Myofascial Neck/Shoulder Pain Causes, Symptoms & Treatment

Myofascial neck/shoulder pain is a very common cause of chronic pain in the neck and shoulder. Myofascial pain or Myofascial Pain Syndrome is defined as a musculoskeletal disorder that causes pain in the area of a muscle in the body, and its surrounding connective tissue known as fascia. The pain can be characterized by multiple trigger points. Trigger points are highly sensitive muscle foci that are painful to touch and refer pain to the surrounding area. Specifically, in the neck/shoulder region, muscles commonly involved include the rhomboids, trapezius, levator scapulae, supraspinatus, and infraspinatus. The pain can be acute or chronic and likely occurs due to overuse, postural changes, or muscle trauma. Muscle knots can develop, contributing to increased neck and shoulder pain.

Overuse or trauma to the neck muscles, as well as stress and postural mechanics, can all lead to myofascial pain in the neck/shoulder. The clinical scenarios leading to this diagnosis can range from patients in motor vehicle accidents, to those who recently started a repetitive overhead activity like painting a ceiling, to patients who work at a desk all day and have improper mechanics when using their computer. Muscles may become tight or inflamed from overuse or injury. Often, these muscles can develop sensitive areas called trigger points. The spectrum of trigger points and persistent inflamed muscles is often referred to as Myofascial pain syndrome. This condition may result in neck and shoulder tension and referred pain towards the shoulder area.

Symptoms of myofascial neck/shoulder pain vary but often include:

• Dull, achy Pain in the muscles of the Neck and upper back
• Tender Knots in the muscles around the neck/shoulder or along the inside edge of your scapula (shoulder blade)
• Referred pain down the arms to the elbow
• Occasional neck stiffness
• Occasional twitching or spasm of the neck/shoulder muscles
• Your doctor may assess your posture, which is often abnormal in myofascial pain syndromes.

Your doctor will perform a physical examination evaluating your range of motion, strength, sensation, and reflexes in your arms. He or she may look for tender areas around the muscles of your neck and upper back, which are referred to as trigger points. X-rays and MRI scans may be ordered in rare circumstances to make sure you do not have a more serious condition, but are usually not necessary. If you experience symptoms of a spinal strain injury that don’t resolve after a week or if it prevents you from doing your normal activities, you should see your doctor. You should also seek medical treatment if you experience radiating arm or leg pain, as these symptoms may suggest nerve damage. Usually, a diagnosis can be made by taking a medical history and conducting a physical examination. Your doctor will want to examine your back and look for signs of a strain, such as inflammation and tenderness, as well as neck and shoulder tension.

Treatment of myofascial pain usually involves non-surgical measures to allow injured muscles to heal properly. Conservative treatments include:

• Rest from activities and sports that place strain on the back, and reducing the time spent at a computer can also help
• Ice to reduce swelling
• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, can help relieve pain and inflammation
• Steroid injection to relieve severe pain
• Physical therapy uses exercise and modalities to restore balance to the muscles and surrounding tissue areas. Therapists focus on targeted stretching and strengthening of affected muscles to correct the mechanical and postural deficiencies that may be causing or exacerbating the problem. Modalities including myofascial release, massage, ultrasound, and phonophoresis, along with an exercise program, are aimed at decreasing pain and preventing further injury.

These treatments are particularly effective for reducing neck and shoulder tension, relieving muscle knots, and addressing referred pain due to trigger points.

Try these exercises to help address your condition:

Below is a PDF of the Exercise Program

Myofascial neck

Surgery is NOT recommended for the treatment of myofascial pain

Patients generally have good relief with proper treatment, but it is also possible to have chronic symptoms or for symptoms to recur. It is necessary to find the underlying cause of the problem so that focused treatment can be delivered. Early interventions lead to better outcomes.

Focused exercise and attention to a correct sitting posture, as well as proper body mechanics, in general, are necessary for better outcomes through the recovery process. You may also be required to participate in a prolonged home exercise program for continued benefit, particularly if your condition involves persistent neck and shoulder tension, trigger points, or referred pain.