Elite Chiropractic
Trigger Points in Shoulders – What is Going On?
A Look at Shoulder Trigger Points
Trigger points, also known as knots, are a common source of pain and discomfort but are rarely taken seriously. Trigger points are a source of real pain and we are looking at how that type of pain impacts the shoulder, how we treat the pain in our office, and then some self-care tips for how you can relieve trigger point pressure in the comfort of your own home.
Understanding Secondary Trigger Points in Shoulder Pain
Shoulder pain can often be attributed to specific muscle trigger points beyond the primary ones directly associated with the shoulder joint. These secondary trigger points in various muscle groups can radiate discomfort to the shoulder, contributing to dysfunction. Here’s a breakdown of these secondary trigger points and their effects:
Deltoid Muscles
- Anterior Shoulder Trigger Points: These are located at the front of the shoulder and primarily cause pain in this area. Pain may manifest when slightly raising the arm forward.
- Lateral Trigger Points: Pain is referred to the outer shoulder area, often exacerbated when lifting the arm away from the body.
- Posterior Trigger Points: These points refer pain to the back of the shoulder, sometimes resulting in a catching sensation when the arm is raised.
Supraspinatus Muscle
- Trigger Points: Typically found at the top of the shoulder, they refer pain to both the outer shoulder and elbow. Arm elevation to the side can trigger a painful catch, and these points might also lead to snapping or clicking sounds in the shoulder.
Pectoralis Major Muscle
- Trigger Points: These are found in the chest region and can radiate pain to the front of the shoulder. Discomfort may extend down to the chest and the inner part of the elbow, influencing movements that involve pushing or lifting.
By understanding these secondary trigger points, individuals experiencing shoulder pain can better identify potential underlying issues and develop targeted treatments or stretches. Always consider consulting a healthcare professional for an accurate diagnosis and appropriate management strategies.
Let’s start with, what’s a trigger point? There are two types of trigger points: active and latent. An active trigger point is a point of pain that will actually refer pain to another part of your body without any sort of stimulation. For example, if you have an active shoulder trigger point you may have pain down your arm, or across your back. A latent trigger point only hurts when pressure is applied, but usually doesn’t bother you without that pressure. To determine what kind of trigger point you are experiencing, it is recommended that you see a specialist (like the doctors in our office).
How Trigger Points in Key Muscle Groups Contribute to Shoulder Pain
Understanding the origins of shoulder pain can be complex, often involving specific trigger points in muscle groups like the deltoid, supraspinatus, and pectoralis major. Each of these muscles can refer pain to distinct areas of the shoulder, causing discomfort and dysfunction.
Deltoid Muscle
- Pain Location: This muscle is unique in its pain referral pattern, as it causes discomfort primarily in the region where it’s located.
- Specific Pain Points:
- Anterior Head: Pain spreads to the front of the shoulder.
- Lateral Side: Discomfort targets the outer shoulder area.
- Posterior Side: Pain manifests towards the back of the shoulder.
- Symptom: A noticeable painful catch when slightly raising the arm forward is a characteristic symptom of these trigger points.
Supraspinatus Muscle
Pain Location: Often impacts the outer shoulder and extends to the elbow.
- Pain Location: Often impacts the outer shoulder and extends to the elbow.
- Movement Impact: Raising the arm to the side may trigger pain, similar to a deltoid-related catch.
- Additional Symptoms: This muscle can cause snapping or clicking noises in the shoulder, adding to movement difficulty.
Pectoralis Major Muscle
- Pain Location:
- Front of the Shoulder: Commonly associated with this muscle.
- Chest Area: Pain can spread across the chest.
These trigger points are integral to understanding shoulder pain’s complexity, and knowing their roles can help improve management and treatment strategies. Identifying and alleviating these trigger points can be an effective approach in relieving shoulder pain and improving mobility.
Understanding Subscapularis Trigger Points and Shoulder Pain
The subscapularis is a key player in shoulder movement, part of the group known as the rotator cuff muscles. This muscle is cleverly nestled deep within the armpit, connecting to the inner side of the shoulder blade. It serves two main purposes: allowing the arm to rotate and keeping the shoulder joint stable during arm movements.What Are Trigger Points?
Trigger points in the subscapularis can cause significant discomfort. These small, hyper-irritable spots are typically felt as knots in the muscle. When they activate, they tend to radiate pain to other areas, rather than just staying localized.
What Are Trigger Points?
Trigger points in the subscapularis can cause significant discomfort. These small, hyper-irritable spots are typically felt as knots in the muscle. When they activate, they tend to radiate pain to other areas, rather than just staying localized.
Impact on the Body:
- Pain Location: Often, pain emanates from the back of the shoulder and follows a strap-like path down to the wrist.
- Movement Restriction: These trigger points are notorious for limiting shoulder movement. People may struggle to lift their arm sideways beyond 45 degrees or have difficulty reaching across to the opposite armpit.
- Frozen Shoulder: An extreme consequence is the development of a “frozen shoulder,” medically referred to as adhesive capsulitis, severely restricting mobility.
Symptoms to Watch For:
Recognizing subscapularis trigger points involves noting that pain felt in these areas can often masquerade as other shoulder conditions. Alongside movement restrictions and referred pain, a distinctive band-like pain around the wrist often signals their presence.
Identifying and addressing these trigger points can require professional assessment, usually involving techniques like physical therapy or massage to alleviate symptoms and restore functionality.
Understanding Infraspinatus Trigger Points and Their Role in Shoulder Pain
The infraspinatus muscle, part of the rotator cuff group, is located on the back of the shoulder blade. This muscle extends from the lower portion of the shoulder blade to the top of the upper arm bone, known as the humerus. Its primary role is to rotate the arm outward at the shoulder and maintain joint stability during movement.
Impact of Infraspinatus Trigger Points
Trigger points in the infraspinatus can lead to significant shoulder discomfort. These points, when activated, cause pain that typically starts in the shoulder joint and radiates along the front and side of the arm. This can severely restrict arm movements, making simple tasks like reaching behind your back or performing self-care activities, such as brushing your hair or teeth, challenging.
Recognizing Symptoms of Infraspinatus Trigger Points
- Deep Shoulder Pain: Individuals often experience deep-seated pain within the shoulder joint, which can mistakenly suggest joint damage.
- Radiating Pain: The discomfort may extend down the front of the upper arm, mimicking conditions like bicipital tendonitis, especially in athletes. In more severe cases, the pain can spread down the arm to the hand or up to the neck.
- Interference with Sleep: Sleeping postures are crucial too. Side sleepers typically find it painful to lie on the affected side. Even sleeping on the opposite side might cause discomfort unless the upper arm is adequately supported by a pillow.
Understanding and identifying these trigger points in the infraspinatus muscle is essential for managing and alleviating shoulder pain effectively. By recognizing the symptoms, individuals can take steps toward treatment, potentially involving stretching, physical therapy, or consulting with a healthcare professional for further evaluation
How Trapezius Trigger Points Spread Pain Throughout the Body
The trapezius muscle, a substantial diamond-shaped muscle located at the neck’s base and extending across the upper back, plays a crucial role in our movements and posture. This muscle connects to the base of the skull, spine, shoulder blade, and collar bone, facilitating neck and head movement while primarily supporting shoulder blade motion.
What Causes Trigger Points?
Trigger points in the trapezius arise from various factors, including poor posture, emotional stress, and physical injuries such as whiplash or falls. Even sleeping in unfavorable positions or under a ceiling fan can contribute to their development.
How Do Trigger Points Spread Pain?
These trigger points can transmit pain far beyond their immediate location. They often cause discomfort in the back and sides of the neck, the temple area, behind the ear, the back of the head, and the shoulder joint. This pain pattern frequently complicates or exaggerates common shoulder issues.
Key Symptoms of Trigger Points
The trapezius muscle might develop several trigger points, but the lower trapezius trigger point is particularly notorious for causing shoulder-related discomfort. This specific point often causes pain, tenderness, and a “heavy” sensation at the top of the shoulder. These symptoms often precede other issues like neck pain or headaches.
Addressing Trigger Points
Effectively managing shoulder pain usually begins by addressing the active trigger points in the trapezius. By releasing these points, the resulting referred pain can be alleviated, thereby improving overall shoulder function and reducing discomfort.
This approach to tackling shoulder pain highlights the interconnected nature of the body and how specific muscles can influence widespread discomfort.
What causes trigger point pain in the shoulder? There are several ways a trigger point can be created. You may lift something heavy and later on start to feel pain. Repetitive action can also cause trigger points, and is commonly seen in pitchers, swimmers, and volleyball players, but can be seen in a desk worker who sits for long periods of time with their shoulders rounded forward (tight shoulders, anyone?). Perhaps you have a job that requires you to lift and move objects often. That kind of repetitive motion can bring on a trigger point. Let me also mention that visceral issues (internal organs) can also be a source of trigger points. If you are emotionally stressed, have arthritis, maybe an organ issue … things going on inside the body can manifest themselves as a trigger point.
Understanding the Role of Subscapularis Trigger Points in Frozen Shoulder Syndrome
The subscapularis muscle, a crucial part of the rotator cuff, plays a significant role in arm rotation and stabilizing the shoulder joint. This muscle is located deep within the armpit and connects to the inner surface of the shoulder blade.
How Trigger Points Affect Movement
When trigger points develop in the subscapularis, they don’t just cause localized pain. These tension areas can lead to discomfort radiating through the back of the shoulder and extending in a band-like pattern to the wrist. This widespread pain can result in what’s commonly known as frozen shoulder syndrome.
Impact on Shoulder Mobility
The condition known as frozen shoulder, or adhesive capsulitis, often arises when these trigger points inhibit normal movement. Those affected will notice a significant decrease in the ability to move their shoulder. For instance, lifting the arm sideways can be severely restricted, typically not exceeding 45 degrees. Additionally, reaching across the chest to touch the opposite side becomes nearly impossible.
Summary of Symptoms and Effects
The presence of subscapularis trigger points is a hidden contributor to frozen shoulder syndrome. Patients experience:
- Deep shoulder pain
- Limited shoulder mobility
- Radiating pain patterns
Addressing these trigger points is essential in alleviating symptoms and restoring full range of motion to the shoulder joint. Understanding this connection is vital for effective treatment and management.
Understanding the Impact of Trigger Points on Rotator Cuff Muscles
Trigger Points and Shoulder Dysfunction: A Closer Look
The shoulder joint stands out because it depends more on muscle support than on bones and ligaments. This design offers incredible flexibility, but also places a heavy reliance on the surrounding muscles to maintain stability and function.
One major consequence of this reliance is susceptibility to trigger points, particularly in the rotator cuff muscles. These knots or tight areas within the muscle fibers can significantly disrupt the shoulder’s performance.
How Trigger Points Contribute to Dysfunction
- Muscle Imbalance: Trigger points can create tension and weakness in certain muscles, leading to an imbalance. When muscles of the rotator cuff are affected, this can result in improper arm movement and reduced range of motion.
- Altering Movement: The presence of trigger points can alter the normal path of the shoulder blade during arm movements. This distortion can lead to inefficient or incorrect motion patterns, exacerbating shoulder dysfunction.
- Pain and Reduced Function: Trigger points frequently contribute to pain, not just locally, but also radiating into other areas. This pain can discourage movement, leading to stiffness and further dysfunction.
The Rotator Cuff’s Role in Shoulder Health
The rotator cuff comprises four key muscles that secure the upper arm to the shoulder blade. When these muscles harbor trigger points, it results in:
- Limited Flexibility: Compromised ability to perform everyday tasks.
- Reduced Strength: Difficulty in maintaining shoulder stability.
- Increased Risk of Injury: Greater likelihood of strains or further complications.
Addressing these trigger points through physical therapy or specialized massage techniques can restore normalcy, ensuring that the shoulder joint functions smoothly and pain-free. By focusing on maintaining the health of the rotator cuff muscles, one can greatly diminish the risk of shoulder dysfunction caused by these pesky trigger points.
Understanding the Role of the Trapezius Muscle in Shoulder Movement and Pain
The trapezius muscle plays a pivotal role in the movement and function of the shoulder. Shaped like a diamond, this large muscle spans from the base of the skull across the neck and upper back, attaching at the shoulder blade, collarbone, and along the spine. Its primary job is to manage the movements of the shoulder blade, but it’s also integral to the motion of the neck and head.
Key Functions of the Trapezius Muscle
- Shoulder Blade Movement: The trapezius is crucial for elevating, depressing, retracting, and rotating the shoulder blades.
- Neck and Head Support: It assists in head and neck movements, providing stability and a range of motion.
Causes and Impact of Trigger Points
Trigger points—localized areas of tenderness—can disrupt the function of the trapezius. These points often develop due to factors such as:
- Poor posture
- Emotional and physical stress
- Injuries like whiplash or falls
- Awkward sleeping positions
When these trigger points form within the trapezius muscle, they can lead to referred pain in several areas including the neck, the region behind the ear, the temple, and notably, the shoulder joint itself.
Symptoms and Treatment
The lower trapezius, in particular, is significant when dealing with shoulder pain. Active trigger points here can cause discomfort, a sensation of heaviness at the top of the shoulder, and are often linked with neck pain and headaches.
Treatment often begins with addressing these trigger points, as releasing them can alleviate associated symptoms, improve shoulder mobility, and reduce pain. Understanding and treating the trapezius effectively can thus be instrumental in managing shoulder-related disorders.
Understanding the Role of Rotator Cuff Muscles in Shoulder Function
The rotator cuff is an essential group of muscles and tendons in the shoulder, playing a pivotal role in both movement and stability. Comprising four primary muscles, each contributes uniquely to the shoulder’s functionality.
- Infraspinatus: Primarily responsible for the external rotation of the arm, this muscle aids in the lateral movement, allowing you to rotate your shoulder outwards.
- Supraspinatus: Crucial for lifting the arm, it facilitates the initial 15 degrees of shoulder abduction, essentially kick-starting the upward motion of your arm.
- Subscapularis: This muscle plays a key part in internal rotation, moving your arm inward toward the body. It also provides stability to the front of the upper arm bone in the shoulder socket.
- Teres Minor: Working in tandem with the infraspinatus, this smaller muscle assists in external rotation and adds support to the shoulder capsule.
Collectively, these muscles stabilize the shoulder joint, ensuring the arm moves securely and efficiently within the joint. They prevent dislocations and help maintain the shoulder’s alignment during various activities, from daily tasks to athletic endeavors. By balancing movement with stability, the rotator cuff muscles are crucial in maintaining shoulder health and function.
What’s the Pain Presentation?
It’s pretty safe to say that almost every person on the planet has experienced pain from a trigger point at least once. Perhaps not in the shoulder, as we are discussing, but somewhere in their body. As I mentioned before, trigger points are very real and can present pain in several forms. The most common areas in the shoulder for trigger points to form are the top of your shoulder, rotator cuff, inside your shoulder blade, and the back of your armpit. Depending on its location, the point can refer to pain down your arm into your hands, which often mimics a nerve issue.
While these areas are prone to trigger points, it’s important to understand which specific muscle groups are most affected. Clinical experience highlights that more than ten muscle groups can be involved, but the following three are most frequently impacted:
- Infraspinatus: Part of the rotator cuff, this muscle can cause pain that radiates down the arm, mimicking nerve pain.
- Subscapularis: Also within the rotator cuff, trigger points here can cause discomfort that extends to the back of the shoulder blade.
- Trapezius: Located at the top of the shoulder, this muscle often harbors trigger points that can lead to neck and shoulder pain.
By recognizing these common areas and affected muscle groups, you can better understand the source of your discomfort and seek targeted treatment options.
Symptoms Linked to Trapezius Trigger Points
The trapezius muscle, a significant player in our upper body mechanics, can exhibit up to four active trigger points. Among these, the most frequently implicated in shoulder discomfort is the lower trapezius trigger point.
Common Symptoms
- Localized Pain: A hallmark sign is a sharp or aching pain radiating to the top of the shoulder joint. This discomfort can extend beyond localized pain to involve the neck and trigger headaches.
- Tenderness: Individuals often experience heightened sensitivity or tenderness in the affected area, making it uncomfortable to touch or apply pressure.
- Heavy Sensation: Many people report a pervasive, heavy feeling in the shoulder region, which can affect mobility and contribute to an overall sense of fatigue in the upper body.
Progression of Symptoms
These symptoms frequently manifest in a predictable pattern. Initial discomfort in the shoulder often leads to subsequent neck pain issues and can evolve into headache symptoms if left unaddressed.
Treatment Approaches
Addressing these symptoms typically involves targeted therapeutic techniques aimed at releasing the tension within the trapezius trigger points. Focusing initially on the lower trapezius point is a common practice among our healthcare providers when treating shoulder pain disorders.
By understanding these symptoms and their progression, individuals can seek timely intervention to alleviate discomfort and prevent further complications.
We urge you to share this information with as many people as possible. You, your friends, family, co-workers, whoever it may be doesn’t have to live with pain. Oftentimes we believe the myth that trigger point type pain is just made up in our head. Not true. In fact, if not treated something like a latent trigger point could become active causing long-term issues for other parts of your body. Society has also bought into the self-limiting belief that trigger points just go away. Nope. The pain will often subside (when the active trigger point gets downgraded to a latent trigger point), but the trigger point itself does not go away. It will lie dormant until some activity causes it to become active again. And think about it, what if a trigger point is an indicator of something going on with an internal organ. That could be very serious. Don’t wait – see a specialist!
Symptoms of Subscapularis Trigger Points
When dealing with subscapularis trigger points, individuals often experience symptoms that mimic conditions like frozen shoulder or adhesive capsulitis.
Key Indicators
- Deep Shoulder Pain: One of the primary symptoms is a persistent, deep ache in the back of the shoulder.
- Restricted Shoulder Movement: People often find it challenging to lift their arm sideways beyond a 45-degree angle. Reaching across the body can also prove difficult.
- Radiating Wrist Pain: A distinctive sign is a strap-like pain encircling the wrist of the affected arm, especially noticeable when trigger points are active.
These symptoms can significantly impact daily activities and mobility, prompting individuals to seek effective solutions for relief.
How Do Infraspinatus Trigger Points Affect Arm Movement?
Infraspinatus trigger points can significantly restrict arm mobility and impact daily activities. When these specific points on the muscle are active, they can create a sensation of tightness or pain, causing limited range of motion in the shoulder.
Common Challenges Due to Infraspinatus Trigger Points:
- Reaching Behind the Back: Simple actions like fastening a bra or tucking in a shirt become difficult as the arm’s ability to rotate backward is compromised.
- Hair Care Activities: Tasks such as combing your hair or styling it require arm elevation and rotation, movements that are often hindered by these trigger points.
- Oral Hygiene: Brushing teeth can be a struggle because the muscle’s tension limits the arm’s flexibility, making it hard to reach the mouth comfortably.
These trigger points essentially reduce the ease with which one can perform overhead or behind-the-back motions, leading to discomfort in everyday tasks. Regular stretching and exercises targeting shoulder muscles can help alleviate these restrictions and improve mobility.
Symptoms Associated with Infraspinatus Trigger Points
Infraspinatus trigger points can lead to a range of discomforting symptoms. Individuals typically experience a deep-seated pain located within the shoulder joint, which might misguidedly suggest joint damage to those affected.
Pain Distribution
- Deep Shoulder Pain: The discomfort is primarily situated deep within the shoulder, making it feel more severe.
- Arm Pain: The pain can radiate down the front of the upper arm. Athletes may mistake this for bicipital tendonitis due to similar sensations.
- Extensive Pain Reach: In extreme instances, the pain may stretch from the shoulder to the hand and may also ascend to the neck area.
Impact on Sleep
Side-sleepers often face difficulty lying on the affected shoulder. Moreover, attempting to sleep on the opposite shoulder might also trigger pain unless the upper arm is properly propped with a pillow.
Understanding these symptoms can help in distinguishing the discomfort stemming from infraspinatus trigger points from other conditions, allowing for more targeted management and relief.
Putting Things in Motion
There are two main trigger points on the shoulder that we most commonly treat in our office: the backside of the shoulder blade and between the shoulder blade and the spine. Oftentimes these two trigger points refer to pain down the arm, cause hands and fingers to go to sleep, etc. There are two active release therapies we use in the office to help relieve pain and allow the shoulder to move freely again.
The first is the Seat Belt Motion. While we apply pressure to the trigger point, the patient mimics the motion of putting on a seat belt. This allows us to work through the length of the muscle, releasing any adhesion, and help to alleviate the trigger point discomfort.
The second is the Punching Motion. We apply pressure to the inside of the shoulder blade while the patient makes a punching motion straight out and across the body. This helps with a greater range of motion, decreases pain, and actively releases the muscles around the shoulder blade. Check out the video demonstration of both motions.
We also recommend a chiropractic adjustment of the upper back and neck, along with the type of active release treatments. Combined, they play a vital role in the health of your shoulders. Additionally, our office offers Cupping Therapy, Dry Needling, Muscle Work and Instrument Assisted Soft Tissue Mobilization (IASTM)— a fancy way to say scraping tool.
A Self-Release Guide
First and foremost, please see a specialist to identify and properly treat trigger points. In between those appointments is when I highly recommend using some self-release techniques at home. To release two common shoulder trigger points all you need is a ball and a wall. I recommend a Lacrosse ball because of its density. People often grab a tennis ball (too squishy) or a baseball (too hard), but I find the most effective ball of all is the Lacrosse ball.
The same two motions we use for active release in the office can be used for self-release at home: Seat Belt Motion and Punching Motion. Technical, huh? But they are accurate descriptions of the types of movement to employ while actively pressing the Lacrosse ball between your shoulder and a wall. Please watch these two videos for how to properly self-release:
To expand your understanding and technique, consider exploring instructional videos by experts who specialize in trigger point therapy. While the videos below were originally crafted to educate therapists on locating and releasing these trigger points, they have proven to be valuable resources for non-professionals as well.
If you have a partner and a little time, these videos can guide you in mastering self-treatment techniques effectively. Give those a try, and see how that helps.
Let’s Recap
- Trigger points are real and they can cause real pain, and often times refer pain to other areas of the body.
- Trigger points are best treated through active release techniques by a specialist.
- Particularly with trigger points in the shoulder area, chiropractic adjustments to the neck and upper back can offer pain relief.
- Remember, you do not have to live in pain. Get your trigger points diagnosed and addressed.
Let’s Recap
- Trigger points are real and they can cause real pain, and often times refer pain to other areas of the body.
- Trigger points are best treated through active release techniques by a specialist.
- Particularly with trigger points in the shoulder area, chiropractic adjustments to the neck and upper back can offer pain relief.
- Remember, you do not have to live in pain. Get your trigger points diagnosed and addressed.