Understanding Trigger Points – Irritating Tags, Burning Shoulders

This post is especially interesting for people with sensory processing disorder.

This trigger point creates an aggravating burning or itching sensation between the shoulder blades. It is associated with a trigger point in the middle trapezius just near the superior angle of the scapula.

Client’s Description

referral - trapezius - middle - rootPeople complain about tension in their shoulders so I press on for more specific information. They only complain about burning in their shoulders if this is really aggravated. They will admit that tags in their shirts bother them. It is not likely that they came in for a massage because their tags are bothering them, so I usually ask about that when they complain of shoulder tension.

This trigger point was an interesting part of my work with special needs children in the mid-90s. I was writing a book on trigger points and working with children with sensory processing disorder. This was the first trigger point that I associated with sensory processing disorder. After this, I found trigger points associated to their common issues like sensitivity to seams in their socks, pervasive fight-or-flight, low muscle tone, hypertonicity, etc. Learning to create lasting relief from these trigger points through cranial work allowed me to make big differences in their ability to regulate.

coffee shop shrugThis section of the trapezius is aggravated by lifting the shoulder up and back in a shrugging motion.  The more likely cause in today’s culture is that people lean on their elbows while working on their laptop. I work near Emory and see it all the time with students in coffee shops. They sit for hours in this posture leading to chronic tightness in the middle trapezius and weakness in the middle bellies of serratus anterior.

Self Care

A hot shower across the upper back with stretching the arm down and across will offer some relief. Sitting up straight was good advice from your parents as well. This is usually more complicated than a change in posture or a quick shower. This can be released and retrained by a downward pushing exercise like decline bench or dips. Most of the time, this is a problem in a more sedentary person who needs some bodywork to help release this pattern.

In most cases, some work is needed to improve posture and balance the shoulder girdle needed for lasting results.  Your trigger point specialist can help with that.

Therapy Notes

Trapezius is a complex muscle with 3 bellies that cross many joints. The first illustrations show the origin/insertion of just the middle belly while other two shows the origin/insertion of the whole trapezius.

oit-trapezius-posterior-middle oit-trapezius-anterior-middle

oit-trapezius-posterior oit-trapezius-anterior

This middle section of the trapezius (shown here in red)  is active in retracting and lifting the of the scapula. Middle traps are notorious for being tough and leathery. The right approach usually involves restructuring posture so that shoulders naturally hang in the right place.

Trapezius is complex and this section releases more easily when the lamina groove has been worked to release the multifidi. Make sure that you catch the upper cervicals first they balance the head and will be key in moving it back so that middle trapezius is not pulling the shoulders back to counter balance. Then, mobilize the vertebrae in the upper thoracics and lower cervicals. The shearing that happens at C6/C7/T1 support the trigger points in this muscle. The upper thoracics are key here but can be difficult to mobilize without working the spine above them. Also, mobilize the acromioclavicular joint.

Similar Patterns

There are several muscles that create pain in this area but this is easy to single out. The sensation is less likely to be described as pain and more likely to be described as burning, tension or irritability.

Click on these categories to see if there is a referral pattern that better describes your concerns.

tags-upper-back tags-base-of-neck


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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