Pain in the neck and shoulders is often related to areas of muscle tightness or knots called trigger points. These usually involve the trapezius, a broad, flat triangular shaped muscle that overlies the back of the neck and a portion of the trunk with attachments to the shoulder blade and collar bone. The trapezius helps with movement and stability of the head, neck and shoulders. Neck and shoulder pain can also arise from trigger points in the surrounding muscles such as the rotator cuff muscles, deltoids, pectoralis and the latissimus dorsi.
A trigger point is a small area of muscle spasm which involves both the muscle and fascia (connective tissue) between and around the muscle fibers. It is therefore also called a myofascial trigger point. It may be felt as a nodule or tight band. What causes trigger points is unclear but it may be activated by injury, continuous or repetitive strain or poor posture.
The area is usually irritated and painful and may have diminished blood supply. The pain often radiates in a particular pattern affecting other regions; for example, trigger points in the trapezius can result in a headache. Trigger points can mimic other painful conditions and are often difficult to diagnose.
The physicians and therapists at the American Spine Center have a great deal of experience identifying and managing pain due to trigger points. Trigger points in the neck and shoulder are identified by reviewing your symptoms and the pattern of pain radiation. A thorough physical examination is performed to look for other abnormalities. Your doctor will examine your posture and evaluate movement. The area of pain is palpated. Pressing a trigger point may reproduce pain. The muscle may respond by twitching. There may also be a change in temperature in the region.
Treatment may involve the use of muscle energy techniques and application of deep pressure (manual therapy), ischemic compression to stimulate blood circulation, massage, mechanical vibration, ultrasound, electrostimulation and laser therapy. Once all trigger points are identified and deactivated, the muscle is stretched to improve its range of motion. Trigger point injections or dry needling may be recommended for refractory symptoms.