Best Exercises for Myofascial Pain and Trigger Points
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By Dr. Jeffrey Peng, MD · Published March 6, 2025 · 5 min read
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Myofascial pain syndrome and trigger points are among the most common causes of chronic musculoskeletal pain, affecting an estimated 85% of patients who visit chronic pain clinics. Despite how widespread this condition is, effective treatment remains a challenge for many patients and clinicians alike. Traditional management typically involves soft tissue modalities such as massage, acupuncture, and electrotherapy with devices like TENS units. However, a growing body of evidence suggests that exercise therapy — particularly a combination of stretching, strengthening, and aerobic exercise — may be one of the most effective strategies for treating myofascial trigger points.
In this article, I review three systematic reviews that examined the role of exercise in managing myofascial pain and explain how a multimodal rehabilitation approach can help patients achieve the best outcomes.
What Is Myofascial Pain Syndrome?
Myofascial pain syndrome is a chronic pain condition characterized by the presence of myofascial trigger points — hyperirritable spots within taut bands of skeletal muscle. These trigger points can cause local and referred pain, muscle stiffness, and restricted range of motion.
The prevailing theory behind trigger point formation is the energy crisis hypothesis. According to this model, trigger points develop in areas of muscle with poor oxygen and energy supply. Without adequate metabolic resources, the affected muscle fibers remain in a sustained contracted state, leading to the tight muscles, muscle spasms, and painful knots that patients commonly experience. This understanding is important because it provides the rationale for why exercise — which improves blood flow and metabolic activity in muscle tissue — can be such a powerful treatment tool.
Does Stretching and Strengthening Help Trigger Points?
A systematic review published in the Journal of Physiotherapy examined whether stretching combined with strengthening exercises could reduce symptoms of myofascial pain (Mata Diz et al., 2017). The review included eight randomized controlled trials with a total of 255 participants.
When the results from six of those studies were pooled, the authors found that exercise therapy significantly reduced pain intensity compared with minimal or no intervention. The weighted mean difference was −1.2 points on a 0-to-10 pain scale. While this may sound modest, it represents a clinically meaningful improvement for patients dealing with chronic pain.
Importantly, a sensitivity analysis revealed that combining stretching and strengthening exercises produced even greater short-term pain reduction (−2.3 points on the same scale) compared to minimal or no intervention. This suggests that a comprehensive exercise program targeting both flexibility and muscle strength yields superior results to either approach alone.
This makes physiological sense. Stretching and strengthening exercises improve blood flow to the affected muscle group, which may help address the underlying energy crisis driving trigger point formation. By delivering more oxygen and nutrients to the contracted tissue, a targeted rehabilitation program can begin to restore normal metabolic function in the muscle.
Can Aerobic Exercise Treat Myofascial Pain?
While stretching and strengthening have received the most research attention, a systematic review published in the Journal of Exercise Rehabilitation specifically examined whether aerobic exercise improved symptoms of myofascial pain (Ahmed et al., 2018). The researchers screened 1,331 articles and identified 23 for full review. Remarkably, 22 of those 23 studies focused on stretching and strengthening — only one study specifically investigated aerobic exercise as an intervention for myofascial pain.
That single eligible study examined whether a water-based aerobic exercise program could help myofascial pain in the neck and upper back. Participants were divided into two groups: a control group receiving routine care, and an intervention group completing a one-hour water exercise program three times per week for eight weeks.
The results were noteworthy. The water-based aerobic exercise group demonstrated significantly lower neck and shoulder muscle pain, higher pain pressure thresholds, and an overall reduction in the number of active trigger points compared to the control group. These findings suggest that aerobic exercise has a meaningful role to play in trigger point management, even though the research base remains thin. This is clearly an area that deserves more investigation.
How Does Exercise Reduce Trigger Point Pain?
A larger and more recent systematic review and meta-analysis published in Pain Medicine analyzed 24 randomized controlled trials evaluating physical exercise programs for myofascial trigger points (Guzmán-Pavón et al., 2021). The pooled results showed that exercise programs produced significant improvements in pain intensity, pressure pain threshold, and range of motion.
Several mechanisms explain why exercise is so effective for myofascial pain:
Improved local blood flow. Stretching and strengthening increase perfusion to the affected muscles, delivering the oxygen and metabolic substrates needed to resolve the energy crisis at the trigger point.
Reduced systemic inflammation. Aerobic exercise helps lower circulating inflammatory markers throughout the body — an effect that stretching and strengthening alone cannot achieve. This systemic anti-inflammatory response explains why water-based aerobic exercise helped trigger points in the neck and shoulders even though the exercise targeted the whole body.
Endorphin and catecholamine release. Endurance activities stimulate the production of anti-inflammatory signaling molecules and promote the release of endorphins and catecholamines. These neurochemicals provide natural pain relief and are responsible for the well-known "runner's high" phenomenon.
A Multimodal Approach to Treating Myofascial Pain
In my practice, I recommend a comprehensive, multimodal approach to managing myofascial pain syndrome. Rather than relying on any single treatment, the best outcomes come from combining several evidence-based strategies:
Trigger point injection needling therapy to directly address active trigger points and break the cycle of sustained muscle contraction.
Exercise therapy including targeted stretching and strengthening exercises for the affected muscle groups, combined with regular aerobic activity such as walking, swimming, or cycling.
Self-directed acupressure therapy using tools such as a foam roller, tennis ball, therapy ball, or lacrosse ball to perform self-myofascial release at home.
This multimodal framework addresses myofascial pain from multiple angles — the local trigger point, the regional muscle imbalance, and the systemic inflammatory environment. For patients willing to commit to a consistent rehabilitation program, this approach puts them in the best possible position to achieve long-term relief.
If you are dealing with chronic myofascial pain and would like personalized guidance, consider scheduling a consultation to discuss a treatment plan tailored to your needs.
References
1. Mata Diz JB, de Souza JRLM, Leopoldino AAO, Oliveira VC. Exercise, especially combined stretching and strengthening exercise, reduces myofascial pain: a systematic review. Journal of Physiotherapy. 2017;63(1):17-22. doi:10.1016/j.jphys.2016.11.008
2. Ahmed S, Khattab S, Haddad C, Babineau J, Furlan A, Kumbhare D. Effect of aerobic exercise in the treatment of myofascial pain: a systematic review. Journal of Exercise Rehabilitation. 2018;14(6):902-910. doi:10.12965/jer.1836406.205
3. Guzmán-Pavón MJ, Cavero-Redondo I, Martínez-Vizcaíno V, Fernández-Rodríguez R, Reina-Gutierrez S, Álvarez-Bueno C. Effect of physical exercise programs on myofascial trigger points-related dysfunctions: a systematic review and meta-analysis. Pain Medicine. 2021;21(11):2986-2996. doi:10.1093/pm/pnaa253
Medical Disclaimer: This content is for educational purposes only and does not substitute for the medical advice of a physician. Always consult your healthcare provider before beginning any new treatment program. The information presented reflects the opinion of Dr. Jeffrey Peng and does not represent the views of his employers or affiliated hospital systems.
