After rounds of PT, then 2 robotic partial rib resections, my child is in PT to strengthen wasted muscles from years of problems. With all rounds of PT my child had severe knots in the upper back muscles, neck muscles, and shoulder muscles. It wasn't until the physical therapist started using trigger point try needling did the muscles finally relax. There was a significant difference even after the first round of treatment. It accomplished what months of therapy and massage could not do. It eliminated pain that was associated with the tight muscles which was created by the natural position used to help her body cope with the arterial and venous TOS.