The foam roller, by itself, can be sweet healthy trigger point pain.
My calfs seem to be one part knot to three parts muscle.
I start off with the foam roller. On goes my leg. next goes a nice, big, dense pillow. Then a 30# dumbbell. Finally, my opposite leg.
Then I wait. sometimes the muscle goes into a cramp by itself, sometimes I have to contract it. But when it decides to spasm, I work on stretching it out, and lo and behold the knot feels smaller than it did when I started.
I don't know whether I'm right in what I'm feeling, or if I'm deluding myself, but at the very least it's teaching me to deal with pain, which is always a useful skill.
What I think I might need is a skilled massage therapist who's also part sadist. That might be the way to go...