Trigger Point Therapy for Frozen Shoulder

If you or someone you know has dealt with frozen shoulder (or adhesive capsulitis), you know how limiting and painful it can be. Frozen shoulder causes pain, stiffness, and a restricted range of motion in the shoulder joint, often taking months or even years to resolve. While physical therapy and other treatments play essential roles in managing frozen shoulder, one lesser-known but highly effective method is trigger point therapy.

In this article, we’ll explore the role of trigger points in frozen shoulder, take a closer look at the insights from Drs. Janet Travell and David Simons, the pioneers in trigger point research, and discuss how trigger point therapy can be an invaluable tool in managing this condition.

What is Frozen Shoulder?

Frozen shoulder, or adhesive capsulitis, is a condition where the connective tissue capsule surrounding the shoulder joint becomes thickened, stiff, and inflamed. The capsule typically becomes adhered, or “stuck,” reducing the range of motion and causing pain. Frozen shoulder progresses through three main stages: the painful "freezing" stage, the stiff "frozen" stage, and the gradual "thawing" stage, where movement slowly returns.

This condition is frustratingly common, especially among people over 40 and those with underlying conditions like diabetes. Unfortunately, frozen shoulder doesn’t have a quick fix and can linger for a year or more, impacting daily activities and quality of life.

Trigger Points and Frozen Shoulder: Insights from Travell and Simons

Trigger points are areas of hyperirritability in muscle tissue that feel like small knots or tight bands within the muscle. They can cause pain in specific patterns and often “refer” pain to other areas of the body. When it comes to frozen shoulder, the muscles surrounding the shoulder joint—particularly the rotator cuff muscles, deltoids, trapezius, and levator scapulae—are prone to developing trigger points due to the limited movement and increased tension caused by the condition.

In their seminal work, Travell and Simons identified several muscles prone to developing trigger points that can contribute to shoulder pain and restricted movement. They noted that trigger points in the subscapularis, infraspinatus, and supraspinatus muscles, for instance, can produce pain that mimics or worsens the symptoms of frozen shoulder. By addressing these trigger points, therapists can often achieve improvements in shoulder mobility and pain relief, even if the underlying capsule stiffness persists.

According to Travell and Simons, trigger points in the shoulder and upper back muscles can not only restrict shoulder movement but also contribute to “referred pain” patterns that radiate to areas like the upper arm, back of the shoulder, and even down to the forearm. These pain patterns overlap with the discomfort felt by many people with frozen shoulder, which is why addressing these trigger points can provide relief.

How Trigger Point Therapy Works

Trigger point therapy involves locating and applying pressure to these sensitive spots or “knots” within the muscles. The goal is to release the muscle tension, relieve pain, and improve mobility in the affected area. Here’s a simple breakdown of how it’s done:

• Identify the Trigger Points: The therapist assesses areas of pain and restriction around the shoulder and upper back, feeling for knots or bands of muscle tension.
• Apply Pressure: Using fingers, thumbs, or even tools, the therapist applies gentle pressure directly on the trigger points, holding the pressure for a short period.
• Stretch and Release: After releasing the pressure, the therapist may guide the patient through gentle stretches to lengthen the muscle and enhance the effect of the treatment.

Trigger point therapy for frozen shoulder often involves multiple sessions to make significant progress, as it can take time to release chronic tension patterns. The work of Travell and Simons highlighted that consistent trigger point release in key muscle groups can help restore function and ease pain over time.

Key Muscles and Trigger Points to Target for Frozen Shoulder

Certain muscles are more prone to developing trigger points that contribute to frozen shoulder symptoms. Here are the most common ones, based on Travell and Simons' research:

Subscapularis
The subscapularis is a powerful rotator cuff muscle that helps stabilize the shoulder joint and assists with internal rotation. Trigger points in the subscapularis often refer pain to the back of the shoulder and down the arm. When trigger points are active in this muscle, shoulder rotation becomes restricted, which is a key limitation in frozen shoulder. Releasing these points can help relieve shoulder stiffness and pain.

Infraspinatus
Another rotator cuff muscle, the infraspinatus, is located on the back of the shoulder blade and plays a role in external rotation. Trigger points in this muscle can refer pain down the shoulder and outer arm, mimicking some of the radiating pain often reported in frozen shoulder. Releasing trigger points in the infraspinatus can significantly improve shoulder range of motion.

Supraspinatus
This small muscle runs along the top of the shoulder blade and helps lift the arm away from the body. Trigger points here often refer pain to the outer shoulder, which can feel like a “toothache” in the joint. Tightness in the supraspinatus muscle can limit arm abduction (lifting the arm away from the side), a movement commonly restricted in frozen shoulder.

Upper Trapezius and Levator Scapulae
The upper trapezius and levator scapulae muscles run from the upper shoulder to the neck. Trigger points in these muscles are notorious for referring pain to the upper shoulder and neck, leading to tension and discomfort. When the shoulder is immobile for extended periods, these muscles can become tense, making it harder to move the shoulder freely.

Trigger Point Therapy Techniques for Frozen Shoulder

While traditional trigger point release can be effective, there are several approaches therapists use for patients with frozen shoulder:

Ischemic Compression
This is a common method where the therapist applies steady pressure to the trigger point until it “releases.” The pressure is applied gradually and held for several seconds before releasing. This technique helps desensitize the area and release the tension in the muscle, which can alleviate pain and improve shoulder movement.

Stretch and Spray Technique
Popularized by Travell and Simons, this technique involves stretching the affected muscle while applying a cooling spray along the muscle fibers. The spray distracts the nervous system, making it easier for the muscle to relax and stretch. While the spray isn’t commonly used in all practices, the combination of stretching after trigger point release remains effective.

Myofascial Release
Frozen shoulder often involves fascial restrictions, which can make the muscles feel even tighter. Myofascial release involves slow, sustained pressure on the fascia (the connective tissue around muscles) to improve mobility. This technique complements trigger point release by addressing fascial tightness.

Instrument-Assisted Techniques
Sometimes therapists use tools like massage balls, foam rollers, or even handheld devices to apply pressure to trigger points. These tools can be beneficial for reaching muscles like the infraspinatus or subscapularis, which are deeper and harder to access with hands alone.

Supporting Research on Trigger Point Therapy for Frozen Shoulder

Research on trigger point therapy for frozen shoulder specifically is still evolving, but studies have shown that treating trigger points in the shoulder muscles can effectively reduce pain and improve mobility in those with adhesive capsulitis. A study published in Journal of Pain Research demonstrated that patients with shoulder pain, including those with frozen shoulder, experienced significant pain reduction and range of motion improvements after a series of trigger point therapy sessions.

Another study in the Journal of Manual and Manipulative Therapy found that myofascial trigger point release, when combined with stretching exercises, led to faster recovery times and better shoulder mobility in patients with chronic shoulder conditions. While these studies are promising, the work of Travell and Simons continues to serve as the foundational reference for therapists treating frozen shoulder with trigger point therapy.

Integrating Trigger Point Therapy into a Comprehensive Treatment Plan

Trigger point therapy alone may not be enough to resolve frozen shoulder entirely, but it’s a powerful tool when used as part of a broader treatment plan. Here’s how it fits into a comprehensive approach to frozen shoulder:

Physical Therapy
Stretching and strengthening exercises are essential for frozen shoulder recovery. After trigger points are released, the shoulder has a greater range of motion, making it easier for the patient to perform exercises that improve mobility and strength.

Heat Therapy
Applying heat before trigger point therapy can help soften muscle tissues, making it easier to release tension. Moist heat packs applied to the shoulder before a session can enhance the effectiveness of trigger point work.

Self-Help Techniques
Many therapists teach patients self-massage techniques or use tennis balls, massage balls, or handheld tools to apply pressure to trigger points between sessions. These tools are useful for managing pain and maintaining progress outside of therapy.

Patient Education
Educating patients on posture, body mechanics, and how to avoid movements that exacerbate trigger points is essential. Maintaining good shoulder positioning and using proper ergonomics can prevent reactivating trigger points and promote lasting recovery.

Final Thoughts on Trigger Point Therapy for Frozen Shoulder

Frozen shoulder can be a stubborn, painful condition, but trigger point therapy provides a valuable means of managing pain and improving mobility. By targeting specific muscles with trigger points known to contribute to shoulder restriction and pain, therapists can help patients achieve greater range of motion, reduced discomfort, and an improved quality of life.

If you’re struggling with frozen shoulder, speak with a qualified therapist about incorporating trigger point therapy into your treatment plan. While it may take time and consistent work, trigger point therapy offers a safe, effective, and natural way to manage frozen shoulder symptoms and support your recovery journey.

Medical Disclaimer: This article is for informational purposes only and should not replace professional medical advice. Always consult a qualified healthcare provider before starting any new therapy, especially if you have underlying health conditions.

References

• Travell, J. G., & Simons, D. G. (1999). Myofascial Pain and Dysfunction: The Trigger Point Manual. Lippincott Williams & Wilkins.
• Alvarez, D. J., & Rockwell, P. G. (2002). "Trigger points: Diagnosis and management." American Family Physician.
• Bron, C., & Dommerholt, J. (2012). "Trigger points and muscle chains in myofascial pain: Implications for treatment." Journal of Manual and Manipulative Therapy.