What is the controversy surrounding the existence of myofascial trigger points (MTPs)?

The controversy surrounding trigger points centers on their scientific validity and clinical relevance. Many healthcare providers question whether trigger points—described as hyperirritable spots in skeletal muscle that are painful when compressed—truly exist as discrete physiological entities. Critics argue that there is insufficient objective evidence to confirm their existence, pointing to the lack of reliable diagnostic tests, inconsistent identification between practitioners, and the absence of clear histological or imaging markers. Proponents maintain that trigger points are real clinical phenomena that cause myofascial pain and can be effectively treated through techniques like dry needling, massage, and pressure release. The debate is further complicated by the subjective nature of pain assessment, placebo effects in treatment responses, and the overlap between proposed trigger point symptoms and other musculoskeletal conditions. This controversy impacts treatment approaches, with some clinicians basing entire therapeutic systems around trigger point therapy while others avoid the concept entirely, preferring to focus on evidence-based pain management strategies with stronger scientific support.