Home » Therapist Notes – Pain at the Base of the Head and Under Shoulder Blade

Therapist Notes – Pain at the Base of the Head and Under Shoulder Blade

Treatment of trigger points that create starts with atlas mobilizations. Once the upper cervical area is mobilized, trigger points in the suboccipital region release more easily and comfortably. Then, follow up with direct treatment along the lamina groove.

It is worth noting that this complaint is usually two other patterns. Displacements in the upper cervical region produce the pain at the upper neck and stiffness in movement. The trigger point in the serratus posterior superior usually creates the pain under the shoulder blade.


Start by Understanding the Anatomy.
About the coloring of the illustrations…

Multifidi and rotatores are interspinous muscles that manage tension and balance between vertebrae.


Treatment Sequencing

Mobilize the upper cervical vertebrae.

Multifidi trigger points are strongly governed by vertebral mobility. Even though this trigger point is in the multifidi near C3, it is difficult to get a more complete release and lasting relief without first mobilizing the atlas and axis.

This post has few different techniques for mobilizing the atlas.



Balance the Upper Cervical Region

This post helps to clear the muscular tension around the upper cervical vertebrae to balance tension. This sequence allows the vertebrae to stay mobile once the client becomes weight-bearing. Moreover, joint work, followed by muscular work, promotes a structure that is better at self-correcting after treatment.


Direct Treatment of the Problem Area

This post is has a classic NMT routine for releasing trigger points in the lamina groove, including this one near C3. Any remaining trigger points or fixated vertebrae can be released with static pressure.


Balance the Area with Stretching

Assisting the client with this stretch routine is helpful after mobilizing the vertebrae and releasing the posterior cervical musculature. The upper belly of anterior scalene attaches to the transverse process of C3 and may need to be released to balance movement, especially with Forward-Head Posture.



This site is undergoing changes. Starting in early 2020, we began changing the format of the posts to include more extensive self-care, illustrations, therapist notes, anatomy, and protocols. We appreciate your input and feedback. You will see us adding posts and updating older posts as time permits.


Weekly Featured Post

Is the pain from
degenerative discs or
trigger points in the muscle?

This post discusses the differences in pain from disc problems and pain from trigger points. Who should you see to help with your pain?

Tony Preston has a practice in Atlanta, Georgia where he sees clients. He has written and taught about anatomy, trigger points, and cranial therapies since the mid-90s.

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*This site is undergoing major changes. We are reformatting and expanding the posts to make it easier to read, more accessible, and
to include more patterns with better self-care. In the meanwhile, there will be inconsistency in formatting, content, and readability until we get the old posts updated. Please excuse our mess.