Muscles
Masseter Trigger Points
Symptom Area: Head and Neck
Masseter Trigger Points are explored here through their location and referred pain pattern. Muscle knots is an everyday term used for tender muscular spots; myofascial pain describes pain involving muscle and its surrounding connective tissue. Primary cause of jaw pain, ear pain and bruxism-related headache — the strongest muscle of mastication per gram.
Where you feel it
When the Masseter holds active trigger points, you usually notice it as cheek pain (like sinusitis), earaches/tinnitus (ringing)/itch, teeth grinding (bruxism), temporomandibular joint disorders (tmj) and upper and lower molar tooth pain (toothache). Where the pain spreads: Superficial points refer to the upper and lower molars, eyebrow and TMJ. What often sets it off: Bruxism (day and night), clenching under stress, chewing gum, malocclusion, prolonged dental work.
Overview
Thick superficial muscle running from the zygomatic arch to the angle of the mandible. Elevates and protrudes the jaw. Trigger points are extremely common in bruxers and people with TMJ dysfunction.
Trigger point locations
Superficial layer points along the body of the muscle, plus deep layer points behind the zygomatic arch (often intraorally accessible).
Referred pain pattern
Superficial points refer to the upper and lower molars, eyebrow and TMJ. Deep points refer to deep ear pain and the side of the head.
Palpation & testing
Externally with pincer grip on the cheek and jaw angle. Intraorally with a gloved finger for deep fibers.
Common causes
Bruxism (day and night), clenching under stress, chewing gum, malocclusion, prolonged dental work.
Self-care & clinical treatment
Awareness of clenching, soft-diet phase during flare-ups, jaw relaxation drills, intraoral and extraoral self-massage. Clinically: needling (extra- and intraoral), occlusal splint referral when indicated.
Treatment protocol
For Masseter, the general protocol applies: sustained pressure release on the taut band, then stretch and active movement in the newly gained range.
Position and palpation: Externally with pincer grip on the cheek and jaw angle.
Regional precaution for clinicians: In the neck and jaw, needle placement must respect the carotid sheath, the external jugular vein, the vertebral artery in the suboccipital region and the lung apex behind the lower scalenes and the medial supraclavicular fossa.
Primary Symptoms
Secondary Symptoms
Often confused with
These muscles cause the same primary symptoms, so they are checked together:
Related muscles in this region
Related articles
- The headache that arrives at the end of the day: a suboccipital and trapezius treatment plan
- Do stretching and exercise actually change a trigger point? What the trials show
- Jaw pain, clicking and morning tightness: the chewing-muscle trigger points behind it
- What is actually inside a trigger point? What imaging and biochemistry studies show
- Trigger points and tension-type headache: what studies found
- Cheek Pain (like Sinusitis): which trigger points cause it and how to treat them
References
- • Travell & Simons, Vol. 1
- • Effectiveness of dry needling for upper-quarter myofascial pain: a systematic review and meta-analysis — J Orthop Sports Phys Ther 2013;43(9):620-34
- • The effectiveness of trigger point dry needling for musculoskeletal conditions by physical therapists: a systematic review and meta-analysis — J Orthop Sports Phys Ther 2017;47(3):133-49
- • Effectiveness of trigger point dry needling for multiple body regions: a systematic review — J Man Manip Ther 2015;23(5):276-93
- • A systematic review of manual therapy techniques, dry cupping and dry needling in the reduction of myofascial pain and myofascial trigger points — J Bodyw Mov Ther 2019;23(3):539-46
- • Physiologic effects of dry needling — Curr Pain Headache Rep 2013;17(8):348
- • Trigger point dry needling for the treatment of myofascial pain syndrome: current perspectives within a pain neuroscience paradigm — J Pain Res 2019;12:1899-911
- • Myofascial trigger points then and now: a historical and scientific perspective — PM R 2015;7(7):746-61
- • Pertinent dry needling considerations for minimizing adverse effects — Int J Sports Phys Ther 2016;11(5):651-62
- • Adverse events associated with therapeutic dry needling — Int J Sports Phys Ther 2020;15(1):103-13
- • Lidocaine injection versus dry needling to myofascial trigger point: the importance of the local twitch response — Am J Phys Med Rehabil 1994;73(4):256-63
- • Myofascial Pain and Dysfunction: The Trigger Point Manual (2nd ed.) — Williams & Wilkins, Baltimore
Medically reviewed by: Marco Aruffo — physiotherapist since 2006, specialised in myofascial pain · Last reviewed:
