Trigger point & pressure point therapy for your shoulder pain

Trigger points or “pressure points”: which do we use?

Trigger point and pressure points such as acupressure use largely the same points, but vary considerably in how you choose which points to treat and the way they are treated.

In this section:

• Pressure points
• Trigger points
• Which we choose

Pressure points (eg. acupuncture points)

What they are

Ancient civilisations found that certain points were associated with various conditions including shoulder pain, and that pressing on them or needling gave relief. Without modern science they had no idea what was going on so they made made up their own “science” with things like “meridians” and “energy flows” (1–6).

How therapist choose which points to treat

These points are just a collection of observations made of people with similar conditions over the years, so in summary, someone with a sore shoulder hundreds of years ago was relieved by treating certain points, so they press on the same spots with you.

Traditional therapists who practice these systems have no way of telling whether any particular point is really involved or not. The points are said to do things like block energy flows along meridians, but this "theory" is of abslutely no use in working out which points are involved. No one has found these energy flows, let alone build a measuring device to find out where they are blocked. 

How therapists treat these points

These points are treated with needles and pressure, as they have been traditionally for centuries.

(Myofascial)Trigger points

What they are

More recently scientists have “re-discovered” these points calling them (myofascial) trigger points, or trigger points for short, and subjected them them to modern scientific analysis. Simply, they have found that they are parts of muscles that have spasmed or cramped, forming a lump and having a host of adverse effects on your body including referring pain. For more information please see our article Your Complete Guide To (Myofascial) Trigger Points .

How therapists treat these points

While needles and pressure have been successfully used for centuries, scientific analysis of the points has enabled scientists to develop more efficient ways of treating them, such as the vibration massage discussed later.

How to find which points

As mentioned above most trigger point or pressure point guides for shoulder pain only show a hand full of points. However, the scientists found trigger points in 17 different muscles, and most gave multiple trigger points. While showing you a hand full of points makes for an attractive headline and an easy to follow guide, clearly they only address a small part of the problem so relief will be at best partial and temporary. Later in this guide we will show you an efficient way to systematically and quickly check them all.

The basic therapy

In this section we will show you how to do the basic trigger point therapy, then later in this guide show you:

• how to use this on each muscle, and
• a systematic way to do them all quickly.

The recommended therapy: vibration massage

As mentioned above people have been pressing on points and sticking them with needles for centuries, and these therapies have strong advocates. While they are moderately effective, by studying the trigger points scientists have worked out more efficient and effective therapies. As discussed in The best treatment for trigger points , the best method is vibration massage. It is safe, highly effective, and easy to do on yourself.

In this section:

• How vibration massage works
• How to use vibration massage
• Choosing the proper equipment

How to use vibration massage

Please check out our excellent videos below:

1. How to use a vibration massager
2. What is the most effective trigger point therapy

Choosing the proper equipment

While there are a lot of vibrating massagers on the market very few are able to deliver the serious amounts of therapeutic standard vibrations need to effectively treat trigger points. This is why when looking for something for our Chiropractic patients to use we built our own . For more information please see our article How to choose a massager . However, you will need to avoid the following.

Specific points an therapy for each muscle

In this section we will go over each of the 17 muscles involved, including the common points for each. In the video we demonstrate the examination and treatment techniques for each, plus a systematic routine to quickly check and treat them all.

Infraspinatus, Teres Maj. & Min.

We’ll group three of the most important muscles together: infraspinatus, teres minor and teres major. As these diagrams shows they’re at the back of your shoulder blade. In these diagrams the “x”s are the trigger points and the red is where they usually shoot pain. The best way to massage these is lay on your side to put your arm up so the muscles are easy to access.

Trapezius, Supraspinatus

The upper trapezius muscle runs across the top of your shoulder and up the side of your neck. According to the scientists this was the second most common problem muscle for shoulder pain.

The supraspinatus sits underneath the upper trapezius muscle in a groove at the top of your shoulder blade. These are very easy to reach and examine for trigger points. The trapezius is at the top so you can easily start with the flats of your fingers, but supraspinatus is in a bit of a groove so you need to curl your fingers a bit to get to it.

Massage these sitting up, holding the massager with the opposite hand so the muscles I’m massaging are relaxed. If you sit up straight you’ll see the muscle is on slope so you need to grip the massager so it doesn’t slide off, but if you lean slightly across and forward it makes the part more horizontal so it’s a lot easier to hold. What you can do is move over the muscle systematically, giving anything you find a good soak. When you’re to the side over the top of supraspinatus just remember it’s deep and in a groove so give it a good soak.

The middle and lower trapezius ar best massaged sitting, leaning forward.

Deltoid muscles

As these diagrams show they they run from your shoulder to part way down your arm, with part at the front, side and back. These are easy to reach and examine. And the easiest way to massage these is laying on your side. You roll backwards a bit for the front part, on your side for the side part, then forward for the back part of the muscle. Again, work systematically and give anything you find a good soak.

Biceps and Triceps

Now your biceps and triceps muscles are very easy to massage. It sits at the front and back of your arm running from your shoulder to your elbow so it’s very easy to reach and examine. To massage the muscle I just have the massager in the palm of my hand and go over the muscle systematically.

Pectoralis Major and Minor

As these diagrams show the biggest muscle pectoralis major sits on top running from the centre of your chest to the top of your arm, while pectoralis minor sits underneath the outer part running roughly vertical.

Subscapularis

There’s a muscle sitting under your shoulder blade called subscapularis. It normally sits between your ribs and shoulder blade where you can’t get to it, but if you bring your arm up like this your shoulder blade sticks out and you can get to it a bit. With every other muscle I use the flat head on my massager to get the best vibration transfer, but because this one is so hard to get to I use the domed attachment.

What I do is sit the head in there getting the best access I can, and this is where you’ll be really glad you’re using a vibration massager. You’ll never be able to poke your fingers or thumb in far enough to effective massage this muscle, but the vibrations will soak in. That said it is difficult and there are a lot of sensitive structures near there so I definitely recommend getting a professional show you and make sure you are doing it correctly

Scalene Muscles

The last muscles are the scalenes that run deep along side of your neck. The scientists found that these were the least important of the 17 muscles, which is a good thing because I don’t want you self massaging them. They sit on top of sharp pointed parts of your spine right next to some major nerves and blood vessels. Leave these ones to the professionals.

Other things that can help shoulder pain

While treating these muscles can be highly effective (7,9–14)⁠ there can be other issues causing shoulder pain. Please check out the following articles for more information.

Shoulder pain reference articles

Why shoulder pain keeps coming back and what you can do about it
Do exercises help shoulder pain

References

1. Robinson N, Lorenc A, Liao X. The evidence for Shiatsu: A systematic review of Shiatsu and acupressure. BMC Complement Altern Med. 2011;11.
2. Cabo F, Baskwill A, Aguaristi I, Christophe-Tchakaloff S, Guichard JP. Shiatsu and acupressure: Two different and distinct techniques. Int J Ther Massage Bodyw Res Educ Pract. 2018;11(2):4–10.
3. Sun M, Yang M, Rong J, Ma X, Zheng H, Cai D, et al. Trigger points and sensitized acupoints: same book, different covers? Acupunct Herb Med. 2021;1(2):74–80.
4. Dorsher PT, Fleckenstein J. Trigger points and classical acupuncture points: Part 1: Qualitative and quantitative anatomic correspondences. Dtsch Zeitschrift fur Akupunkt. 2008;51(3):15–24.
5. Dorsher PT, Fleckenstein J. Trigger points and classical acupuncture points Part 2: clincal correspondences in treating pain and somatovisceral disorders. Rev Int Acupunt. 2009;62–8.
6. Dorsher PT, Fleckenstein J. Trigger Points and Classical Acupuncture Points Part 3: Relationships of Myofascial Referred Pain Patterns to Acupuncture Meridians. Dt Ztschr f Akup. 2009;52(1):9–14.
7. 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.
8. Bron C. High prevalence of shoulder girdle muscles with myofascial trigger points in patients with shoulder pain. BMC Musculoskelet Disord. 2011;12.
9. 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.
10. Sergienko S, Kalichman L. Myofascial origin of shoulder pain: A literature review. J Bodyw Mov Ther. 2015;19(1):91–101.
11. 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.
12. van den Dolder P, Ferreira PH, Refshauge KM. Effectiveness of Soft Tissue Massage for Nonspecific Shoulder Pain: Randomized Controlled Trial. Phys Ther. 2015;95(11):1467–77.
13. 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.
14. Esparza D, Aladro-gonzalvo AR, Rybarczyk Y. Effects of Local Ischemic Compression on Upper Limb Latent Myofascial Trigger Points : A Study of Subjective Pain and Linear Motor Performance. Rehabil Res Pract. 2019 Mar 4;2019