Trigger Points – Vague pain in the back of the shoulder and arm

Client Description

People usually complain of vague pain in the back of the shoulder and arm. This pain often occurs in passive postures where they are using the long head of the triceps o stabilize the arm. This might happen when they are holding their arms in during crowded travel. It could also happen when they are reaching out for a while tending to the face of a child across from them.


During exercise, this can produce sharp pain and “tennis elbow.” This can produce pain when stretching up to serve a tennis ball. This also hurts during triceps extension in the gym. tricep-pressThese people are easy to spot in the gym as they cannot straighten the afflicted arm during overhead presses. This, in fact, is the standard test. The patient reaches overhead and is not able to straighten the arm with the tight triceps. Interestingly, this almost always happens on the right. Search the web for pictures of people doing overhead presses and the right elbow is almost always bent more than the left.

This produces pain and restriction while serving a tennis ball. The restricted shoulder and the weakened triceps hurt the power in the serve. The pain in the elbow is confused for the classic tennis elbow, which comes from forearm muscles.

Most of them have tried shoulder work and, maybe, forearm work to help with the elbow problem without success.

Self Care

tricep-teres-behindThis triceps stretch is classic and usually well-known. This stretch is more effective for the long head when the hand of the upper arm is placed on the shoulder instead of being pulled to the mid back. Using ice along the outer triceps makes this easier and less painful.

Pressing the elbows into the ears during overhead presses also helps. It is more active and trains the opposing muscles for better motor planning.

Therapy Notes

oit-triceps-long-headoit-triceps-long-head

Unlike the other two heads, the long head of the triceps crosses the glenohumeral joint and generates more pain in the shoulder.  It also crosses the humeroulnar joint, leaving the humerus trapped between the attachments. Both joints need to be mobilized for lasting results. When this has become chronic enough to seek therapy, the muscle fibers almost always also need direct work.


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’d love your feedback. We are adding posts and converting the old posts as quickly as time permits.


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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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