If you’ve ever felt that nagging tightness between your shoulder blades or a dull ache creeping up your neck after a long day at your desk, you’re not alone. Whether it’s from hours spent hunched over a computer, clenching your shoulders during stressful moments, or recovering from a strain you barely remember, that upper body tension has a way of sneaking in and staying longer than it should. Many people chalk it up to “normal stress” or “just getting older,” but for a lot of folks who come through the doors of a physical therapy clinic, the true culprit is something more specific: myofascial pain syndrome.
This condition often develops quietly. It doesn’t usually start with one big moment or injury. Instead, it builds over time, small postural imbalances, repeated habits, or muscle fatigue that gradually add up. What starts as occasional stiffness can turn into constant discomfort, limited movement, and frustration with how your body feels day to day. And because it’s so gradual, many people don’t realize there’s a name for it—or that it’s treatable.
What is myofascial pain?
Your muscles don’t work alone. They’re wrapped in a soft, flexible tissue called fascia—think of it like a supportive layer that helps your muscles glide and move smoothly with each other. But when muscles or fascia become irritated—due to overuse, poor posture, injury, or stress—tight, tender spots called trigger points can develop.
You might notice these as knots that feel sore when pressed. Sometimes they cause pain right at the site, and other times they send pain to a completely different area (what’s known as referred pain). For example, a trigger point in your shoulder might lead to headaches, or a spot near your shoulder blade might make your neck feel tight. These areas limit how well you move, how deeply you can breathe, and how comfortable you feel carrying out normal tasks like turning your head, reaching overhead, or even sitting still for too long.
Where does it usually show up?
While myofascial pain can happen just about anywhere in the body, the upper back, shoulders, and neck tend to be common hotspots—especially for people who sit for long periods or carry daily stress in their posture. Some of the main muscles involved include:
- Trapezius: This broad, triangular muscle spans the upper back and shoulders and is deeply involved in posture, head movement, and lifting. It’s also one of the most common places we hold tension, especially during stressful times or long workdays.
- Levator scapulae: Located along the side of the neck to the top corner of the shoulder blade, this muscle helps lift the shoulder and assists with neck motion. It’s particularly vulnerable when we hunch over phones or computers, or when we sleep in awkward positions.
- Rhomboids: Found between the spine and shoulder blades, these muscles help stabilize and retract the shoulders. If you’ve ever felt that deep, burning ache between your shoulder blades at the end of the day, it may be your rhomboids speaking up.
What causes it?
There isn’t always a clear, single reason for myofascial pain to show up—but in most cases, it’s the result of a combination of small, repeated habits. Common causes include:
- Repetitive movements at work or during exercise
- Poor posture, especially when held for long periods
- Lack of regular movement or general muscle weakness
- Ongoing stress or emotional tension, which can lead to unconscious clenching
- Cold environments where muscles are less mobile
- Old injuries or nerve issues that change how muscles engage
Even everyday actions—like tilting your head to check your phone, always carrying a bag on one shoulder, or sitting in a slouched position—can build up and strain the system over time.
What does it feel like?
People describe myofascial pain in different ways, but there are a few patterns we hear often in the clinic. Most describe it as a deep, persistent ache that doesn’t go away with stretching or rest. It might feel like a dull pressure, a heavy fatigue in the muscles, or a radiating discomfort that shifts throughout the day. Other common sensations include:
- Muscle tightness or restriction in movement
- Pain that travels or feels “spread out”
- A sense of pressure or heaviness in the area
- Reduced range of motion in the shoulders, neck, or upper back
- Fatigue or tenderness with light activity or at rest
These symptoms may be subtle at first but tend to get worse without care. They’re often mistaken for general tension or stress-related soreness, but unlike minor muscle fatigue, myofascial pain doesn’t resolve on its own if the underlying causes are left unaddressed.
The good news is, it’s treatable. Physical therapy focuses on identifying and addressing the root causes of pain—whether that’s postural habits, movement patterns, or mobility restrictions—while helping you rebuild strength and move with more ease. If your discomfort is holding you back or becoming part of your daily routine, it’s time to take the next step toward relief. You don’t have to live with it.
