Trigger points are nasty muscle knots--highly contracted muscle tissue--that often refer pain to somewhere else in the muscle. Trigger points are an all-too-common cause of muscle pain--often severe.

If you've had chronic lower back pain that no one can seem to relieve for long, trigger point treatment might be the remedy you've been seeking. Lower back trigger points are often the cause, or at least a contributing factor, in chronic lower back pain. And, while a professional massage therapist can be very helpful in finding and treating them, you can also learn to do it at home!

Common Lower Back Pain Trigger Points
While trigger points can be anywhere, there are some "ususal suspects" for lower back pain.

One very likely pair of lower back trigger points is just on either side of the spine, at the very bottom of the back, On many people, there are a pair of dimples in the low back. The trigger points are usually just inside the dimples, in the meaty area right before the spine becomes the sacrum. That's the spot.

Two sets of lower back trigger points are actually in the hips.

Look for the first set at the top of the gluteus maximus, where most people have a pair of dimples. If you don't have these handy markers, feel for a pair of distinct bumps of bone, very low on the back (or high on the butt, depending on how you look at it), on either side of the spine, about an inch or so away from the spine. The trigger points are usually found just below the bumps or the dimples, in the thick gluteus maximus muscle.

The second pair of trigger points in the hips are in the gluteus minimus muscles. Find these potential lower back trigger points by pressing into the muscle tissue just below the waist, at the side and back. You might be able to feel the rounded top of the pelvic bone at your waist--it's just below this bone that you want to look. Explore further for more trigger points down the outside of the hip.

And a final likely pair of lower back trigger points is just where the ribs meet the spine. Find the bottom rib, and then follow it inward toward the spine. About an inch away from the spine is a kind of "pocket" where you can almost push underneath the rib. Here's the spot.

How Do I Do Trigger Point Therapy for Myself?
Trigger point therapy consists first of locating the trigger point. Aim for the general areas described above, and then just sort of fish around to find the exact spot. You'll know when you've found one, because it hurts! Often it will make you say Ouch!, or even flinch.

Once you've found it, treat it by putting moderate pressure on it with your fingers or a tool. The pressure usually needs to be uncomfortable to be therapeutic--say a 5-6/10 level of pain (where 10 is high). In other words, it should hurt, but at a tolerable level. If you're holding your breath or gritting your teeth, you're doing it too hard!

You can either hold steady pressure on it for up to 30 seconds or until the pain lessens considerably -- or use a very short, deep stroke, repeated about ten times (or until the pain lessens). Heat applied afterward can help resolve the knot as well.

If you can reach the lower back trigger points with your own hands, you can treat them yourself. Another self-treatment option is to lie on the floor (or stand up against a wall) and place a tennis ball at the site of the trigger point between you and the floor (or wall). Use your body weight to press the tennis ball into the trigger point.

If neither of these techniques work for you, enlist a friend to help.

What Does It Feel Like When I Do It Right?
I'll hurt at first. The pain should be in the 5-6/10 range, where 10 is about the worst pain you've experienced. But the pain usually feels sort of good--that "good hurt" feeling that feels as if it's doing you good. The pain almost always lessens as you hold the pressure on it.

Sometimes treating a trigger point can result in immediate relief. Other times--particularly if you've had it for a long time, it may take treatment over several days or even weeks.

If you get no relief at all after several days of treatment, it's probably not going to help you.

What If I'm Not Pressing in the Right Place?
No worries, really. If you've found a super-tender spot, and you treat it, it's a good thing, whether or not you've found the exact lower back spots I've described here. Trigger points are nasty beasts. They cause pain, stiffness, and weakness in the muscles they affect. So treating them is always good, whether or not you've found the lower back trigger points you intended. Just use common sense and don't press too hard! What you feel should be in the realm of discomfort, not excruciating pain.

What Do I Do After Doing Trigger Point Therapy On Myself?
Put some heat on the trigger point areas for a few minutes after treatment. It feels nice and helps to increase circulation through the area.

How Often Do I Do Trigger Point Treatment?
At least once a day, preferably 3-5 times a day, until the trigger point doesn't hurt anymore when you press on it.

When Should I Not Do Trigger Point Massage?
Don't do trigger point massage over broken or bruised skin. Don't do it over areas where you have reduced sensation. Don't do it over inflamed or swollen areas of your body. Just use common sense!

And here are some great resources for more information:

• The Trigger Point Therapy Workbook, by Claire Davies

• and this great ebook by Vancouver (B.C.) massage therapist Paul Ingraham, Save Yourself from Trigger Points and Myofascial Pain Syndroms.

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