Trigger Point Treatment using Spinal Manipulation: Upper Trapezius, SCM, and Levator Scapulae

The relationship between muscle and joint dysfunctions is well recognized by clinicians, but few studies in the scientific literature analyze this relationship. The two leading theories as to the effectiveness of spinal manipulation for treatment of trigger points are…

  1. Increased tension of the taut muscular bands associated with a TrP and facilitation of motor activity can maintain displacement stress on the joint. Alternatively, it may be that the abnormal sensory input from the joint hypomobility may reflexively activate TrPs. This is consistent with the pain spasms cycle.
  1. It is also conceivable that TrPs provide a nociceptive barrage to the dorsal horn neurons and facilitate joint hypomobility.

There is preliminary evidence investigating changes in muscle sensitivity after the spinal manipulation.

  • Cervical manipulation produced significant increases in pressure pain threshold levels over tender points surrounding a cervical dysfunction.
  • Spinal manipulation at C3-C4 and C4-C5 levels was effective in reducing pain and tightness from trapezius muscle TrPs.
  • Manipulation directed at the C3-C4 segment evoked changes in pressure pain sensitivity in latent TrPs in the upper trapezius muscle.

These results suggest that patients may benefit from manual treatment of joint hypomobility in the management of TrPs. For instance, in patients with allodynic responses, clinicians can start muscle TrP treatment with joint interventions without increasing the muscle pain associated with direct techniques. 



Interaction between Trigger Points and Joint Hypomobility: A Clinical Perspective 


Immediate Effects on Neck Pain and Active Range of Motion After a Single Cervical High-Velocity Low-Amplitude Manipulation in Subjects Presenting with Mechanical Neck Pain: A Randomized Controlled Trial