Why shoulder pain keeps coming back

Overlooked cause one: (myofascial) trigger points

The first overlooked cause of shoulder pain is (myofascial) trigger points, which are those tender lumps in your muscles that therapists find. As shown below, trigger points cause shoulder pain:

1. directly by shooting referred pain, and
2. indirectly by altering the biomechanics of your shoulder causing abnormal stress and impingement.

What are trigger points

Trigger points are those tender lumps in muscles that massage therapists find. For more info please see our article Trigger point basics, but the key issues are that trigger points:

• refer pain
• tighten muscles and inhibit them from functioning normally.

How trigger points cause pain indirectly

Trigger points indirectly cause shoulder pain by tightening muscles and stopping them working properly. This affects the movement of the shoulder joint, potentially causing abnormal stress and pinching (called “impingement syndrome”). Let's share how this happens.

Increased wear and arthritic changes

The pressure is no longer evenly spread across the joint surfaces so the joints wear faster. Long term this causes degenerative or arthritic changes that can be seen on x/ray.

Potential pain syndromes or injury

When your shoulder joint is moving abnormally parts often have to compensate or work in ways they were not designed to and become over-stressed. Over time these can become painful or are easily injured.

Overlooked cause two: a head forward posture

As shown by several studies (3-8), the second overlooked cause of shoulder pain is a head forward posture. This alters the angle that the arm hangs and the direction the shoulder joint moves, which puts a lot of abnormal strain on some parts, and causes others to jamb together when they otherwise would move freely.

The overlooked treatment: trigger point therapy

Trigger points are a major overlooked cause of shoulder pain so it should come as no surprise that treating trigger points is a major overlooked therapy. Trigger point therapy is a very very effective therapy that has been successfully used in many clinical trials. Scientists agree, with one scientific review of 16 studies into shoulder pain stating that trigger points were the most common cause and their treatment should be the number one priority (9)⁠. Further, another researcher stated that if trigger points were not taken into consideration they could perpetuate and aggravate the problem, hindering diagnosis and making the applied treatments ineffective (10)⁠.

Major treatment error one: treating secondary problems

The issues that medics tend to look at such as inflammation, impingement and damage seen on scans are often secondary to the abnormal stresses from the functional and postural issues discussed above. However, these secondary effects are too often treated completely oblivious to their cause.

Major treatment error two: exercises don’t correct abnormal function

While exercises are often prescribed to help shoulder pain, studies show that they are of little help and can often worsen the problem. The reason is very simple. As discussed in our article functional rehabilitation and demonstrated in several studies of shoulder function, exercises cannot correct the abnormal function caused by trigger points or abnormal posture. When the exercises are done your body uses that same abnormal mechanics that causes the problem in the first place, and likely accelerates any damage.

Practical advice for your shoulder pain

Our goal is to give you the best possible resource to help your shoulder pain. We’ve made you aware of some common miss-information and potential pit falls. Now we’ll give you some positive steps. Please keep in mind that we cannot give specific information to those we have not personally examined so consider this as general information to be discussed with a professional familiar with your own needs.

Primary considerations

Treat your trigger points

Trigger points were found to be a major cause of shoulder pain, and several clinical trials showed that treating the trigger points can give excellent relief (2,9,14–18)⁠. We have a comprehensive guide called Massage and trigger point therapy for shoulder pain: with self help options that gives:

• how to find trigger points
• several effective home therapy options
• a list of muscles that can be potentially involved, with specific instructions for each

Stop doing things that may be stirring up your shoulder.

If you know of any activities that are aggravating your condition stop doing them, at least temporarily while your shoulder settles down. This includes any exercises you may have been prescribed.

Secondary considerations

Joint issues

There are often issues within the shoulder and other joints that inhibit them from working normally. The simplest way to think of these is as adhesions or restrictions stopping the joint surfaces from sliding across each other. Please see this article for more information about these and how they are treated.

Medical issues

There are many possible medical causes of shoulder pain that could be considered, especially if the pain is severe or not settling using conservative measures. Some are listed below. Please keep in mind that some may be secondary and will resolve once any abnormal stress is removed, but they may also be:

• primary resulting from something such as an injury
• secondary, but have developed into a problem in their own right.

Some possible medical causes of shoulder pain (11)⁠

• Rotator cuff pathology (tendonitis, tears)
• Bursitis
• Impingement
• Acromioclavicular pathology (sprains, instability)
• Labral tears
• Long-head biceps brachii pathology
• Instability
• Adhesive capsulitis/stiff shoulder
• Scapular dyskinesis
• Fracture
• Cervical radiculopathy

Appendix: research support

We realise that the contents of this article are contrary to information provided by medical journals and respected professionals, so we conclude with documentation of the research papers and clinical trials that support the major points.

Trigger points as a cause of shoulder pain and trigger point therapy as a treatment

• Basic trigger point research showing what they are and what they do (19–23)⁠
• Trigger points highly prevalent in shoulder pain sufferers (9,24,25)⁠
• Those trigger points refer pain to the shoulder (2,10,25)⁠
• Trigger points effect shoulder function and can cause damage or injury (26–28)⁠
• Trigger point therapy relieves shoulder pain (2,9,14,16–18,29)⁠

Head and shoulder forward posture as a cause of shoulder pain

• This posture as a cause (3–8,30)⁠
• Correcting this posture relieves shoulder pain (8)⁠

Medical journals ignore this information

• Examples (11–13)⁠

Medical are procedures ineffective for shoulder pain

• Analgesics, NSAIDS, corticosteroids and physiotherapy (31,32)⁠

Exercises are unlikely to help shoulder pain

• Clinical trial results (29,31,33,34)⁠
• Exercises cannot correct key functional problems (35–37)⁠

References

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