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