Shoulder muscle knots or trigger points...Beware Its A Trap!






I've got a "muscle knot" in my neck and shoulder


How many times do we see this complaint i don't know for sure, its a very common complaint that we hear of in the clinic. Usually its a symptom that accompanies another problem, usually in the neck, upper back or shoulder.


It can cause quite a bit of discomfort and has been known to refer pain into the shoulder blade , up the neck and even into the side of the head.


They have been called knots or trigger points and blamed for a wide range of maladies but what are they and whats going on?


Trigger point referral of trapezius

Why have i got these "trigger points "?


So quite often these are blamed for everything under the musculoskeletal sun but the in reality they are probably no more than the bodies symptomatic reaction to an underlying issue. Its a bit like sneezing or snuffling when you have the cold which is the bodies reaction to the virus. They are no more serious than that and they are very rarely a primary cause of pain or dysfunction.


The majority of good evidence based research actually finds it hard to build up a case to suggest they even exist! Some of the main proponents of this phenomena have even struggled to prove their existence in the context of research enviroment.


However we have all felt a tight painful knot at some point and have all had temporary relief from some one sticking their thumb, elbow or even an acupuncture needle into it.


So i'll give these knots the benefit of doubt and all that, but i'll be hard pressed to believe they are any more than a symptom of a bigger and in alot of cases simpler issue.


Whats the plan in treating the symptom and the cause of these knots or trigger points?


I think the first thing is to tackle is what is really going on with that painful spot in the shoulder area. The painful and tight area you can feel is the upper trapezius which is an important muscle in the function of the shoulder and neck.


The upper trapezius starts from the neck and attaches to the upper border of the shoulder blade.


Upper trapezius function in the shoulder

It helps the shoulder blade rotate so we can lift the arm up and also to maintain the shoulder blade to sit in the correct orientation.


In the majority of people that we see the shoulder blade is often sitting a bit lower and this leads to a lengthening and WEAKENING of the upper trapezius. This results in it struggling to perform its tasks in helping the body move and so its response is to chuck a tantrum and get all worked up creating the mythological, sorry myofascial, trigger point.


Usually what gets us into this situation is prolonged postures where the muscle is constantly on stretch and becomes weaker and unable to perform the duties it is meant to do. Ladies and gentlemen let me introduce you to the screen based society we live in , laptops, ipads and iphones ...oh and you too samsung you don't get off the hook either.


Obviously these devices dont create the problem the problem is US sitting huched over reading leading to a body not fit to sit.


So if its weak and long should i get it short and strong ?


Ha ha thats probably not a bad idea and to be fair its what id be looking at for long term results. All the massage, poking , proding or even injecting is unlikely to provide long term answers.


The first step to this is what ever exercises you want to use i suggest we correct the shoulder blade and thoracic spine posture first. Otherwise your'e just going to get better at being bad !


Easiest way to do this is lift your chest up by about 1cm and think about lifting the tips of your shoulders up 1cm and slightly back. You may find that by doing this you can move your neck better and the knot is less knotted.


The following exercises are what i'd suggest to then strengthen the trapezius muscle. The key with these exercises is to try and keep the arm about 30 degrees away from the side of the body. This improves upper trapezius activity.






Should i bother treating them directly to ease the pain?


As i may have said earlier I'm not a huge fan of the trigger point be all and end all brigade but i am a huge fan of people being in less pain and discomfort. To that end trigger point therapy and massage followed by stretching is fine from a purely symptomatic point of view. Its a short term band aid to get back to the happy place.


My favoured recipe is;

  • Heat x 5-10mins to relax the muscle.

  • Gentle trigger point massage

  • Stretch after.


The stretching is a bit counter intuative but we just want a happier you and it seems to help get this reactive muscle to quieten down.


I am quite happy to use these techniques and do so to get people back to their happy place. Once happy place has been achieved then its off to get the source of the problem sorted out and thats all about better posture and stronger healthier muscle system.


However If you are expecting long term results through passive trigger point techniques and massage, etc you may find this gets less effective as time goes by and unlikely to give you the permanent solution you deserve.

So if you want those knots to get knotted feel free to come and see us at the clinic, we love to watch these trigger points reduced to nothing but a mythological beast.


Remember there ain't nothin wrong with getting strong.


Cheers

Dave


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