Trigger points are those tender lumps in muscles that therapists find. This article covers what they are, what they do, and how they are... Read Article
Is massage good for shoulder pain: with illustrated self massage guide
Massage is widely recommended for the treatment of shoulder pain, but does it work? Yes it does, but only if you use specific trigger point therapy rather than general massage. According to the large number of clinical trials
- massage generally only gives moderate short term relief of shoulder pain at best, and no improvement in function, and
- specific trigger point therapy rather than massage gave far better results.
What we will do to help you to get the best results possible
If you have shoulder pain we want it to get better, so in this article we will show you the following.
We will show you why why massages just give short term relief, and how to do the more effective trigger point therapy.
We will show you the other causes of shoulder pain, including the two most important causes of shoulder pain that doctors commonly miss.
In this section we show you the commonly prescribed shoulder pain remedies that are of little use and can actually cause harm
Section One: Why massages just give short term relief, and how to do the more effective trigger point therapy
Clinical trials tell us massage is generally not effective for shoulder pain
As this conclusion from a scientific review of the 12 available clinical trials of massage for shoulder pain found, massage usually only gives short term relief and no improvement in function (1).
Trigger point therapy is much more effective
While the clinical trial results for general massage were not very encouraging therapy directed at trigger points gave much better results (2–4). To help you with trigger points we share the following resources.
What are trigger points
Trigger points are those deep tender lumps in your muscles that shoot pain when pressed upon. As we’ll discuss later in the section on overlooked caused of shoulder pain they cause pain by both:
- referring pain directly, or
- causing muscles to become tight and not work properly, affecting the mechanics of your shoulders.
For further information please see our resource article: What are trigger points
Professional trigger point therapies
For an evaluation of the professional therapies please see our article: What is the best trigger point therapy
Self trigger point therapies
There are very effective self trigger point therapies. We we encourage you to look at these to save money and enable you to get he amount of care you need to get properly better. Because there is a lot of practical demonstration involved we put together this video and a quick reference summary.
Quick reference video summary
Why we use vibration massage
We apply trigger point therapy with a vibration massager because it is:
• highly effective
• penetrates better
• safer, with no pain
• extremely easy
The basic technique
• find the trigger point
• apply vibration massage for 30-60 seconds
The individual shoulder muscles
Scientists have found that trigger points in any of 17 different muscles can cause shoulder pain. In the video we show how to do trigger point therapy on each.
How to stay safe and get the best results
Continue regular treatment
The initial trigger point therapy just relieves pain. Continue the therapy to eliminate the trigger points completely.
Do not use a massage gun (percussion massager)
percussion massagers are designed to pummel the muscle rather than deliver therapeutic vibrations, making them a lot less effective and potentially harmful.
How to find a suitable vibration massager
Unfortunately most massagers available are either massage guns, ineffective consumer massagers, or both. For how to choose a safe effective machine please see How to choose a massager. The machines we had purpose built got this therapy are:
Section two: The two most important causes of shoulder pain that doctors commonly miss
Medical journals and medical education are heavily influenced by drug companies so doctors often don’t get told about anything that would reduce the sale of drugs. In the case of shoulder pain the two main scientifically proven causes of shoulder pain are omitted, and instead doctors are encouraged to prescribe useless drugs and therapies. To help you evaluate the resulting advice, we
- summarise the omitted causes, and
- in the next section the summarise the useless therapies.
For full details please see our article Why shoulder pain keeps coming back.
Overlooked cause one: a head forward posture
Many scientific trials have shown that having a head forward posture as pictured is a major cause of shoulder pain (5–11). This causes abnormal stress on the shoulder muscles and joint. Instead of being mentioned in medical journals doctors are trained to recognise the damage this causes (eg. impingement syndromes) and treat the symptoms.
Overlooked cause two: (myofascial) trigger points
As mentioned above trigger points can cause shoulder pain by
- direct referral or by,
- causing muscles to be abnormally tight and not work properly, therefore causing abnormal stress and pinching.
In a series of trials, highly credentialed scientists have found that they are are a major cause of shoulder pain, and that treating them gives excellent relief (2–4,12–15). However, this is usually not mentioned in medical journals (16–18)
Section three: commonly prescribed shoulder pain remedies that are of little use and can actually cause harm
Despite being confidently prescribed, this research summary taken from the Journal of Shoulder and Elbow Surgery (19) sums up how useful and “scientific” most of the medically prescribed shoulder pain therapies are.
Exercises alone are particularly stupid
The prescription of exercises to “correct” shoulder function deserves a special mention. Put simply, issues such as having a head forward posture or trigger points cause shoulder joints to function abnormally, creating abnormal stress and pinching that can eventually become painful. Exercises are prescribed rather than remove these impediments to normal function. Of course with the impediments still there function cannot return to normal so the shoulder continues to move in the same damaging way. It is not surprising that one trial of 148 patients found that both a supervised rehabilitation program and a home exercise program actually made the shoulder pain worse (20).
DrGraeme massagers were originally built by Dr Graeme for use in his clinic, and to prescribe to his patients for additional self use at home. Now these are used by colleagues and other professionals for similar purposes. If you are a professional and wish to know more about this therapy, or possibly get a sample massager to trial please check out our practitioner page.
- Kong LJ, Zhan HS, Cheng YW, Yuan WA, Chen B, Fang M. Massage therapy for neck and shoulder pain: A systematic review and meta-analysis. Evidence-based Complement Altern Med. 2013;2013(Feb 28).
- Sergienko S, Kalichman L. Myofascial origin of shoulder pain: A literature review. J Bodyw Mov Ther. 2015;19(1):91–101.
- 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.
- 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.
- Jcu R, Sakthi D. Clinical assessment of subacromial impingement-which factors differ from asymptomatic population. Musculoskeltal Sci Pract. 2017;27:49–56.
- 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.
- 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.
- 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.
- 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.
- Lewis JS, Wright C, Green A. Subacromial impingement syndrome: The effect of changing posture on shoulder range of movement. J Orthop Sports Phys Ther. 2005;35(2):72–87.
- Land H. Clinical assessment of subacromial shoulder impingement – which factors differ from the asymptomatic population? Musculoskeltal Sci Pract. 2017;70:429–40.
- 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.
- Hidalgo-Lozano A, Fernández-De-Las-Peñas C, Alonso-Blanco C, Ge HY, Arendt-Nielsen L, Arroyo-Morales M. Muscle trigger points and pressure pain hyperalgesia in the shoulder muscles in patients with unilateral shoulder impingement: A blinded, controlled study. Exp Brain Res. 2010;
- 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.
- Perez-Palomares S, Oliván-Blázquez B, Arnal-Burró AM, Mayoral-Del Moral O, Gaspar-Calvo E, De-La-Torre-Beldarraín ML, et al. [Contributions of myofascial pain in diagnosis and treatment of shoulder pain. A randomized control trial]https://pubmed.ncbi.nlm.nih.gov/19630975/). BMC Musculoskelet Disord. 2009;10(1):1–7.
- Burbank KM, Stevenson JH, Czarnecki GR, Dorfman J. Chronic shoulder pain: Part I. Evaluation and diagnosis. Am Fam Physician. 2008;77(4):453–60.
- Burbank KM, Stevenson JH, Czarneck GR, Dorfman J. Chronic shoulder pain: Part II. Treatment. Am Fam Physician. 2008;77(4):493–7.
- Holmes RE, Barfield WR, Woolf SK. Clinical evaluation of nonarthritic shoulder pain: Diagnosis and treatment. Phys Sportsmed. 2015;43(3):262–8.
- Cloke DJ, Watson H, Purdy S, Steen IN, Williams JR. A pilot randomized, controlled trial of treatment for painful arc of the shoulder. J Shoulder Elb Surg. 2008;17(1 SUPPL.).
- Gleyze P, Georges T, Flurin PH, Laprelle E, Katz D, Clavert P, et al. Comparison and critical evaluation of rehabilitation and home-based exercises for treating shoulder stiffness: Prospective, multicenter study with 148 cases. Orthop Traumatol Surg Res. 2011;97(8 SUPPL.).
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About Dr Graeme
Several years ago Dr Graeme, a Chiropractor practicing in Victoria, Australia was looking for a serious hand held massager his patients could use at home to get the extra quality massage they needed. The ones he found in the shops and on-line for home use looked nice but were not serious, and... read more
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