertheless, there is one section of the group where massage is particularly appreciated: from the thick muscle at the base of the neck, down through the region between the shoulder blades, tapering off around their lower tips. There is no doubt that this part of a back massage feels even better than the rest even the low back, despite its own quite perfect spots, cannot compete. Read more.
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for pain: in the lower back, buttocks, related to: low back pain, sciatica, sacroiliac joint hip, hamstrings dysfunction
muscle(s): gluteus maximus
13Perfect Spot No. 13 Massage Therapy for Low Back Pain (Again) Some of the Perfect Spots are perfect because they are surprising they arent where you thought theyd be, and its delightful to discover the real source of pain. Others are perfect because they are exactly where you expect them to be and what a relief it is to be able to treat them. Perfect Spot No. 13 is perhaps the ultimate, the quintessential right where I thought it was trigger point: right at the very bottom of the thick columns of muscle, in the pit of the low back. Read more.
Notes
1. And its not alone. There are actually quite a few important muscles in the human body that are virtually impossible to stretch. I call them: The Unstretchables. BACK TO TEXT 2. Which is a reasonable way of looking at it, as there is intriguing evidence that trigger points are full of waste metabolites: see Toxic Muscle Knots BACK TO TEXT 3. Devan et al. A Prospective Study of Overuse Knee Injuries Among Female Athletes With Muscle Imbalances and Structural Abnormalities. Journal of Athletic Training. 2004. PubMed #15496997. For a more detailed analysis of this research, see Iliotibial band syndrome and patellofemoral pain syndrome arent as simple as they seem. BACK TO TEXT 4. That statement is harder to back up with a single reference, but you can read about it in detail in Save Yourself from Patellofemoral Pain Syndrome!. BACK TO TEXT
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Perfect Spot No. 9, in the pectoralis major muscle of the chest
The pecs are popular muscles. Of the 700+ muscles1 in the human body, the pectoralis major is one of the dozen or so that most people can name and point to. It also harbours one of the most commonly-encountered and significant yet little known trigger points in the human body, and can produce pain much like a heart attack in both quality and intensity. The pectoralis major covers the entire top half of your chest. It is mostly an arm mover, although it also stabilizes the joint between your sternum and collar bone. Specifically, it is the hugging muscle: it powerfully pulls and rotates the arms towards the center of your body. Like all the big flexors, its incredibly strong. The pectoralis major is so large, spreading out like a fan across the entire chest, that no matter what position the shoulder is in, the pectoralis major can do its job with at least some of its
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fibers. (The pectoralis minor, by the way, is quite a different muscle. As its name suggests, it is much smaller. It is completely covered by the pectoralis major, and does not move the arm at all!) The pectoralis major is also, interestingly, one of the only muscles in the human body that is almost always much larger in men than it is in women, which accounts for much of the difference in upper body strength between the genders. Ive massaged thousands of people, and even the strongest women usually have relatively thin pectoralis major muscles. Regardless, Perfect Spot No. 9 is a good massage location for both men and women. No. 9 is easy to find by touch, because it is on the edge of a distinctive pocket or hollow directly underneath your collarbone. The pocket is a small, umuscled space between the deltoid and the pectoralis major. If you explore right below your collarbone, it is easy to find the soft spot between these two large muscles. Once youve found it, press towards the sternum against the edge of the hollow thats pectoralis major youre pressing and youve found Perfect Spot No. 9. Thumb pressure is often adequate to stimulate this spot, but many people especially men, with their larger pectorals may need knuckles or even an elbow to get a clear signal. Pressure on Spot No. 9 tends to relieve that uncomfortable sense of constriction and stagnancy in the chest. This spot feels good because the pectoralis major is partly responsible for the common problem of a collapsed chest, the shoulders rolled forward and inward. Almost everyone feels tight in the chest because of this, particularly people who routinely work or play with computers (which is almost everyone, these days). Pressure on Spot No. 9 tends to relieve that uncomfortable sense of constriction and stagnancy in the chest, creating a sense of having more space to breathe in, which is quite pleasant. Although No. 9 is a specific spot on the edge of the pectoralis major, its also quite effective to massage the entire space underneath the clavicle, using the big knuckles.
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You would need some oil or lotion for this, of course, and its best to glide towards the centre, catching Spot No. 9 along the way.
Bonus pectoralis major tip

A lot of men would like to have better developed and well-defined pectoralis major muscles for aesthetic reasons, because huge pecs are pretty much the definition of a masculine trait. Unfortunately, few men understand which exercises will achieve this effect! The confusion arises from the fact that the bottom half of the pectoralis major performs some different functions than the top half. To define the pectoralis major, you primarily need to exercise the bottom half of the muscle. While all pectoralis major fibres adduct and internally rotate the shoulder, only the lower fibres extend the shoulder. Therefore, the best pectoralis major training exercises include some resistance to shoulder extension. Those exercises are: chin ups or front lat (latissimus dorsi) pull-downs with a wide grip2 a standard bench press or a dumbbell press on a decline bench (thats with the feet higher than the head) barbell pullover, in which you lie on your back, holding a barbell over your head, and then lift it over your face cable crossover, in which you pull weighted cables from high and outside towards the center of your body Note that standard wide-position push ups are a good general pectoralis major exercise, but do not isolate any part of the pectoralis major.
Further Reading
Descriptions of the chest exercises mentioned in the last section, and many more.

Trigger point therapy isnt too good to be true: its just ordinary good. It can probably relieve some pain cheaply and safely in many cases. Good bang for buck, and little risk. In the world of pain treatments, thats a good mix. But pain is difficult and complex, no treatment is perfect, and there is legitimate controversy about the science of trigger points. The phenomenon of sensitive spots on the body is undeniable but their nature remains somewhat puzzling, and the classic
5/16/13 1:09 PM
image of a tightly contracted patch of muscle could just be wrong. On the one hand, you can measure their electrical activity, take samples of their highly acidic tissue chemistry, and now a new MRI-like technology can now show them as well. On the other hand, some of that may be wrong, and all of it could essentially just be side effects of a more basic problem. No one really knows. What we do know is that people hurt. Muscle pain is clinically significant, but medically obscure. As Dr. David Simons wrote, Muscle is an orphan organ. No medical speciality claims it. Many patients can benefit from educating themselves. The Perfect Spots are based on a decade of my own clinical experience as a massage therapist, and years of extensive science journalism on the topic. Want to know more? This is the tip of the iceberg. Ive written a whole book about it

1Perfect Spot No. 1 Massage Therapy for Tension Headaches Under the back of the skull must be the single most pleasing and popular target for massage in the human body. No other patch of muscle gets such rave reviews. It has everything: deeply relaxing and satisfying sensations, and a dramatic therapeutic relevance to one of the most common of all human pains, the common tension headache. And no wonder: without these muscles, your head would fall off. They feel just as imhttp://saveyourself.ca/articles/perfect-spots/spot-07-masseter.php Page 26 of 39
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portant as they are. Read more.

2Perfect Spot No. 2 Massage Therapy for Low Back Pain This Perfect Spot lives in the thoracolumbar corner, a nook between your lowest rib and your spine right where the stability of the rib cage gives way to the relative instability of the lumbar spine. Muscle tends to bunch up around this joint between the last of the thoracic vertebrae and the first of the lumbar. The sweet spot consists of trigger points in the upper-central corner of the quadratus (square) lumborum muscle and in the thick column of muscle that braces the spine. Read more.
4Perfect Spot No. 4 Massage Therapy for Neck Pain, Chest Pain, Arm Pain, and Upper Back Pain Deep within the Anatomical Bermuda Triangle, a triangular region on the side of the neck, is the cantankerous scalene muscle group. Massage therapists have vanished while working in this mysterious area, never to be seen again. The region and its muscles are complex and peculiar, and many lesser-trained massage therapists have low
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confidence working with them. Read more.

related to: carpal tunnel syndrome, tennis elbow (lateral epicondylitis), for pain: in the elbow, arm, wrist, and golfers elbow (medial hand epicondylitis), thoracic outlet syndrome, and several more muscle(s): extensor muscles of the forearm, mobile wad (brachioradialis, extensor carpi radialis longus and brevis), extensor digitorum, extensor carpi ulnaris
7Perfect Spot No. 7 Massage Therapy for Bruxism, Jaw Clenching, and TMJ Synhttp://saveyourself.ca/articles/perfect-spots/spot-07-masseter.php Page 28 of 39
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drome Your masseter muscle is your primary chewing muscle not the only one, but the main one and it covers the sides of the jaw just behind the cheeks. Its also the main muscle that clenches your jaw and grinds your teeth, unfortunately, and its one of the most common locations for trigger points in the entire human body. It is probably an accomplice in most cases of bruxism (thats latin for grinding your teeth) and temporomandibular joint syndrome (a painful condition of the jaw joint), plus other unexplained painful problems in the area. Read more.
for pain: in the side of the face, jaw, teeth (rarely) related to: bruxism, headache, jaw clenching, TMJ syndrome, toothache, tinnitus
muscle(s): masseter
8Perfect Spot No. 8 Massage Therapy for Your Quads A lot of quadriceps aching, stiffness and fatigue emanates from an epicentre of knotted muscle in the lower third of the thigh, in the vastus lateralis, a huge muscle one of your biggest that dominates the lateral part of the leg. Stretching it is effectively impossible, but massage is an option: although often shockingly sensitive, Perfect Spot No. 8 can also be quite satisfying. Its also often complicates or contributes to other problems in the area, especially runners knee (iliotibial band syndrome). Read more.
9THIS PAGE (Perfect Spot No. 9 Massage Therapy for Your Pectorals) 11Perfect Spot No. 11 Massage Therapy for Upper Back Pain This spot is too large to really be called a spot its more of an area. The thick columns of muscle beside the spine are routinely littered with muscle knots from top to bottom. Nevertheless, there is one section of the group where massage is particularly appreciated: from the thick muscle at the base of the neck, down through the region between the shoulder blades, tapering off around their lower tips. There is no doubt that this part of a back massage feels even better than the rest even the low back,
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despite its own quite perfect spots, cannot compete. Read more.
Notes
1. See How Many Muscles? BACK TO TEXT 2. Signorile et al. A comparative electromyographical investigation of muscle utilization patterns using various hand positions during the lat pull-down. Journal of Strength & Conditioning Research. 2002. PubMed #12423182. BACK TO TEXT
Perfect Spot No. 10, in the arch muscles of the foot

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If you have or think you may have plantar fasciitis, you may prefer to start with this article instead: Save Yourself from Plantar Fasciitis! The tenth of the Perfect Spots is one of the most popular of the lot, and right under your feet literally. It lies in the center of the arch muscles of the foot. This is one of the Perfect Spots that everyone knows about. No massage is complete without a foot massage!
Why is the arch of the foot a Perfect Spot for a massage?

It isn't difficult to understand why the arch muscles of the foot would harbour a Perfect Spot for massage. They are, after all, the hardest working muscles in the human body. Our feet absorb an incredible amount of punishment, yet usually feel no worse than just stiff and tired. Injury here is common, but not nearly as common as you might expect. The arch of the foot is a fascinating structure. The arch is like a bow without an arrow, and its curved shape is created by a string of muscles and elastic connective tissues. Every time you take a step, your weight pushes down on the arch. It doesnt collapse because of an artful combination of bone shape, springy ligaments, long stirrupt tendons from leg muscles and the arch muscles. The arch muscles of the foot itself dont actually kick in until you reach quite heavy loads: about 400 pounds.1 Although that sounds like quite a lot, loading may spike that high in an average person with every step. We dont have muscles there for nothing, of course! (The biggest arch supporter is probably the tibialis posterior, deep in the calf.2 And the tibialis anterior is another one and it also has a perfect spot for massage, no. 3). Still, the forces on
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all of these structures are relentless and often very large no wonder they get exhausted! When these support mechanisms fail, the connective tissue in the arch may start to degenerate and fray a kind of tendonits called plantar fasciitis. However, many people just develop really significant muscle knots in the arch, and in other arch supporting muscles.
There is another reason why this spot is significant. The skin of the feet has a disproportionate number of nerve endings, like the face and the hands, yet the feet are generally abused or at least neglected. Therefore the sensations of foot massage seem particularly rich and diverse in contrast to the usual stomp, stomp, stomp of their daily stimulus.
How do you find muscle knots in the arch of the foot?

Not only is this probably the most perfect of all Perfect Spots, but it is also perfectly easy to find: it is exactly in the center of the bottom of the foot, halfway between the heel and the ball, and halfway between the inside and outside edges (perhaps slightly closer to the inside).
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The arch muscles generally feel best when pressed on an angle, for example towards the outside of the foot. But this is a minor point: any angle will do!
What does massaging the arch of the foot feel like?

You will know it when you feel it! Having massaged thousands of people and thousands of feet, I can tell you without hesitation that the center of the arch muscles is a popular, feel good spot. It usually produces a clear, sweet ache with mild to moderate thumb pressure only. Note that despite its popularity, Perfect Spot No. 10 usually does not cause any referred sensation thats the satisfying, spreading ache that is often associated with other significant trigger points. Don't take the lack of referred sensation to mean that what you're doing isn't working! All massage feels better when someone else does it, but this is especially true of foot massage. Although it is easy to massage your own foot (and highly recommended if you have no other choice), receiving a foot massage is one of lifes truly delicious experiences, the apple pie la mode of touch.
What about reflexology?

Some believe that there is yet another reason why foot massage feels so good: there may be neurological and/or energetic connections between each part of the sole of the foot and every other region and system of the body. This is called reflexology. Reflexologists claim that foot massage can have a therapeutic effect on any part of the human body. This claim is extraordinary, and extraordinary claims require extraordinary evidence (Carl Sagan, Brocas Brain, 1972). I have certainly never seen nor heard of such evidence, although (to quote another old chestnut of skepticism) absence of evidence is not evidence of absence. The phenomenon may exist, whether there is clear evidence for it or not. However, it is most likely that the profound sensations of foot massage simply gave someone the idea that foot massage was unusually important. I have no trouble with the general idea of therapeutically significant connections between body parts, or even with the particular idea that massaging the foot could affect organs and systems. That is plausible.
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I doubt, however, that the average colourful reflexology map is 100% accurate at least, not compared to the average textbook anatomy diagram. If the connections exist at all, they are probably subtle, and there is probably significant natural variation between individuals. Only a study of a large number of carefully compared observations by several extremely skilled and knowledgeable practitioners could hope to confirm that stimulating a certain tiny spot on the foot has a therapeutic effect on a certain organ and even then it wouldnt necessarily be true of every person. My own personal experience with reflexology is that it feels as good as any other foot massage, but no better, and has no apparent additional therapeutic effect. Still, a foot massage is always a pleasant experience in and of itself.

Trigger point therapy isnt too good to be true: its just ordinary good. It can probably relieve some pain cheaply and safely in many cases. Good bang for buck, and little risk. In the world of pain treatments, thats a good mix. But pain is difficult and complex, no treatment is perfect, and there is legitimate controversy about the science of trigger points. The phenomenon of sensitive spots on the body is undeniable but their nature remains somewhat puzzling, and the classic image of a tightly contracted patch of muscle could just be wrong. On the one hand, you can measure their electrical activity, take samples of their highly acidic tissue chemistry, and now a new MRI-like technology can now show them as well. On the other hand, some of that may be wrong, and all of it could essentially just be side effects of a more basic problem. No one really knows. What we do know is that people hurt. Muscle pain is clinically significant, but medically obscure. As Dr. David Simons wrote, Muscle is an orphan organ. No medical speciality claims it. Many patients can benefit from educating themselves. The Perfect Spots are based on a decade of my own clinical experience as a massage therapist, and years of extensive science journalism on the topic. Want to know more? This is the tip of the iceberg. Ive written a whole book about it
Page 34 of 39
5/16/13 1:09 PM

2Perfect Spot No. 2 Massage Therapy for Low Back Pain This Perfect Spot lives in the thoracolumbar corner, a nook between your lowest rib and your spine right where the stability of the rib cage gives way to the relative instability of the lumbar spine. Muscle tends to bunch up around this joint between the last of the thoracic vertebrae and the first of the lumbar. The sweet spot consists of trigger points in the upper-central corner of the quadratus (square) lumborum muscle
5/16/13 1:09 PM
and in the thick column of muscle that braces the spine. Read more.
5/16/13 1:09 PM
related to: carpal tunnel syndrome, tennis elbow for pain: in the elbow, arm, wrist, and (lateral epicondylitis), golfers elbow (medial hand epicondylitis), thoracic outlet syndrome, and several more
muscle(s): extensor muscles of the forearm, mobile wad (brachioradialis, extensor carpi radialis longus and brevis), extensor digitorum, extensor carpi ulnaris
7Perfect Spot No. 7 Massage Therapy for Bruxism, Jaw Clenching, and TMJ Syndrome Your masseter muscle is your primary chewing muscle not the only one, but the main one and it covers the sides of the jaw just behind the cheeks. Its also the main muscle that clenches your jaw and grinds your teeth, unfortunately, and its one of the most common locations for trigger points in the entire human body. It is probably an accomplice in most cases of bruxism (thats latin for grinding your teeth) and temporomandibular joint syndrome (a painful condition of the jaw joint), plus other unexplained painful problems in the area. Read more.
for pain: in the side of the face, jaw, teeth (rarely) related to: bruxism, headache, jaw clenching, TMJ syndrome, toothache, tinnitus
muscle(s): masseter
Page 37 of 39
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8Perfect Spot No. 8 Massage Therapy for Your Quads A lot of quadriceps aching, stiffness and fatigue emanates from an epicentre of knotted muscle in the lower third of the thigh, in the vastus lateralis, a huge muscle one of your biggest that dominates the lateral part of the leg. Stretching it is effectively impossible, but massage is an option: although often shockingly sensitive, Perfect Spot No. 8 can also be quite satisfying. Its also often complicates or contributes to other problems in the area, especially runners knee (iliotibial band syndrome). Read more.
9Perfect Spot No. 9 Massage Therapy for Your Pectorals The pecs are popular muscles. Of the 700+ muscles in the human body, the pectoralis major is one of the dozen or so that most people can name and point to. It also harbours one of the most commonly-encountered and significant yet little known trigger points in the human body, and can produce pain much like a heart attack in both quality and intensity. Read more.
10THIS PAGE (Perfect Spot No. 10 Massage Therapy for Tired Feet (and Plantar Fasciitis!)) 11Perfect Spot No. 11 Massage Therapy for Upper Back Pain This spot is too large to really be called a spot its more of an area. The thick columns of muscle beside the spine are routinely littered with muscle knots from top to bottom. Nevertheless, there is one section of the group where massage is particularly appreciated: from the thick muscle at the base of the neck, down through the region between the shoulder blades, tapering off around their lower tips. There is no doubt that this part of a back massage feels even better than the rest even the low back, despite its own quite perfect spots, cannot compete. Read more.
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for pain: anywhere in the upper back, related to: scoliosis mainly between the shoulder blades
muscle(s): erector spinae muscle group
Notes
1. Basmajian et al. The Role of Muscles in Arch Support of the Foot. Journal of Bone & Joint Surgery. 1963. PubMed #14077983. BACK TO TEXT 2. Thordarson et al. Dynamic support of the human longitudinal arch: a biomechanical evaluation. Clin Orthop. 1995. PubMed #7634700. BACK TO TEXT
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Massage Therapy for Bruxism, Jaw Clenching, and TMJ Syndrome

The masseter muscle is strong (and special)