Is Your Shoulder Pain Actually Coming From Your Neck? Understanding Trigger Points and Why Dry Needling Works
One of my favorite moments with patients is when I press on a muscle in their neck…
…and they immediately say,
“Whoa! That’s exactly where my headache is!”
Or I work on a muscle near the shoulder blade and they ask,
“How are you making my elbow hurt from back there?”
The answer?
Trigger points.
They’re one of the most misunderstood—and one of the most fascinating—things we treat at Apex Sports Medicine.
And once you understand how they work, you’ll also understand why dry needling has become one of my favorite tools for treating chronic muscle pain.
What Exactly Is a Trigger Point?
A trigger point is a hyperirritable spot within a tight band of muscle that has become dysfunctional.
Think of it like a muscle fiber that never quite learned how to turn off.
Instead of fully contracting and relaxing the way healthy muscle should, a trigger point remains in a constant state of increased tension.
Researchers believe these areas develop because of a combination of:
- Repetitive overload
- Muscle injury
- Poor recovery
- Chronic compensation
- Sustained postures
- Stress on the nervous system
Over time, trigger points develop changes in their local chemistry, including decreased blood flow (ischemia), lower oxygen levels (hypoxia), increased inflammatory chemicals, and an acidic environment that can make the muscle increasingly sensitive.¹²
The Weirdest Thing About Trigger Points…
They Usually Hurt Somewhere Else.
This is called referred pain, and it’s one of the biggest reasons trigger points are often overlooked.
For example:
A trigger point in the upper trapezius may cause pain into the side of your neck or behind your eye.
A trigger point in the sternocleidomastoid (SCM) can contribute to headaches, jaw pain, dizziness, facial pain, ear discomfort, or even symptoms that feel like sinus pressure.
A trigger point in the gluteus minimus can create pain that feels remarkably similar to sciatica.
A trigger point in the infraspinatus can send pain all the way down the arm, making people think they have a shoulder joint problem when the primary issue is actually within the muscle itself.
That’s why we don’t just ask:
“Where does it hurt?”
We ask:
“Where is the pain coming from?”
Those are often two very different questions.
The predictable referral patterns of myofascial trigger points were first mapped by Drs. Janet Travell and David Simons and continue to be supported in modern pain science.²³
Why Trigger Points Don’t Just Go Away
Here’s something I explain to patients almost every day.
If you’ve had the same “knot” in your shoulder for three years…
It’s probably not just a knot anymore.
Research suggests that chronically active trigger points exist in an environment of:
- Reduced circulation
- Relative hypoxia
- Increased inflammatory mediators
- Heightened nerve sensitivity
- Altered muscle metabolism¹⁴
That helps explain why stretching feels good…
…for about ten minutes.
The muscle isn’t simply tight.
The tissue itself has become dysfunctional.
And until we change that environment, the muscle often continues to tighten right back up.
Why Dry Needling Works So Well
This is where dry needling shines.
At Apex Sports Medicine, dry needling isn’t about “sticking needles into muscles.”
It’s about restoring normal muscle physiology.
A thin, sterile needle is placed directly into the dysfunctional trigger point.
This often produces what we call a local twitch response—a brief involuntary contraction of the muscle.
While it might feel a little strange, it’s actually something we like to see.
Research suggests that eliciting a local twitch response can help:
- Reduce excessive muscle activity
- Normalize electrical activity within the muscle
- Improve local blood flow
- Decrease pain-producing chemicals
- Restore healthier muscle function⁵⁶
In other words…
We’re helping reset a muscle that’s been stuck in “protective mode.”
Dry Needling Is Even Better as Part of a Bigger Plan
Here’s the thing.
Trigger points rarely develop for no reason.
Remember our conversation about chronic muscle tightness?
Muscles usually become overloaded because:
- Recovery is poor.
- The muscle is weak.
- The muscle is compensating for another area.
That’s why at Apex, dry needling is rarely the entire treatment.
It’s one piece of our Three-Prong Approach.
Chiropractic Care
We restore proper joint motion so muscles don’t have to guard unstable or restricted joints.
Myofascial Therapy
Dry needling, instrument-assisted soft tissue mobilization (IASTM), Active Release-style techniques, cupping, and hands-on soft tissue work help improve tissue quality, restore circulation, and reduce myofascial restrictions.
Corrective Exercise
Finally—and this is the part that keeps trigger points from coming back—we identify why that muscle became overloaded in the first place.
If a weak glute is causing your hamstring to overwork…
We strengthen the glute.
If poor shoulder mechanics are overloading your upper trap…
We fix the movement pattern.
Because lasting relief comes from solving the problem—not just treating the symptom.
Could Trigger Points Be Causing Your Pain?
You might be surprised.
Trigger points are common contributors to:
- Tension headaches
- Neck pain
- Shoulder pain
- Tennis elbow
- Hip pain
- Sciatica-like symptoms
- Jaw pain (TMJ)
- Calf tightness
- Plantar fasciitis
- Low back pain
Sometimes the pain isn’t where you think it is.
That’s why a thorough movement assessment makes all the difference.
Stop Chasing Pain. Start Treating the Source.
Pain doesn’t always start where you feel it.
Sometimes the headache begins in your neck.
Sometimes the “sciatica” begins in your glute.
Sometimes the shoulder pain starts in a muscle you’ve never even heard of.
At Apex Sports Medicine, we don’t just treat where it hurts—we find out why it hurts.
And when trigger points are part of the problem, dry needling can be one of the most effective tools we have to help you move better, recover faster, and finally get lasting relief.
References
- Shah JP, Phillips TM, Danoff JV, Gerber LH. An in vivo microanalytical technique for measuring the biochemical milieu of human skeletal muscle. Journal of Applied Physiology.
- Simons DG, Travell JG, Simons LS. Travell & Simons’ Myofascial Pain and Dysfunction: The Trigger Point Manual.
- Dommerholt J, Fernández-de-las-Peñas C. Trigger Point Dry Needling: An Evidence and Clinical-Based Approach.
- Simons DG. Review of Integrated Trigger Point Hypothesis.
- Kietrys DM, Palombaro KM, Azzaretto E, et al. Effectiveness of Dry Needling for Upper-Quarter Myofascial Pain: A Systematic Review and Meta-analysis. Journal of Orthopaedic & Sports Physical Therapy.
- Gattie E, Cleland JA, Snodgrass S. The Effectiveness of Trigger Point Dry Needling for Musculoskeletal Conditions by Physical Therapists: A Systematic Review and Meta-analysis. Journal of Orthopaedic & Sports Physical Therapy.