We’ve all felt it, that radiating pain that shoots throughout your head and neck when you touch a small spot in your back muscle. You may have heard of trigger points, but what are they exactly, how do they impact your body, and—most importantly—how do you get rid of them?

Trigger points are bands of muscle fibers that are not happy; it’s like a traffic jam of tension that fatigues your body of energy. Trigger points are essentially are a build up of metabolic waste products that blocks blood flow, short circuiting the motor units with excessive neuronal impulses. Or, plain and simple, trigger points are those tender bits you always massage at the end of the day that never really seem to go away.

Active trigger points are tender without physical touch. The latent trigger points only hurt when pressed on them, like when you get a massage. The latter are more common with acute injuries and are a way for the body to protect itself, so be nice to these ones if you try to work them out yourself.

So now that you better understand why trigger points hurt, now how do you get rid of them? For my patients suffering from active or latent trigger points, I suggest the following three solutions:

Fix #1: Straighten Up

Poor posture is the root cause of trigger points for the majority of people. Start thinking about your posture throughout your day; whether you’re sitting at your desk or working out, correct postural alignment will reduce chronic strain. A good illustration of how the muscle acts according to your posture is the Upper Crossed Syndrome diagram. I show this picture to my patients to help them understand which are the stretched out, weaker muscles vs. the bound up, tight muscles.

Proper Posture 101

Try to imagine that there is a cable pulling you upward by the back of your head. Gently tuck your chin and roll your shoulders back and all-the-way down (Ease off a little so no strain is felt.) Next, find your neutral pelvis position: place your hands on your hips and find the middle between arching your back and rounding your back. This middle ground is the neutral pelvis that takes stress out of the muscles, ligaments, discs, and joints of the lower back.

Perfect posture is not easy to hold for long periods of time, so try building a new habit of getting up every 20 to 30 minutes to correct your posture. After about three months of actively correcting your posture, your body will automatically correct itself and with less difficulty.

Fix #2: Cross Train

Cross training is a great way to balance the body; by strengthening the opposite muscles used during your typical sport/activity, you’ll avoid overuse or burn out patterns. If you play a sport that requires a lot of lower body power, such as soccer, take a couple days to focus on working out your upper body.

Cross Training for Cyclists

If you’re a cyclist, a great cross training workout for scapular strengthening is what I call the “Three-way Band Exercise.” Start your workout on a trainer with a resistance band in your hands. Organize your posture and spread the band with thumbs facing backward with a slight shoulder-blade pinch. Don’t let the arms come forward; keep them in that “T” position to build the back muscles in parallel fiber alignment, which helps you keep your shoulders back during postures on the bike. Personally, I don’t start counting to 15 until I start to feel the burn. Don’t forget to get those shoulders down away from your ears when your doing this, just like they should be when you ride.

Fix #3: Have a Ball

I either have a tennis ball or lacrosse ball with me at all times to roll out knots. I typically like to lie on the ball and shop around until I find the tender bits along the inside of the shoulder blade (scapulae.) Then I’ll breath deeply into the tender area. I usually wait for about 50% reduction in pain or stiffness, and then move to another spot. Don’t do one spot for too long or it will get irritated later. Keep a ball in your car and soften up those spots as you drive home from work or a workout.

Trigger points are nasty, annoying things, but with a visit to a massage therapist, consult with a physical therapist, or just a little effort on your own part, you can work through it.

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Dustin Hancock, DPT graduated from San Diego State University with a bachelor’s degree in kinesiology/nutrition. He went on to receive his doctorate in physical therapy in 2011 from University of St. Augustine, and began his career at Rausch Physical Therapy and Sports Performance in 2012. As a snowboarder and mountain bike enthusiast, Dustin specializes in treating extreme sport athletes. As a physical therapist, Dustin says he looks forward to being a companion every step of the way on his patient’s path to recovery.

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A question that I commonly hear from patients with shoulder pain (and access to Google) is, “What is frozen shoulder?” The truth is, “frozen shoulder” is a common term that’s thrown around, but few people understand the condition or its causes.

What is “Frozen Shoulder?”

The medical term for frozen shoulder is “Adhesive Capsulitis,” and it effects the joint capsule of the shoulder. Every joint within the body contains a capsule surrounding it to provide structural stability; the shoulder joint is special in that it’s one of the most mobile joints in the body, which consequently requires a great deal of ligamentous (capsule) and muscular support to stabilize it.

Like all tissues within the body, the shoulder capsule will attempt to repair itself if damaged, going through the three phases of tissue regeneration: inflammation (swelling), proliferation (scar-tissue), and remodeling.

However, Adhesive Capsulitis is an abnormal inflammatory response; basically, the shoulder thinks it’s damaged, so it sends an unnecessary amount of new collagen (i.e. scar tissue) to the joint. This transforms the typically-mobile shoulder joint into a thick and adhesive one, which ultimately leads to pain and loss of mobility.

Signs You May Have Frozen Shoulder

While a stiff, painful shoulder could be caused by a number of things, many patients or their doctors will incorrectly diagnose it as frozen shoulder. However, the number one indicator that you truly have a frozen shoulder is if there’s a significant decrease in external rotation, especially compared to your other arm. Some other common symptoms include:

• Significant decrease in range of motion, especially loss of external rotation (ability to life your arm overhead)
• Gradual onset of pain lasting at least one month
• Progressive pain in the shoulder that worsens and is not relieved at rest
• Pain that interrupts sleep and/or makes it impossible to sleep on affected side

Again, it’s important to note that these symptoms can also be indicative of other shoulder issues, so you should have your physician or physical therapist do an evaluation to find out the true cause to ensure you get the proper treatment.

Causes of Frozen Shoulder

There are currently two categories of Adhesive Capsulitis, Primary Adhesive Capsulitis and Secondary Adhesive Capsulitis. Primary affects between 2% to 5.3% of the general population and has no known cause; it’s only characterized by a subtle and gradual onset that worsen over time and then resolves, usually within one to three years.

Secondary Adhesive Capsulitis is more common, affecting between 4.3% to 38% of the general population. It occurs in people who have incurred trauma or impingement to the shoulder, or who have had to immobilize their shoulder for a long period, such as after surgery or injury. People who have systemic complications, such as Thyroid Disease or Diabetes Mellitus, are also at risk.

While doctors aren’t sure why this happens to some people, it is more common to occur in:

• People 40 and older, particularly women
• People who have had a previous episode of Adhesive Capsulitis in the opposite shoulder
• People who have concurrent systemic complications (i.e. Thyroid Disease, Diabetes Mellitus, Parkinson’s Disease, etc.)

 

Stages of Frozen Shoulder and Their Symptoms

Due to the naturally-occurring inflammatory condition of Adhesive Capsulitis, it’s important to understand which stage of “Frozen Shoulder” you’re in so you can make sure you get the appropriate treatment.

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Stage 1: Freezing

Key indicator is pain with movement and at rest

Usually lasts for three to nine months

Gradual loss of motion in all directions

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Stage 2: Frozen

Characterized by pain with movement

Usually lasts for nine to 15 months

Inflammation of the joint capsule begins to lessen

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Stage 3: Thawing

Characterized by resolution of pain with residual stiffness

Usually lasts 15 to 24 months after onset

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Top Three Ways to Treat Frozen Shoulder

Depending on which stage you are in, the treatment for Adhesive Capsulitis can vary. Here are three of the most common and effective treatments for regaining a full, pain-free range of motion.

1. Take Anti-Inflammatory Medication

Because of this condition’s correlation with join inflammation, coupled with its gradual progressiveness, inflammatory medication (such as Advil, Motrin IB, etc.) can help relieve pain. For more severe cases, a cortisone injection (a localized injection of an anti-inflammatory medication) is available; consult with your primary care physician or physical therapists about this option.

2. If You’re in Pain: Modify Your Activity

During the painful freezing stage, you should modify the way you move throughout your day to help reduce the amount of irritation and inflammation to the joint. If a certain movement, such as reaching to grab a dish or swinging a tennis racket, causes a significant increase in pain, avoid it.

3. If You’re Just Stiff: Stretch It Out!

Once you’ve progressed into the thawing stage and can lift your arm without pain, then it’s time to start aggressively stretching out that shoulder! Since the shoulder capsule is comprised of dense connective tissue, it requires a prolonged stretch (five to 10 minutes) to create a lasting change in tissue length. As long as you are just feeling tightness/stiffness, NOT pain, then keep stretching. Research has shown that improving external rotation can improve motion in all directions and help get you pain free.

If you’re unsure, come visit us here at Rausch Physical Therapy; we can evaluate your particular and come up with a great home exercise program to get you back to pain-free movement.

 

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Sean Swopes graduated from CSU Fullerton with a bachelor of science in kinesiology. He went on to receive his doctorate in physical therapy in 2015 from University of St. Augustine, and began his career here at Rausch Physical Therapy and Sports Performance. Sean is also a certified Strength and Conditioning Specialist. As a physical therapist, Sean’s goal is to help his patients understand their musculoskeletal impairments and work together to improve them.

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