Having an Agonizing Spot Between Your Shoulders? – Part 1
Updated: Jul 27
Kicki Hjortmarker is known for her broad knowledge and extensive experience working with the human body and mind to heal injuries and chronic pain conditions. She is the founder of Swedish Balance, dedicated to helping people live a balanced life pain-free.
If you are experiencing a persistent, painful spot between your shoulders, or anywhere else in your body, that does not improve with massage or pressure, you may have a trigger point that is referring pain to that area.
You may try to knead, push, or rub the area but find no lasting relief. For example, if you have a headache in the front of your head and rub your forehead but the pain persists, the discomfort may originate from another area of the body. This phenomenon is known as referred trigger point pain.
How do I know if I have referred trigger point pain?
The muscle that is injured is not always the location where you feel pain. A trigger point acts like a faulty electrical wire; it sends pain signals to another part of the body.
Signs of referred pain include:
Pressing on a specific area reproduces familiar pain elsewhere in the body.
Imaging studies, such as X-rays or an MRI, do not fully explain the symptoms.
Pain improves when the trigger point is released through neuromuscular massage therapy or other appropriate treatments.
Some common referred pain patterns are:
The upper trapezius can refer pain to the side of the neck, behind the ear, or into the temple, contributing to tension headaches.
The sternocleidomastoid (SCM) can refer pain around the eye, forehead, or jaw, or even create dizziness, as it attaches to the temporal bone near the ear.
The gluteus medius can refer pain down the outside of the hip and thigh, sometimes mimicking sciatica.
Trigger points in the psoas can refer pain to the lower back, front of the hip, groin, or abdomen.
The piriformis can contribute to pain in the buttocks and down the back of the leg.
So, what is a trigger point?
A trigger point can be as small as a pinhead or the size of a pea. It can also consist of several lumps together or tender spots in a taut band. It can be a hard muscle that feels like a cord or guitar string, ropey and stringy, like spaghetti glued together.
Trigger points can be felt embedded within muscle fibers and myofascial tissue, and they form mainly in the belly of the muscle, where the motor endplate is located.
Trigger points are believed to be implicated in most types of musculoskeletal and mechanical muscular pain, and they can be present in both younger and older people.
Trigger point pain has even been demonstrated in small children. I have personally worked on children as young as seven years old with symptoms of trigger point pain.
Trigger points can be either active or inactive. When they are inactive or latent, they do not cause pain at the moment.
Secondary trigger points, also called satellite trigger points, often develop in response to the primary trigger point, and they tend to develop along fascial lines under stress.
Pain symptoms may be due to active trigger points, or the pain may have built up over time from latent trigger points.
When you press on a trigger point, it might feel tender, tight, and painful, cause pain to travel to another area, restrict movement, weaken the muscle, and produce tingling or a dull ache.
Why do trigger points form?
Studies have shown that active myofascial trigger points produce spontaneous electrical activity even when the muscle should be at rest.
Rather than holding a static electrical charge like a battery, trigger points behave as if they are electrically overactive.
One of the leading scientific theories proposes that trigger points develop when a small group of muscle fibers becomes stuck in a sustained contraction.
This activity is thought to result from an energy crisis caused by depletion of energy in the area, reduced blood flow, reduced oxygen delivery, and sensitization of nearby pain receptors.
The reason for trigger point formation is multifaceted
There is general agreement that muscle overuse or direct trauma to the muscle can lead to the development of TrPs (trigger points).
However, there are several theories as to why TrPs form, but scientific evidence is lacking.
The nerve root compression theory
It has been widely accepted that when the root of a nerve is traumatized or pinched, trigger points form along that same nerve. But it is still a model rather than a proven fact.
I believe that this theory is true in some cases. I have seen patients who have been medically diagnosed with a pinched nerve at the root, and I have then found and treated trigger points along the nerve, from the root to the nerve ending, or the other way around. The pain has diminished.
I have also experienced this in my own body. I have had nerve compression in my cervical spine due to disc degeneration, bulging discs, and stenosis. At the time of pain symptoms, I have always found plenty of trigger points along the compressed nerve.
It is also believed that the following can cause TrPs formation:
Metabolic disorders
Inflammation
Metabolic byproducts
Bony anomalies
Congenital malformations
Aging
Weight gain
The structure and alignment of the joints and spine
Nutritional and hormonal factors:
Some studies have shown evidence that vitamin C deficiency may perpetuate trigger point activity.
Some studies have shown evidence that iron deficiency may perpetuate TrPs activity.
Vitamin B12 deficiency may increase chronic trigger point formation and fatigue.
There is evidence that estrogen and thyroid deficiencies may contribute to increased TrPs formation.
Researchers also agree that repetitive microtrauma may lead to the development of trigger points just as much as acute trauma.
Additionally, in 2004, Dr. Ferguson, D.C., and Dr. Gerwin, M.D., suggested that chronic parasitic, yeast, and viral infections may increase and perpetuate trigger point formation.
Evidence of trigger points
Dr. Janet Travell, a physician and medical researcher known for her success in treating myofascial pain syndrome (MPS), conducted studies and experiments to find evidence of trigger point formation.
In 1957, she discovered that trigger points generate and receive small electrical currents. She measured these signals with an electromyogram and found that when a small part of the muscle contracted, it caused a small, localized spike in electrical activity.
Can trigger points ever go away?
Yes! Here are some suggestions for what you can do:
Choose foods that fight inflammation.
Correct your posture.
Get regular bodywork, which can help erase trigger points and stop pain symptoms.
Change daily habits that pull joints and the spine out of alignment and perpetuate the formation of TrPs.
Take a look at your ergonomics. How do you sit or stand when working?
Strengthen the body to minimize the overuse of certain muscle groups and find balance in the musculature.
Use self-help tools, such as a foam roller, therapy balls, tennis balls, and a Theracane, to work on trigger points and myofascial release regularly.
Take care of your myofascial trigger point pain now! Call or text Kicki at 1 (323) 404 6613. Email me here.
Read more from Kicki Katarina Hjortmarker
Kicki Katarina Hjortmarker, Holistic Bodyworker
Kicki Hjortmarker has a solid background in the hands-on healing field, treating people with injuries and chronic pain conditions. With a holistic approach, she integrates Neuromuscular Massage Therapy, Craniosacral Therapy, Hypnotherapy, Reiki, Pilates, and more. To practice the artistry of mind/bodywork and massage therapy has been Kicki's lifelong passion. It started with the awareness of her own body as a child and ballet dancer, and, later, as a gymnast who developed chronic lower back pain whilst on the Swedish National Team in Rhythmic Sports Gymnastics. Decades later, she overcame nerve damage and temporary paralysis in one hand. This taught her to trust the healing power of body and mind, and that the body prefers holistic healing methods over conventional treatments. Her mission is to encourage and inspire others to do the same. To trust the healing power of body, mind, and spirit!
