Last updated: 2026-09-08
My neck, shoulder, and back all hurt over a wide area — where should I press?
If you have widespread pain from your neck to your shoulder and back and aren't sure where to press, it can be hard to tell the most painful spot from the point where the pain actually starts. Because myofascial pain syndrome can cause pain to spread to surrounding areas, finding the point to treat requires distinguishing the overall painful area from the specific point causing that pain.
Some patients point with one finger to a single spot between the neck and shoulder, while using their whole palm to indicate a much wider area of discomfort reaching up into the upper back. The spot marked by the finger and the area indicated by the palm give different information. One shows where the pain is most pronounced; the other shows the full extent of symptoms the patient experiences in daily life.
Myofascial pain syndrome can cause localized pain at a specific point in a muscle, and it can also cause pain to be felt at a distance from that point. So when the shoulder and back hurt together, it's important to determine whether these are two separate pain sources or whether pain from a single muscle is simply being felt over a wide area. The experience of briefly feeling relief after rubbing a spot isn't enough on its own to clarify this relationship.
During the exam, it helps to describe not just the single most painful spot but also the full range over which the pain extends. If the area that's uncomfortable at rest differs from the area that hurts when turning the neck or raising the arm, that difference is also useful information. Describing your usual symptoms this way gives the physician a baseline to compare against once the muscle is examined.
How are trigger points found?
A trigger point is a tender spot within a taut band of muscle. Pressing on it can cause pain at that spot, and it can also cause referred pain — pain felt in another area connected to that muscle. Myofascial pain syndrome is characterized by these trigger points along with local and referred pain, and diagnosis is made by evaluating symptoms together with examination findings (Steen Jeremy P et al., 2025).
The physician palpates along the direction of the muscle fibers to find taut bands and the tender points within them. When pressing on a point, the physician asks the patient where it hurts, what it feels like, and whether it matches the pain the patient usually experiences. This distinguishes a simple response of "that spot is tender" from the reappearance of the familiar pain the patient usually feels in the neck, shoulder, or back.
An active trigger point is connected to the pain the patient usually experiences, and pressing on it reproduces that exact symptom. A latent trigger point is different — the patient normally feels no pain there, and it only hurts when pressed. So finding a tender spot by hand doesn't automatically make every such point a treatment target. Whether the response matches the patient's usual symptoms and what discomfort appears during movement are considered together to prioritize which points to treat.
The area over which referred pain spreads varies from patient to patient. If a muscle is assumed in advance to be the cause simply because a certain area hurts, treatment may end up targeting a point that doesn't actually match the real symptoms. There is no single test that can confirm myofascial pain syndrome from palpation findings alone, so the course of the pain, its distribution, and how it changes with movement all need to be interpreted together.
If muscle tightness keeps returning despite massage, it's worth checking whether pressing on the trigger point reproduces the familiar pain. If an unusual pain appears during the exam that differs from the patient's usual pain, describing that difference is also helpful. Confirming this response is what separates a spot that is simply sensitive to pressure from a point that is actually involved in the current symptoms.
How can you tell if the treatment worked?
Before treatment, the physician checks both the tenderness on pressing the trigger point and the specific movements that cause the patient discomfort. This includes which direction of neck rotation causes pain and at what range of arm elevation pain begins, then comparing these same measures after treatment. Feeling less pain when pressed reflects a decrease in tenderness, while being able to turn the neck or use the arm more comfortably reflects an improvement in function. These two types of change don't always occur to the same degree, so each needs to be checked separately.
At Ansim Teunteun Pain Clinic, manual therapy performed directly by a physician addresses both the taut bands and the postures that place strain on the affected muscle. Manual therapy is applied to the trigger points that reproduce the patient's usual pain, and postures that concentrate strain on that muscle during neck and shoulder movement are also reviewed. The goal of treatment is not only to reduce the tightness felt on palpation, but also to help the patient perform movements that had been uncomfortable with greater ease.
A systematic review of myofascial pain syndrome in the neck and upper back reported short- and medium-term improvements in pain and function following manual trigger point therapy (Lew Jennalyn et al., 2021). This finding relates specifically to the manual trigger point therapy examined in that study. Rather than extending this result to the overall outcome of manual therapy that also addresses posture and movement in a clinical setting, it is used here as evidence describing the goal and expected response of directly treating trigger points.
For deeply hardened tissue, a treatment plan combining extracorporeal shock wave therapy may be used. Even then, the physician confirms whether the area being treated connects to the patient's usual pain. The fact that tissue is deep or hard does not by itself predict how many treatment sessions will be needed or how effective they will be; instead, the decision to continue treatment is based on comparing reductions in tenderness with improvements in movement.
For patients whose pain makes manual therapy hard to tolerate, pressure intensity and treatment area are reduced accordingly. Pressing harder does not necessarily mean the trigger point is being treated more effectively. If pain increases and movement becomes more uncomfortable after pressure is applied, whether the stimulation was appropriate should be reconsidered — this is not accepted as a sign that treatment is working well.
If pressing hurts less immediately after treatment but turning the head is still difficult, the tenderness response and the functional response differ. Conversely, if some tightness remains on palpation but the patient can now perform a previously uncomfortable movement more easily, a functional change has occurred. Understanding the treatment response fully requires checking both what can be felt by hand and what movements the patient can actually perform.
If things aren't improving and your arm is losing strength, don't wait
If pain and function don't improve even after treating a trigger point, the initial diagnosis should be reviewed before repeating treatment at the same point. This involves asking again when the pain started, whether the painful area has grown wider or shifted location compared to the start, and whether any new symptoms have appeared — to determine whether the trigger point identified at first still explains the current discomfort.
If new or worsening arm numbness or muscle weakness develops, the physician checks sensation, muscle strength, and reflexes, and evaluates for a possible nerve-related cause. In particular, it's important to distinguish between reluctance to move because of pain and an actual loss of strength. Even if a trigger point can be felt in the muscle, another condition may be present at the same time, so a newly developed nerve symptom should not simply be attributed to existing muscle tightness.
Pain accompanied by fever, or pain that worsens sharply after an injury, calls for evaluation of the underlying cause without delay. If such changes occur, treatment for muscle tightness should be paused while the background of the symptoms is investigated. Having previously been treated for myofascial pain syndrome does not by itself explain the cause of a new symptom.
Nerve block procedures are not automatically connected to treatment just because a trigger point is present. If a reassessment confirms neuropathic pain, this is considered separately based on the specific indication and the patient's condition. If the pain is determined to be neuropathic, trigger point treatment is not repeated, and treatment shifts to an approach suited to that cause. Because treating a muscle trigger point and treating neuropathic pain have different goals, the treatment direction changes to match the newly identified cause.
Jinyeol Kwon · Specialist in Anesthesiology and Pain Medicine · Ansim Teunteun Pain Clinic
References
- Steen Jeremy P, Jaiswal Kishore S, Kumbhare Dinesh (2025). Myofascial Pain Syndrome: An Update on Clinical Characteristics, Etiopathogenesis, Diagnosis, and Treatment. Muscle Nerve. PMID: 40110636
- Lew Jennalyn, Kim Jennifer, Nair Preeti (2021). Comparison of dry needling and trigger point manual therapy in patients with neck and upper back myofascial pain syndrome: a systematic review and meta-analysis. J Man Manip Ther. PMID: 32962567
Frequently Asked Questions
Q. Can trigger points be confirmed with MRI or ultrasound?
Imaging alone, whether MRI or ultrasound, is not enough to confirm a trigger point. Imaging is considered when another muscle or tendon condition, or nerve compression, is suspected, and ultrasound can be useful for checking the treatment site and surrounding structures.
Q. If I have myofascial pain syndrome, do I have to get injection treatment?
Having a trigger point doesn't mean injection treatment is required. The plan — whether exercise, stretching, manual therapy, or injection treatment — is based on the severity of the pain, how much it limits daily activities, and how the patient has responded to prior treatment.
Q. Can I press on trigger points at home with a massage ball?
Avoid assuming that a painful spot you haven't had examined is a trigger point and pressing on it firmly. If you use a massage ball, don't press directly on the front or side of the neck; apply it lightly to muscle areas only, and stop if pain worsens or numbness occurs.
Q. How often should I change position while working?
Rather than applying the same interval to everyone, the timing should be based on when tightness tends to begin and the nature of the work. Don't wait until you feel uncomfortable — change position or take a short walk before that point, and you can adjust the interval by tracking when symptoms tend to appear.