Written by Ansu Susan Kuriakose, BPT · Clinically reviewed by Jasmal K, BPT, MPT · Last reviewed 5 October 2026
Neck and shoulder trigger points (myofascial pain)
Tight, tender "knots" in the muscles between your neck and shoulders can cause aching, stiffness and even headaches. These are often called trigger points, and the condition is called myofascial pain. It's common, especially with long hours at screens, on phones or on two-wheelers, and it responds well to treatment.
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What are trigger points?
A trigger point is a tight, tender spot within a muscle that can be painful when pressed and may send pain to another area. When trigger points cause ongoing pain, it's called myofascial pain syndrome. They're most often found in the trapezius, the large muscle across the top of your shoulders and upper back.
An honest note: there's no fully reliable examination for trigger points. A 2025 review found that studies diagnose and treat them in different ways, and follow patients for different lengths of time.
Common contributors include long periods in one position, stress, poor sleep, and sudden increases in activity.
Symptoms
- aching, tight muscles across the top of the shoulders or between the shoulder blades
- tender knots that hurt when pressed
- pain that spreads, for example from the shoulder into the neck or head
- neck stiffness
- headaches, often starting at the back of the head
When neck pain needs urgent help
How it's diagnosed
At your Maana Spine assessment, your physiotherapist asks about your symptoms and routine, checks how your neck and shoulders move, examines the muscles for tender trigger points, and checks for nerve involvement or other causes, such as a neck disc problem.
You'll get a physiotherapy diagnosis and a personalised plan. You don't need a scan to book; if one would help, your physiotherapist will recommend an MRI or X-ray.
How we treat trigger points at Maana Spine
Treatment follows Maana Spine DTX™, adapted to muscle-related pain:
Assess: we confirm that muscles are the main source of your pain and rule out other causes.
Decompress: not usually needed for trigger points. If a neck disc problem is also involved, decompression with cervical positioning may be used where it suits your condition.
Restore: radial shockwave therapy (ESWT) for trigger points, hands-on muscle release and physiotherapist-led stretching.
Strengthen: our four-level exercise roadmap (Level 1 Restore, Level 2 Stabilise, Level 3 Strengthen, Level 4 Maintain) to build endurance in the neck, shoulder and upper-back muscles.
Empower: practical changes for work, screens, riding, sleep and stress, with written and app-based home exercise programmes.
Maintain: in-person follow-up at 1, 3, 6 and 12 months. The 1- and 3-month follow-ups are included in your program fee; the 6- and 12-month reviews are charged separately.
A DTX program is typically 15 to 25 sessions of 60 to 75 minutes each. Your physiotherapist will tell you after your assessment how many you're likely to need.
What the research says
- Better than sham. Reviews show shockwave therapy (ESWT) reduces pain from neck and upper-back (trapezius) trigger points more than sham treatment. Evidence that it beats other active treatments, such as dry needling, is weaker.
- Strongest for the trapezius. The strongest evidence for ESWT is for trigger points in the neck and upper back.
- Side effects. Shockwave therapy can cause temporary discomfort during treatment, redness and soreness afterwards, and sometimes bruising.
Practical tips
- Move often through the day, especially at screens and on your phone.
- Try gentle heat on tight muscles if it feels soothing.
- Stay active. Regular exercise helps muscles cope with long days.
- Look after your sleep, as poor sleep can make muscle pain worse.
These are general tips, not a substitute for an assessment.
When to book a spine assessment
Book an assessment if neck and shoulder pain keeps coming back, lasts more than a couple of weeks, causes headaches, or affects your work or sleep. Spine assessments are available at all five Maana Spine clinics in Kochi, Kozhikode, Thiruvananthapuram, Aluva and Perinthalmanna. The consultation fee is ₹250, and no doctor's referral is needed.
Book a Spine Assessment · or call or WhatsApp +91 99950 09403
Frequently asked questions
What does a trigger point feel like?
A tight, tender knot in the muscle that hurts when pressed, and may send pain to nearby areas such as the neck or head.
Does shockwave therapy work for muscle knots?
Reviews show shockwave therapy reduces pain from neck and upper-back trigger points more than sham treatment. Evidence that it beats other active treatments, such as dry needling, is weaker.
Is shockwave therapy painful?
It can be uncomfortable during treatment, and the area may be red or sore afterwards. Your physiotherapist adjusts the intensity to keep it tolerable.
Can trigger points cause headaches?
Yes. Trigger points in the neck and shoulder muscles can refer pain into the head.
→ Headaches from the neck
Will massage get rid of trigger points?
Hands-on muscle release can ease them, but lasting relief usually needs exercise and changes to daily habits too.
How many sessions will I need?
Your physiotherapist will suggest a plan after your assessment.
References
- Trapezius myofascial pain syndrome meta-analysis, 2020. sciencedirect.com
- Wu et al. Annals of Translational Medicine, 2022. atm.amegroups.org
- Meta-analysis of randomised trials of ESWT for trapezius myofascial pain syndrome, 2019. doi.org/10.1097/MD.0000000000019085
- Scoping review of ESWT for myofascial trigger points, 2025. pmc.ncbi.nlm.nih.gov/articles/PMC12565389
- Systematic review of ESWT complications in plantar fasciitis. International Journal of Surgery, 2017;46:133–145. pubmed.ncbi.nlm.nih.gov/28890412
- Australian Physiotherapy Association. Vertebrobasilar insufficiency and cervical arterial dissection factsheet, 2025. australian.physio