Can (myofascial) trigger points cause shoulder pain

CONTENTS

What are trigger points
How trigger points cause shoulder pain

• How trigger points cause pain directly
• How trigger points cause pain indirectly

Why shoulder pain keeps coming back
The solution
The treatment of trigger points
Professionals
Appendix: muscles found to directly cause shoulder pain
References

What are trigger points

How trigger points cause shoulder pain

It is clear that trigger points are a big cause of shoulder pain. Studies have found that compared with people who have no pain, the shoulder muscles of shoulder pain sufferers are usually riddled with trigger points (1–4)⁠, and many clinical trials have shown that massage or trigger point therapy relieves this pain (1,5–9)⁠. Lets look at the way trigger points can cause this pain: directly and indirectly (commonly both).

How trigger points indirectly cause shoulder pain

The basic principles

Why shoulder pain keeps coming back

There are two main trigger point related reasons shoulder pain keeps coming back.

1. The medical profession largely ignores trigger points, meaning that the real cause of shoulder pain is not addressed and in-appropriate treatment is given instead.
2. If trigger points are identified they are usually treated so as to stop them hurting but not eliminate them, so of course they eventually start causing pain again.

Trigger points are largely ignored by the medical profession

Despite all the evidence to the contrary trigger points are barely mentioned in medical journals.
Example One:
The article Clinical evaluation of non-arthritic shoulder pain: diagnosis and management (18)⁠ in medical journal Physician and Sports Medicine makes no mention of trigger points

Example Two:
The articles Chronic shoulder pain: part I Evaluation and Diagnosis and part II treatment (19,20)⁠ in the journal American Family Physician tells doctors that if they do notice a trigger point it is probably fibromyalgia instead.

We can only speculate why that is, but basically every source of information for doctors relies on money from drug companies, and if you wanted to sell lots of pain killers and other drugs you couldn’t come up with a much better plan than not telling doctors about trigger points.

Providing the wrong treatment

With trigger points omitted from medical journals doctors most commonly just detect the pinching and secondary issues it causes and make the diagnosis of shoulder impingement syndrome (10)⁠. Of course treating impingement should include treating those trigger points that are shortening and weakening muscles causing the abnormal function. Instead doctors are instructed to prescribe remedial exercises, analgesics, anti-inflammatory drugs and cortisone needles, plus of course surgery when the secondary damage gets worse (18,20)⁠.

Superficially the prescription of exercises sounds sensible, but as discussed in our article on functional rehabilitation function of the shoulder joint cannot return to normal as long as the things that cause it to be abnormal remain. This means that so called corrective exercises usually do not return function to normal. This has been demonstrated by several trials that found that using therapies directed at the underlying muscular issues combined with exercises gave much better results than when exercises alone were used (21–24)⁠. Further, scientists have been able to detect and monitor the abnormal programming of shoulder muscles. They have found that exercises fail to change this programming (25)⁠, whereas the treatment of trigger points returns it to normal (26)⁠.

Trigger points inadequately treated

The second issue that typically causes shoulder pain to keep coming back is that most treatments for trigger points merely stop them from referring pain, not eliminate them. This is discussed in our article Trigger point treatment: deactivation or elimination, but in summary trigger points start as small lumps that are only detected when a therapist presses on them and they shoot pain. Over time they develop, becoming much larger and having considerable adverse effects on muscle function, then eventually they may be aggravated and cause pain. Trigger point therapies are typically used and tested to just revert the trigger points back to as they were before shooting pain. You feel much better, but of course they still inhibit muscle function and are usually re-aggravated to shoot pain again.

The solution

If you have shoulder pain we’ve seen that trigger points are a large and important cause of shoulder pain that is largely ignored by medicine and too often inadequately treated. If trigger points are causing or contributing to your shoulder pain typical treatments like anti-inflammatory drugs and exercises will not fix the problem, and your session of trigger point therapy or the trigger point release you saw on Youtube will only provide temporary relief. To properly eliminate shoulder pain we recommend you consult a professional who deals with shoulder problems and is knowledgeable about trigger points, and discuss incorporating the strategy below to eliminate trigger points in your management.

Why you need professional help

Unless it is a very simple problem there will likely be factors other than trigger points contributing to your shoulder pain. Some examples may include:

• If you have a head and shoulder forward posture contributing to your problems this will need to be addressed
• If the problem has been there a while there may be some weakening of muscles and stiffening of joints due to disuse.
• There may be some activity you are doing that is contributing to the problem.

The treatment of trigger points

In this section we will give an overview of how trigger points are treated. We will first discuss how trigger point therapies work, then how these can be incorporated into a plan to eliminate your trigger points and keep yourself trigger point free.

Number of treatments

Our example above and other clinical trials show that courses of 3-12 sessions of therapy reduce pain but eliminate less than one third of trigger points (10,29,30). Therefore a very large number of treatments are necessary to eliminate trigger points properly. Because of this it is best if some therapy can be self applied, it it will become very expensive.

Our choice of therapy

Getting started treating your trigger points

Although self treatment with a vibration massager is very simple, trigger points can be part of more complex issues. It is also good to have a professional advise how to find them and where to apply the therapy. To get started you will need to find a good professional who understands trigger points. If you go to our get a massager page then select your country you should find near the top a link to a list of clinics that may be able to help. Alternatively, you can find a qualified professional such as a Chiropractor, Osteopath or Physiotherapist and discuss this with him or her.

Getting a suitable vibration massager.

You will need an effective vibration massager. There is a lot of miss-information and ineffective machines available. I’ve linked some information below to help you choose, or you can use the safe option and get one of ours.
Video: How to choose a massager
Article: Percussion vs vibration massage
Video: Our highly effective vibration massager

Apendix: the muscles found to directly cause shoulder pain

Upper trapezius muscle
Middle trapezius muscle
Lower trapezius muscle
Infraspinatus muscle
Supraspinatus muscle
Subscapularis muscle
Teres minor muscle
Teres major muscle
Anterior deltoid muscle
Middle deltoid muscle
Posterior deltoid muscle
Pectoralis major muscle
Pectoralis minor muscle
Biceps brachii muscle
Triceps brachii muscle

References

1. Sergienko S, Kalichman L. Myofascial origin of shoulder pain: A literature review. J Bodyw Mov Ther [Internet]. 2015;19(1):91–101. Available from: http://dx.doi.org/10.1016/j.jbmt.2014.05.004
2. Bron C. High prevalence of shoulder girdle muscles with myofascial trigger points in patients with shoulder pain. BMC Musculoskelet Disord . 2011;12.
3. Hidalgo-Lozano A. Muscle trigger points and pressure pain hyperalgesia in shoulder muscles in patients with unilateral shoulder inpingement: a blinded controlled study. Exp Brain Res. 2010;202:915–25.
4. McEvoy J, Dommerholt J. Myofascial Trigger Points of the Shoulder. Phys Ther Shoulder. 2012;351–79.
5. Gordon CM, Andrasik F, Schleip R, Birbaumer N, Rea M. Myofascial triggerpoint release (MTR) for treating chronic shoulder pain: A novel approach. J Bodyw Mov Ther . 2016;20(3):614–22.
6. Van Den Dolder PA, Roberts DL. A trial into the effectiveness of soft tissue massage in the treatment of shoulder pain. Aust J Physiother . 2003;49(3):183–8.
7. Shih YF, Liao PW, Lee CS. The immediate effect of muscle release intervention on muscle activity and shoulder kinematics in patients with frozen shoulder: A cross-sectional, exploratory study. BMC Musculoskelet Disord. 2017;18(1):1–10.
8. Van Den Dolder PA, Ferreira PH, Refshauge KM. Effectiveness of soft tissue massage and exercise for the treatment of non-specific shoulder pain: A systematic review with meta-analysis. Br J Sports Med. 2014;48(16):1216–26.
9. Hains G, Descarreaux M, Hains F. Chronic Shoulder Pain of Myofascial Origin: A Randomized Clinical Trial Using Ischemic Compression Therapy. J Manipulative Physiol Ther. 2010;33(5):362–9.
10. Bron C, De Gast A, Dommerholt J, Stegenga B, Wensing M, Oostendorp RAB. Treatment of myofascial trigger points in patients with chronic shoulder pain: A randomized, controlled trial. BMC Med. 2011;9.
11. Lucas KR, Rich PA, Polus BI. How common are latent myofascial trigger points in the scapular positioning muscles? J Musculoskelet Pain. 2008;16(4):279–86.
12. Jcu R, Sakthi D. Clinical assessment of subacromial impingement-which factors differ from asymptomatic population. Musculoskeltal Sci Pract. 2017;27:49–56.
13. Alizadehkhaiyat O, Roebuck MM, Makki AT, Frostick SP. Postural alterations in patients with subacromial impingement syndrome. Int J Sports Phys Ther. 2017;12(7):1111–20.
14. Skolimowskil J, Barczyk K, Dudek K, Skolimowska B, Demczuk-Włodarczyk E, Anwajler J. Posture in people with shoulder impingement syndrome. Ortop Traumatol Rehabil. 2007;9(5):484–48498.
15. Otoshi K, Takegami M, Sekiguchi M, Onishi Y, Yamazaki S, Otani K, et al. Association between kyphosis and subacromial impingement syndrome: LOHAS study. J Shoulder Elb Surg . 2014;23(12):e300–7.
16. Hunter DJ, Rivett DA, McKeirnan S, Smith L, Snodgrass SJ. Relationship between Shoulder Impingement Syndrome and Thoracic Posture. Phys Ther. 2020;100(4):677–86.
17. Land H. Clinical assessment of subacromial shoulder impingement – which factors differ from the asymptomatic population? Musculoskeltal Sci Pract. 2017;70:429–40.
18. Holmes RE, Barfield WR, Woolf SK. Clinical evaluation of nonarthritic shoulder pain: Diagnosis and treatment. Phys Sportsmed. 2015;43(3):262–8.
19. Burbank KM, Stevenson JH, Czarnecki GR, Dorfman J. Chronic shoulder pain: Part I. Evaluation and diagnosis. Am Fam Physician. 2008;77(4):453–60.
20. Burbank KM, Stevenson JH, Czarneck GR, Dorfman J. Chronic shoulder pain: Part II. Treatment. Am Fam Physician. 2008;77(4):493–7.
21. Arias-Buría JL, Fernández-de-las-Peñas C, Palacios-Ceña M, Koppenhaver SL, Salom-Moreno J. Exercises and Dry Needling for Subacromial Pain Syndrome: A Randomized Parallel-Group Trial. J Pain. 2017;18(1):11–8.
22. Senbursa G, Baltacı G, Atay A.Comparison of conservative treatment with and without manual physical therapy for patients with shoulder impingement syndrome: A prospective, randomized clinical trial. Knee Surgery, Sport Traumatol Arthrosc. 2007;15(7):915–21.
23. Yemul SR. COMPARISON OF SUPERVISED EXERCISE WITH AND WITHOUT MANUAL PHYSICAL THERAPY FOR PATIENTS WITH SHOULDER IMPINGEMENT SYNDROME. J Cur Res Rev . 2013;05(05):5.
24. Bang MD, Deyle GD. Comparison of supervised exercise with and without manual physical therapy for patients with shoulder impingement syndrome. J Orthop Sports Phys Ther. 2000;
25. De Mey K, Danneels L, Cagnie B, Cools AM. Scapular muscle rehabilitation exercises in overhead athletes with impingement symptoms: Effect of a 6-week training program on muscle recruitment and functional outcome. Am J Sports Med. 2012;40(8):1906–15.
26. Lucas KR, Rich PA, Polus BI. the Effects of Latent Myofascial Trigger Points on Muscle Activation Patterns During Scapular Plane Elevation. Jclb . 2007;25(8):765–70.
27. Simons DG. Understanding effective treatments of myofascial trigger points. J Bodyw Mov Ther. 2002;6(2):81–8.
28. Dommerholt J, Bron C, Franssen J. Myofascial Trigger Points: An Evidence-Informed Review. J Man Manip Ther. 2006;14(4):203–21.
29. Shah JP, Phillips TM, Danoff J V., Gerber LH. An in vivo microanalytical technique for measuring the local biochemical milieu of human skeletal muscle. J Appl Physiol. 2005;99(5):1977–84.
30. Grieve R, Barnett S, Coghill N, Cramp F. Original article: Myofascial trigger point therapy for triceps surae dysfunction: A case series. Man Ther . 2013;18:519–25.