Can (myofascial) trigger points cause shoulder pain

What are trigger points

How trigger points cause shoulder pain

As discussed below trigger points can cause shoulder pain both directly and indirectly.

How trigger points indirectly cause shoulder pain

Trigger points indirectly cause shoulder pain by altering the posture and movement of your shoulder joint, creating abnormal stress and possibly pinching. As discussed in our article Trigger point basics trigger points do this by causing muscle to tighten and not be able to work normally. Here we'll show you the basic principles of how this works, then two specific ways this can affect the balance and movement of your shoulder.

The basic principles

As an extra note, there are other causes of posture like this, with one of the most common being issues with the spine.

Shoulder impingement and abnormal wear

Re-occuring shoulder pain: why shoulder pain keeps coming back

To give it to you perfectly straight there are two main reasons shoulder pain either doesn't go away or keeps coming back.

1. Fundamental causes such as trigger points and head forward posture are ignored, and instead symptom relieving drugs and ineffective therapies are prescribed.
2. If trigger points are diagnosed they are inadequately treated.

Let's look at each of these.

Trigger points and head forward postures are largely ignored by the medical profession

Despite all the evidence to showing that trigger points cause shoulder pain and the many clinical trials showing that trigger point therapies relieve this pain (1,5–9) 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.

Because of the heavy influence of drug companies on medical journals it is a common problem that causative issues are ignored and doctors are advised to prescribe symptom relieving drugs.

Ineffective therapies are prescribed

treating symptoms with drugs etc.

Shoulder impingement (pinching) is the most common medical diagnosis (10)⁠. Doctors recognise that tissues become inflamed, painful and eventually damaged. However, rather than correct the cause of the abnormal function doctors are instructed to prescribe analgesics, anti-inflammatory drugs and cortisone needles, plus of course surgery when the secondary damage gets worse (18,20)⁠.

Prescribing exercises that cannot fix the problem

To the uninformed exercises sound like a good idea. However as discussed in our article on functional rehabilitation the abnormal shoulder function is the body's attempt to compensate for parts that are unable to work properly, and as long as the part is abnormal it will keep doing it. That can't be corrected with exercises (25,26). The only way is to restore normal function to the problem part.

The important thing to understand is that if the ball is moving around abnormally in the socket pinching and creating abnormal stresses it's going to do exactly the same thing when doing exercises. This will just cause further long term damage.

Trigger points are inadequately treated

If trigger points are diagnosed they generally continue to cause pain because most treatments are merely designed to temporarily stop them shooting pain. This means the trigger points are still there indirectly causing pain, and start shooting pain directly again when re-aggravated.

A massive problem

This applies whether it's a trigger point release seen on YouTube or a course of needles, laser or some other therapy provided by a respected professional. We believe it is:

1. deceptive because patients are lead to believe the problem is being fixed, and
2. could almost be considered negligent as the problem is left there still causing problems.

We is discussed in our article Trigger point treatment: deactivation or elimination, however will show you one piece of evidence to confirm it is all correct,

The solution

The trial above shows that a typical course of say six sessions of dry needles or laser will just be very expensive temporary pain relief. However, it does point the way to a better solution. Those 12 extensive sessions did manage to relieve much of the shoulder pain and eliminate 1/3 of the trigger points. This suggests that if the therapy is continued further trigger points will be eliminated. Of course you will need an effective home therapy so you can do at least some yourself otherwise it will become very expensive.

This forms the basis of our shoulder pain solution. Full details are in our article Massage and trigger point therapy for shoulder pain: with self care options. This is a step by step guide which includes:

• what trigger points are
• how to find them
• several effective home treatments
• detailed illustrated instructions for each of the muscles possibly involved.

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

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