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Neck - Upper Back Pain Trigger Points

Neck Pain

Trigger Point Therapy for Neck and Upper Back Pain

Everyone has had one of those days when you woke up and couldn't turn your head. You were forced to walk around like Frankenstein, if you could manage to walk around at all. Your neck is constantly aching and if try to move it the wrong way a sharp pain punishes you. It can be real misery.

What can an episode of neck pain like this teach us? I think the first lesson is that we just don't realize how critical head movement is to whole body movement. When you are moving around, your head leads the way. If you can't move your head, you have a really have a hard time moving your body at all.


The second lesson is a real simple one; your head is heavy.

It takes a great deal of muscular strength and endurance to hold your head in position and move it. Your neck and shoulder muscles take a real beating throughout the day, and it doesn't take much additional stress to overload these muscles and ignite active trigger points in them.

The last lesson that the annoying neck pain monster teaches us is about posture. When you are battling neck pain you naturally seek head positions that don't put any strain on your aching neck muscles. Usually this means lying down, but if you are in an upright position it means that you are constantly trying to "balance" your head perfectly on your neck. Tilt your head forward or to the side a tiny bit and you are punished by the neck pain.

A good visualization to use for proper posture (and less neck pain) is to imagine that you have a hook on the top (apex) of your head and that a chain is suspending you from the ceiling, like a puppet. This will position your head properly over your shoulders and align your spine naturally, drastically reducing the work load on your neck and back muscles. If you can learn this posture lesson and put into practice in your daily life, it can benefit you in many ways. Not to mention it keeps the neck pain monster away.

If you are currently suffering from neck pain, trigger point therapy will definitely help alleviate the pain and relax your neck muscles. But the most important thing you should do is find a way to rest your overloaded neck muscles. Whether you are seated or lying down, use pillows to support your head so that your neck muscles can relax and rest. Your pain will be your guide.

There are two muscle groups that are the stars in neck pain disorders, the Trapezius and the Levator Scapula, and a few others that are the supporting cast.

Trap TrPs
Trap Sym

The Trapezius Trigger Points that Cause Neck Pain

The Trapezius is the large, diamond shaped muscle group that forms the base of the neck and upper back region. It has attachment points at the base of the skull, along the spine, on the shoulder blade, and on the collar bone.

When this muscle contracts it typically moves the shoulder blade, but it also plays a part in moving the neck and head. Trigger points in this muscle refer pain to the back and side of the neck, to the temple region, behind the ear or back of the head, to the shoulder joint, and in the upper back region.


Trigger points in this muscle develop for a number of reasons, including

poor posture, emotional stress, whiplash injuries, falls, and poor sleeping positions (or sleeping under a strong ceiling fan). Additionally, hypoglycemia (low blood sugar)  and dehydration (like the dehydration associated with a hangover) may activate trigger points in this muscle.

Trapezius Trigger Point Symptoms

A person coming to see me with active trapezius trigger points may have any or all of the following symptoms, depending on how far along their trigger point activity has progressed:

  • Neck Pain and Stiffness: Trapezius trigger point pain usually starts in the neck, along one side. If there is significant stiffness in the neck it typically means that the levator scapula trigger points are involved as well.

  • Headache: The pain will spread to the base of the skull, behind the ear, to the temple, and above the eye. Often this headache pain will exist simultaneously with the neck pain.

  • Pain at the Angle of the Jaw: In severe cases, the pain may extend down into the rear jaw region. This pain can activate other trigger points that contribute to TMJ disorder symptoms.

  • Top of the Shoulder Pain or Soreness: In most cases, the neck and headache pain will be preceded by pain, soreness, and a sense of "heaviness" on the top of the shoulder (acromio-clavicular) joint. This sensation is produced by the lower trapezius trigger point and is not often noticed by the patient until I remove it by releasing the trigger point. I think in most people, this pain is present so much that they learn to ignore it. It's the proverbial "weight of the world on the shoulders" sensation.

Lev trps
lev sym

The Levator Scapulae Trigger Points that Cause Neck Pain

The Levator Scapulae muscle is a long, thin muscle located on each side of the neck. The muscle attaches to the upper spinal vertebrae, and runs downward, twisting as it does, to attach to the upper end of the shoulder blade.


The Levator Scapula contracts to raise the shoulder blade (such as when you shrug your shoulders), and helps to rotate the head to the same side.


This muscle is overloaded by common postural distortions, sporting activities, and car accidents.


The trigger points in this muscle refer pain and stiffness to the side of the neck, base of the neck, and to the inside of the shoulder blade. Active Levator Scapulae trigger points make a person unable to turn their head, so they will often have to turn their body instead.


Additionally, trigger point-induced tension in this muscle will often bring about a shortness of breath.

Levator Scapulae Trigger Point Symptoms

Patients that come to me with active levator scapula trigger points will typically have one glaring symptom; they can't turn their head because of neck pain. Often they won't be able to turn their head to either side because of this aching pain at the base of their neck, but turning their head to one side is much more painful. This is the side that has the active levator scapulae trigger points.

The pain is strongly concentrated at the angle of the neck (where the neck and shoulder come together) but will extend up the side of the neck and down into the upper back as well.

They typically keep their head positioned right above their shoulders as tilting it forward makes the pain worse. The shoulder on the painful side may be held higher than the other shoulder too.

These trigger points can mimic some of the symptoms of a panic attack, like shortness of breath and an exaggerated sense of the "weight of the world on your shoulders" feeling, which is interesting since the levator scapulae muscles act to raise the shoulders. 

2nd Trps

Secondary Trigger Points That Contribute to Neck and Upper Back Pain

There are trigger points in other muscles that can contribute to neck and upper back pain disorders, but clinically they would never be considered as a singular cause of this type of pain. They are more like a supporting cast.

The first are the Splenius and Semispinalis trigger points. This is actually a group of four muscles that run in a vertical orientation deep in the neck, and are generically called the Posterior Cervical muscles. The muscles in this group are the Splenius Capitus, the Splenius Cervicis, the Semispinalis Capitus, and the Longissimus.

These trigger points refer pain in a similar pattern to the levator scapulae trigger points. mainly to the side of the neck, angle of the neck, and the upper back regions. They can also refer pain, numbness, and burning sensations to the base of the skull.

The second set of trigger points that play a role in neck and upper back pain, but don't actually refer any pain to the neck and back are the those in the Pectoralis Major muscle. This muscle is called "the Pecs" and makes up most of the chest muscle mass. It has a very strong biomechanical relationship with the trapezius and rhomboid muscles in the upper back, meaning that trigger point activity easily spreads between these muscles. In my clinical experience, sometimes I have to release these trigger points in order for my treatment of the trapezius trigger points to be effective and long lasting.

Finally, the Scalene trigger points can refer pain to the upper back and shoulder. From a clinical perspective, these are important trigger points to consider in upper back pain disorders. The reason that I list them as secondary trigger points here is because these trigger points create pain in so many places that you probably wouldn't even notice the upper back pain created by them. Also, even though the scalene muscle is in the neck, it's trigger points don't really create any significant neck pain.

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Related Instructional Videos from Dr. Perry

While the videos below were created to teach therapists how to locate and release these trigger points, many non-professionals have used them to learn these techniques successfully.

If you have a partner, a little time, you can use these videos to learn how to treat your own trigger points.

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Related Articles from Dr. Perry

More extensive articles on these muscles and trigger points are available from Dr. Perry on our sister website Click on the titles below to read them:

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