To answer that question lets look at the causes of shoulder pain. The different possible causes for pain in the shoulder are very wide, from acute injury (direct trauma, strains and sprains) to overuse, wear and tear, impingements etc… The list is long.

In this post we will be focusing on non-acute pain and injury which account for the majority of shoulder pain complains we see in clinic. In case of non-acute shoulder pain, or pain that’s not a result of a sudden accident or trauma, we have to mention Trigger points and myofascial restrictions as two major treatable causes.

Trigger points are hyper-irritable spots within a taut band of a muscle fibre. These are caused by different stressors, from diet to overuse. When a muscle holds trigger points its functionality is reduced and the risk of injury increases. Trigger Point can be latent (they are present but they are not causing pain or other symptoms) or active (when they trigger pain and other symptoms either locally in the area where they’re found or referring somewhere else in the body).

Myofascial restrictions on another note are restrictions within the fascial tissue. The fascial tissue is a connective tissue in our body that holds everything in place, so it has a structural role. 

This tissue is everywhere in our body and I mean EVERYWHERE. It creates the membranes where the brain sits, it wraps around muscles and goes through them, it goes all the way down to the microscopic cellular level providing structure for the cells. The Myofascial tissue is complex and it has different properties in different parts of the body depending on its function.

One of its more powerful characteristics is its sensitivity, the Myofascial tissue has more nerve endings than the skin itself. This last characteristic of the fascia makes it very sensitive and reactive to the environment, which means that it’s affected by pretty much everything that’s going on inside and outside of our body, from thoughts to diet to exercise to a busy day.

Both elements, that is Trigger Points and Myofascial tissue are inseparable in the sense that when a Trigger Point exists in a muscle fibre, the fascial is unavoidably involved too because the fascia goes down to the cellular level as we saw above, so a good way to address the body is having that into consideration.

When coming up with an effective treatment for musculoskeletal pain and or injury, in this case shoulder pain, these two elements (Trigger Points and Myofascial tissue) must be assessed and addressed accordingly. Visit this link to clinical massage if you’re interested in learning more about the treatment method we use in clinic.

Simultaneously as we look for Trigger Points and Myofascial restrictions we must also ask ourselves the following question “What has caused these to develop in the first place? After we address the pain we must try to correct what caused the MFR restrictions or inflammation and Trigger Points.

The most common primary causes are stress, overuse, poor biomechanics or posture that leaves the joints vulnerable to injury and weakness. 

In case of the shoulder girdle some of the muscles listed above cause pain on top or/and around the shoulder.

Restrictions in some of the muscles and structures that attach to the shoulder girdle affect the correct positioning of the joint, affecting its range of motion and ability to function correctly and increasing the risk of injury or the development of clinical presentations.

As it relates to the topic, we covered some of these presentations, Frozen shoulder, Carpal tunnel, neck pain and pain down the arm on previous posts. 

A good treatment approach is assessing and addressing accordingly all structures involved in the shoulder girdle, releasing the Trigger Point that might be present and also returning the joint to a more functional place structurally. This last one is the hardest things.

Since our body is all interconnected we can’t just press “reset”. The shoulder might be affected by ultimately any other structure in the body and the presentations are as varied as the number of people in this world.

It’s the task of the soft tissue therapist trying to solve the puzzle. It’s fascinating.