Understanding Trigger Points – Pain at the Base of the Head and Under Shoulder Blade

Years of clinical experience reveal that pain under the shoulder-blade with neck pain are usually caused by two or three other patterns. The pain under the shoulder is most commonly this trigger point. Pain at the top of the neck is most commonly this trigger point. Stiffness in the neck with pain under the shoulder is most likely this trigger point. Click on these posts to see if they sound more like your pattern. 

referral - semispinalis cervicis  referral - levator scapula  referral - serratus posterior superior - posterior

Client Description 
referral - multifidi - mid-cervical

With this trigger point, people complain about pain at the base of their head. When I press for more detail, they may tell me about the tension in their neck and the sore shoulder. It is easy to palpate the tender lump and displaced vertebrae in this area.

People complain more about achy pain than restricted movement. This muscle doesn’t create much restriction in mobility of the neck like levator scapula does, which creates a similar pattern. If you’re looking to see if this is your pattern, make sure you compare the details to the similar muscles in the Therapy Notes.

People are seldom aware of how this particular trigger point is started although many complain about doing too much computer work or sleeping in an awkward position.


You can get temporary relief with ice and stretch of the neck. Many clients will do the entire neck stretching routine under a hot shower each morning to get rid of the stiffness and tension. This often becomes a regular, preventive measure.

These muscles tighten because of displaced joints in the lower neck. Stretching helps with temporary relief. Your trigger point specialist can address this more thoroughly for longer lasting relief.

Therapy Notes

oit-multifidi-cervicalMultifidi are special in their overlapping, multi-stranded configuration. They are somewhat variable, but generally, they originate on the transverse of a vertebra, skip two vertebrae and attach to the 2-4 vertebrae above that. These illustrations show the typical configuration of a single cervical multifidus and the overlapping configuration of multifidi in the lamina groove.

There are exceptions to the typical structure, and cervical multifidi are included. They originate on C5-C7 and insert on C2-C5, leaving some with single strands that only skip over one vertebra. This second pic shows a configuration of how the multifidi overlap to create a thick, complex muscular structure that moves vertebrae in relation to each other. Rotatores lay under the multifidi, and semispinalis muscles lay above the multifidi, but the bulk of muscle in the lamina groove is made of the multifidi.

There are several things to note about treatment:  With colored origin and insertion bones, it shows vertebrae are wedged and compressed by this muscle. Trigger points are associated with the displaced vertebrae. It is easy to palpate the relaxation of the multifidi when the vertebrae are mobilized.

There are other trigger points that refer pain at the base of the head and stiffen the neck. Like cervical multifidi, most of them cross the joints between the occiput and C2. Resolving displaced vertebrae that create a bind in the upper cervicals is key in most cases of neck pain.

Cervical multifidi can create some restriction in rotating the neck but the muscles that primarily restrict turning of the head are levator scapula, upper trapeziussplenius cervicis and obliquus capitis. When there is a severe restriction in turning, it indicates that more than one of these muscles is involved.

and some related posts…

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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