Trigger Points or Something More? When Muscle Knots Signal Deeper Problems

You’ve named them. Those spots between your shoulder blades that feel like marbles under your skin. The one on the left you call “Fred.” The stubborn one near your neck that’s been there so long it feels like part of your anatomy. Your massage therapist works on them, your spouse rubs them, you’ve even bought one of those medieval-looking foam rollers that promises to work them out.

But they always come back. Same spot. Same nagging ache that builds throughout the day until you’re desperate for relief by evening. And lately, you’ve noticed something else—the pain seems to be spreading. What started as a knot in your shoulder now sends tentacles of discomfort down your arm, up your neck, sometimes even causing headaches.

At Arizona Pain and Spine Institute, Dr. Asim Khan and Dr. Daniel Ryklin see patients every day who thought they just had “bad knots” only to discover something more complex was happening. Understanding the difference between simple trigger points and deeper problems can mean the difference between endless temporary relief and actually solving the problem.

What Trigger Points Really Are (And What They’re Telling You)

Let’s start with what these knots actually are, because understanding them helps explain why yours might be different. A trigger point is essentially a small patch of tightly contracted muscle that refuses to relax. Imagine a fist that’s been clenched so long it’s forgotten how to open. That’s your trigger point—a micro-cramp that’s become permanent.

These contracted areas create a fascinating cascade of problems. First, they strangle their own blood supply. Without proper blood flow, the muscle tissue doesn’t get oxygen or nutrients, and waste products build up. This creates a chemical soup of irritation that makes the muscle contract even more. It’s like a Chinese finger trap—the harder you pull, the tighter it gets.

Dr. Ryklin, who specializes in identifying biomechanical weaknesses, explains it this way: “A simple trigger point is like a spot fire. It’s local, contained, and with the right treatment, we can put it out. But when patients come to me with trigger points that keep returning or seem to be multiplying, that tells me we might be dealing with a forest fire—something systemic that’s causing these spot fires to keep igniting.”

The typical trigger point responds well to massage, stretching, or trigger point injections. You press on it, it hurts in that “good hurt” way, and afterward you feel relief. Maybe not permanent relief, but genuine improvement for days or even weeks. That’s a simple trigger point doing what simple trigger points do.

But then there are the other ones. The ones that laugh at massage. The ones that come back within hours of treatment. The ones that seem to have friends that show up in predictable patterns. These are trying to tell you something important.

When Your Trigger Points Form a Pattern

Here’s where it gets interesting, and where Dr. Khan’s expertise in complex regional pain syndromes becomes invaluable. When trigger points start forming patterns, they’re often revealing an underlying condition that needs different treatment entirely.

Take myofascial pain syndrome, for instance. This isn’t just having multiple trigger points—it’s when your entire fascial system (that web of connective tissue that wraps around all your muscles) becomes dysfunctional. The fascia gets thick, sticky, and hypersensitive. Instead of sliding smoothly as you move, it catches and pulls, creating trigger points at predictable stress points.

Patients with myofascial pain syndrome often tell me the same story. It starts with one stubborn knot, usually after some minor injury or period of stress. Then another appears nearby. Then another. Soon, they have a constellation of trigger points that all seem connected. Press on one, and you might feel it in three other spots. It’s like a network of pain that spreads along invisible highways through your body.

Dr. Khan sees this pattern frequently: “When a patient shows me trigger points that follow specific fascial lines—say, from the shoulder blade, up the neck, over the skull to behind the eye—I know we’re dealing with myofascial dysfunction. Treating individual trigger points would be like playing whack-a-mole. We need to address the entire fascial system.”

The Long-COVID Connection Nobody’s Talking About

Since 2020, Arizona Pain and Spine Institute has seen a dramatic increase in patients with widespread trigger points that don’t behave normally. These patients often had mild or moderate COVID-19, recovered from the acute illness, but then developed mysterious muscle pain weeks or months later.

The pattern is distinctive. Unlike typical trigger points that develop from overuse or injury, these appear seemingly randomly. A patient might wake up with trigger points in their calves, upper back, and jaw all at once. Traditional trigger point therapy provides minimal relief, and the knots seem to migrate—better in one spot one day, worse in another the next.

What’s happening here is systemic inflammation affecting the neuromuscular system. The virus triggers an ongoing inflammatory response that makes muscles hyperreactive. They contract too easily and won’t release properly. The fascia becomes inflamed and sticky. The nervous system becomes hypersensitive, amplifying pain signals.

For these patients, treating trigger points with standard injections is like trying to bail out a boat while ignoring the hole in the hull. The inflammation needs to be addressed first, which is why Dr. Ryklin often combines trigger point therapy with anti-inflammatory treatments, sometimes including regenerative medicine approaches like PRP to help reset the inflammatory response.

The Fibromyalgia Revelation

Then there are the patients who’ve been getting trigger point injections for years with decreasing effectiveness. They have tender points all over their body. They’re exhausted. They don’t sleep well. They’ve been told they’re depressed or anxious, that it’s all in their head. But Dr. Khan knows better.

“When I see widespread trigger points, especially in predictable locations, combined with fatigue and sleep disturbances, I start thinking fibromyalgia,” he explains. “The research now shows that up to 40% of Long-COVID patients meet the criteria for fibromyalgia. But even before COVID, fibromyalgia was often misdiagnosed as just having lots of trigger points.”

The difference matters because the treatment is completely different. Fibromyalgia is a central sensitization disorder—the nervous system’s volume control for pain is turned up too high. Injecting trigger points might provide temporary relief, but it won’t address the underlying nervous system dysfunction. These patients need a comprehensive approach that might include medication to calm the nervous system, gentle exercise to recalibrate pain processing, and sometimes innovative treatments like stellate ganglion blocks to reset the sympathetic nervous system.

Your Desk Job Might Be the Culprit

Now, not every complex trigger point pattern indicates a serious condition. Sometimes, it’s just modern life catching up with us. Dr. Ryklin sees this constantly in Phoenix’s growing population of remote workers.

“Since 2020, I’ve treated hundreds of patients who developed trigger point patterns that perfectly match their work setup,” he notes. “They have trigger points on the right side of their neck from looking at a monitor that’s off to the side. Trigger points in their right shoulder from reaching for a mouse that’s too far away. Lower back trigger points from a chair that doesn’t support them properly.”

These patterns are actually good news because they’re fixable. But here’s the key: treating the trigger points without addressing the ergonomics is futile. It’s like mopping up water while the faucet is still running. This is where Dr. Ryklin’s background in physical medicine and rehabilitation shines. He doesn’t just inject the trigger points—he helps patients understand the biomechanical problems causing them.

For these patients, treatment might involve an initial series of trigger point injections to “reset” the muscles, combined with PRP to promote healing in overworked tissues. But the real solution comes from fixing the workspace, strengthening supporting muscles, and breaking up the static positions that create these problems.

The Treatment Ladder: From Simple to Sophisticated

So how do you know what kind of trigger points you have, and more importantly, what to do about them? At Arizona Pain and Spine Institute, the approach is systematic and personalized.

The evaluation starts with what Dr. Khan calls “trigger point mapping.” He and Dr. Ryklin examine not just where your trigger points are, but how they behave. Do they refer pain to other areas? Do they follow anatomical patterns? How do they respond to pressure? This detective work reveals whether you’re dealing with simple muscle knots or something more complex.

For straightforward trigger points, the treatment is straightforward too. Trigger point injections using a small amount of local anesthetic can provide immediate relief. The needle itself helps break up the contracted muscle fibers, and the anesthetic interrupts the pain cycle, allowing the muscle to finally relax. Most patients feel improvement within minutes that lasts weeks to months.

But when the evaluation reveals patterns suggesting myofascial pain syndrome, the approach expands. Dr. Khan might recommend combining trigger point injections with PRP therapy. The trigger points get immediate relief from the injections, while the PRP addresses the underlying fascial dysfunction. The growth factors in PRP can help restore normal fascial flexibility and reduce the inflammation that keeps creating new trigger points.

For patients with suspected fibromyalgia or Long-COVID-related muscle pain, the treatment becomes even more comprehensive. This might include a series of trigger point injections to provide relief while addressing the underlying condition with medications, stellate ganglion blocks to reset the nervous system, or even spinal cord stimulation for severe cases where the nervous system is stuck in a pain amplification pattern.

Martha’s Journey: From Trigger Points to Truth

Let me tell you about Martha, because her story illustrates perfectly how trigger points can be the tip of the iceberg. Martha is a 52-year-old accountant from Scottsdale who came to see Dr. Khan after two years of worsening upper back pain.

“I’d been getting massages every two weeks,” Martha told us. “The therapist would work on these knots in my shoulders and I’d feel better for maybe two days. Then they’d be back, sometimes worse than before. I tried everything—yoga, acupuncture, even bought one of those expensive massage chairs. Nothing lasted.”

Dr. Khan’s examination revealed something interesting. Martha’s trigger points weren’t random. They formed a clear pattern from her lower neck, across her shoulders, down both arms, and even into her hands. When he pressed on one particular spot near her shoulder blade, Martha felt tingling all the way to her fingers.

“That’s when Dr. Khan explained that my trigger points were actually secondary to cervical radiculopathy—a pinched nerve in my neck,” Martha recalls. “The nerve irritation was causing the muscles to guard and spasm, creating trigger points. Treating the knots without addressing the nerve problem was like treating smoke while ignoring the fire.”

The treatment plan was multi-faceted. First, a cervical epidural injection to calm the irritated nerve. Then, strategic trigger point injections to release the chronic muscle spasms. Finally, PRP injections into the facet joints of her neck to promote healing of the degenerative changes causing the nerve compression.

Six months later, Martha is a different person. “I still get the occasional knot from working long hours, but it’s normal now—the kind that goes away with stretching or a quick massage. The constant, spreading pain is gone. I wish someone had looked at the bigger picture two years ago.”

When to Seek Specialized Help

So how do you know when your trigger points need more than just another massage? There are several signs that it’s time to see specialists like Dr. Khan and Dr. Ryklin.

If your trigger points keep returning to the exact same spots despite treatment, that’s a red flag. Normal muscle knots from overuse should resolve with appropriate treatment. If they’re coming back within days, something is perpetuating them.

Pay attention if your trigger points seem to be multiplying or spreading in patterns. One knot becoming two becoming ten is not normal progression. Similarly, if pressing on a trigger point causes pain, tingling, or other sensations far from that spot, you might be dealing with nerve involvement or fascial dysfunction.

Trigger points accompanied by other symptoms deserve investigation. Are you also experiencing fatigue that doesn’t match your activity level? Sleep disturbances? Mood changes? Morning stiffness? These might indicate conditions like fibromyalgia or inflammatory disorders.

The failure of conservative treatment is perhaps the clearest sign. If you’ve tried massage, stretching, exercise, ergonomic improvements, and over-the-counter medications without lasting relief, it’s time for a deeper look.

Your Action Plan: From Recognition to Relief

If you’re recognizing your own struggle in these words, here’s what you need to know about taking action. First, document your trigger points. Where are they? When did they start? What makes them better or worse? Do they follow any patterns? This information is gold for physicians like Dr. Khan and Dr. Ryklin.

When you call Arizona Pain and Spine Institute at (480) 986-7246, tell them you have chronic trigger points that aren’t responding to conventional treatment. Ask about a comprehensive evaluation to determine if there’s an underlying condition. Be prepared to discuss your complete health history, including any recent illnesses, injuries, or life stressors.

During your evaluation, be honest about what you’ve tried and what’s helped, even temporarily. Sometimes the pattern of what provides relief is as diagnostic as the pattern of pain itself.

If you’re offered a treatment plan that goes beyond simple trigger point injections, understand that this is actually good news. It means they’ve identified why you’ve been suffering and have a strategy to address the root cause, not just the symptoms.

The Path Forward: Hope for Lasting Relief

Here’s what I want you to remember: those persistent trigger points aren’t a character flaw. They’re not because you’re not stretching enough or exercising correctly. They’re your body’s way of telling you something needs attention, and that something might be more complex than just a muscle knot.

At Arizona Pain and Spine Institute, Dr. Khan and Dr. Ryklin have the expertise to decode what your trigger points are trying to tell you. Whether it’s simple muscle dysfunction, myofascial pain syndrome, fibromyalgia, Long-COVID effects, or nerve involvement, they have the tools and treatments to address the real problem.

The combination of trigger point injections for immediate relief, PRP or stem cells for tissue healing, and comprehensive treatment for underlying conditions offers hope for lasting improvement. You don’t have to accept those persistent knots as permanent residents.

Visit their website to learn more about trigger point injections and regenerative medicine options. Read about how they’ve helped others break free from the cycle of temporary relief and recurring pain.

Those trigger points you’ve named, befriended, and fought with for years? It might be time to finally say goodbye to Fred and his friends. Not just for a few days or weeks, but for good. The answer might be more complex than you thought, but that’s exactly why Arizona Pain and Spine Institute exists—to solve complex pain problems that others have given up on.

Your journey from trigger points to truth, from temporary relief to lasting solution, starts with a single phone call. Make it today, before those knots invite more friends to the party.

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Medical disclaimer: This article provides general information about trigger points and related conditions. Individual diagnosis and treatment vary. Not all trigger points indicate underlying conditions. Consult with qualified healthcare providers for proper evaluation and treatment recommendations.