Myofascial pain
Trigger Points & Muscle Knots | North Vancouver
That deep, ropey knot that aches at rest and shoots pain somewhere else when you press it. Dry needling reaches the muscle fibres that stretching and rubbing can't.
What it is
Understanding your trigger points.
Trigger points are tight, irritable knots inside a muscle, taut bands or nodules that are sore to press and often refer pain somewhere else entirely. A knot in the shoulder can send pain up into the head; one in the glute can mimic sciatica down the leg. Beyond the ache, they can stiffen a muscle, cut its range, and leave it feeling weak, which is why they get blamed for everything from tension headaches to nagging back pain. At Medstar Sport Physio in North Vancouver, we assess and treat this through a one-on-one physiotherapy appointment, confirming the pattern and building a plan from there. We see patients from across Vancouver and the North Shore, many of whom cross Lions Gate Bridge or take the SeaBus for treatment here.
They form when a muscle is overworked, strained, or held in one position for too long. Hours hunched at a desk, a repetitive task, the residue of an old injury, stress that keeps muscles clenched, all of it creates the imbalances and local overload that let these knots set in. Poor recovery, dehydration, and run-down muscles make the tissue even more prone to forming them.
Left alone, a trigger point doesn't just sit there quietly. It changes how the muscle works, recruits its neighbours to compensate, and spreads the pain pattern beyond where it started. That cascade is why treating the knot itself usually isn't enough, we also have to address the posture, habit, or weakness that keeps feeding it.
What to expect
A single irritable trigger point often releases noticeably right after a dry needling session, sometimes with a day of mild post-treatment soreness like you've worked out. Knots that have been there for months, or that keep coming back, take a series of sessions paired with the right exercise and habit changes, the needling settles the muscle, but the strengthening and ergonomic work are what keep it settled. If your pain doesn't behave like myofascial pain should, we'll reassess rather than keep needling a muscle that isn't the culprit.
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Common questions
About trigger points.
What is IMS dry needling and how is it different from acupuncture?
IMS uses the same fine needles as acupuncture but is grounded in Western anatomy and neurophysiology rather than meridians. The needle is placed directly into a taut, knotted muscle band to provoke a brief twitch that releases the trigger point and calms the irritated nerve supply. It targets the specific muscle driving your pain rather than traditional acupuncture points.
Does dry needling hurt?+
Most people feel the needle go in only faintly, then a deep cramp or twitch when it hits the trigger point, brief and a sign it's working. Afterward the muscle can feel sore or tired for a day or so, similar to post-exercise ache. We adjust how aggressive we are to your tolerance, and the soreness is short-lived.
Why does pressing a knot in my shoulder cause pain in my head?+
That's referred pain, and it's the hallmark of trigger points. A knotted muscle can send pain to a predictable area away from the muscle itself, shoulder knots referring into the head and neck is a classic pattern behind many tension headaches. Recognising the pattern is how we trace the headache back to the muscle actually causing it.
Can I just keep using a massage gun or foam roller instead?+
Self-release tools help with general tightness and are great for maintenance, but they often can't reach or fully release a stubborn, deep trigger point, that's where dry needling has an edge. And neither addresses why the knots keep forming. Pairing hands-on or needling treatment with the strength and posture work is what actually breaks the cycle.
What causes trigger points to form in the first place?+
Trigger points form when a muscle is overworked, strained, or held in one position for too long. Hours hunched at a desk, a repetitive task, the residue of an old injury, and stress that keeps muscles clenched all create the imbalances and local overload that let these knots set in. Poor recovery, dehydration, and run-down muscles make the tissue even more prone to forming them.
How long does it take for a trigger point to go away?+
A single irritable trigger point often releases noticeably right after a dry needling session, sometimes with a day of mild post-treatment soreness like you've worked out. Knots that have been there for months, or that keep coming back, take a series of sessions paired with the right exercise and habit changes. The needling settles the muscle, but strengthening and ergonomic work are what keep it settled.
Will trigger points just come back after treatment?+
They can, if the posture, habit, or weakness that fed them isn't addressed alongside the knot itself. Targeted strengthening helps the muscle handle its workload without re-knotting under fatigue, and posture, ergonomic, and stress-load coaching removes the daily input that keeps regenerating trigger points. Treating the knot alone, without these, usually isn't enough to keep it from returning.
Do you treat the sore spot or something else?+
Both. The assessment maps the referral pattern back to its source, because the spot that hurts often isn't the muscle that's actually the problem, such as a shoulder knot referring pain into the head. We treat the trigger point itself with dry needling and hands-on release, then address whatever posture or habit is feeding it so the pain pattern doesn't just move somewhere else.
Reviewed by Amir Ahmadi, PhD, MSc PT, Registered Physiotherapist, Certified IMS Therapist, College of Physical Therapists of British Columbia (CPTBC). Last reviewed July 2026.
This page is for general information only and does not constitute medical advice, diagnosis, or treatment. Individual presentations vary, and assessment findings and treatment plans differ from person to person. If you are experiencing severe symptoms, neurological changes (numbness, weakness, bowel or bladder changes), or a significant trauma, contact your physician or emergency services. Physiotherapy at Medstar Sport Physio & Health is provided by physiotherapists registered with the College of Physical Therapists of British Columbia (CPTBC).