Trigger Points – Pain in front of shoulder when reaching out to the side

Client’s Description

People complain of pain in the front of the shoulder when reaching to the side while their arm is at shoulder level. It is easy to adapt movement to avoid this unless there is a specific activity like holding the passenger seat while driving.

This problem can be aggravated by carrying a backpack. The straps create pressure on the trigger point eliciting the pain pattern while carrying the pack. This also aggravates the muscle so that it may become chronic. The shoulder may also ache from the pressure of a seat belt.

This produces “that good stretch feeling” in the front of the shoulder during the Warrior-2 pose. If it is chronic, it will restrict the arm from lifting to shoulder height, when unwatched. If it is happening regularly, the stretch lengthens the clavicular pec but the muscle will still have weakness during contraction. In this case, the shoulder joints need work.

The trigger point is activated by strenuously reaching forward as when putting things on a shelf, reaching over something to paint or reaching out to grab a falling object. One client complained of this after spending some time trying to reach over a deep dresser to hang pictures.



First, try to correct the perpetuating activity of wearing a back pack. Often, that is not possible as it is a part of activities of daily living. A good shoulder stretching routine or shoulder strengthening routine is useful to build opposing muscles.

low-doorway-stretchDoorway stretches
are great for this but need to be done gently at first with the elbows slightly below the shoulder on the door frame. The same stretch at with the elbows at shoulder height is also helpful.  Two things will really speed this process; using the ice and stretch method or making this a regular habit by stretching several times a day for just a few seconds each time.

Therapy Notes

A chronically shortened clavicular produces a slumped shoulder with an internally rotated arm. This is similar to the internal rotation created by subscapularis but with the protracted shoulder, except that the shoulder blade is pulled forward. When this tight, it may create aching in the back, between the shoulder blades.

This is often activated with the underlying trigger points in pectoralis minor. The pain patterns are similar and usually need to be treated at the same time. The symptoms and impaired activities are different and can indicate the primary trigger point. Separating the fibers to specify treatment on each muscle is often needed for lasting results. Mobilization of the acromioclavicular and glenohumeral joints may occur with stretching and other therapy but need to be mobilized for lasting results.

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When you stop coughing,
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There are also several self-care items to help you when the coughing hurts in your side, or in your back.

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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