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Supercharged

Therapist TM

How can you shoulder a burden if the burden is your shoulder?

Admit it, your shoulders were designed to make every action possible, they adduct, abduct, flex, extend both vertically and horizontally and circumduct which means they can perform tasks as simple as lifting a pen through to carrying loads that can be as much as your weight or even greater. However, despite their versatility, shoulders are not well designed and are prone to injuries when overworked. And that explains the hassle of being unproductive when experiencing mild to intolerable shoulder pain. In today’s article, we are to learn the Best Pain-Free Subscapularis Massage for Shoulder Pain.

Whatever kind of pain it is, many therapists elect to focus on massaging the region of the complaint without looking further into the mechanisms of the shoulder. Massaging the local region is an effective solution if we are working towards increasing our mild inflammatory response when we work on the tissues, the general increase of fresh blood to your muscle and oxygen-rich nutrients purportedly assisting in tissue health BUT, a deep tissue massage could worsen the situation.



The American Massage Therapy Association defines the shoulder as the interlocking of bones, cartilage, tendons, and fluid.  It comprises muscles including the upper trapezius and levator scapula above, the rhomboids and lower trapezius medially, and the latissimus dorsi posterior and laterally. It also contains the rotator cuff which includes supra and infraspinatus, teres major and minor, and the subscapularis which is the largest and strongest muscle of the four rotator cuff muscles. A tricky muscle to access but necessary if you want good outcomes.

Despite that, not a lot of people do work on the subscapularis when treating shoulder pain and when they do, it is painful and uncomfortable. In this article let me unravel a way for you to treat the pain without pain.

Here is how to apply the Best Pain-Free Subscapularis Massage for Shoulder Pain:

  1. Standing – Check the range of internal rotation (medial rotation).

We should always get a benchmark of ROM when treating. It is for the patient as well as us to understand the before and after of treatment.

FABRE for internal and external mobility is a great way to start. By this I mean to have them bend their elbow at a 90-degree angle, swing it inward reaching behind the back, and touch the inferior aspect of the opposite scapula. By doing this, you and your client can get an understanding of the quality and amount of mobility through the range, how stiff the shoulder is, where they feel the pain and or restrictions, and post-treatment, you can get a comparison and more ideas on what extra work needs doing or what exercise prescription is required.

  1. Supine – Lay down on a table.

A massage table is perfect but NOT completely necessary. If you don’t have one you can look for a flat surface that is comfortable i.e., the carpeted floor or a mat, or even a very firm mattress. They need to be able to relax their shoulders. Laying down will also make it easier for you to locate the muscles to work on.

  1. Exercise/treatment – Do low-load muscle activations.

What is low load muscle activation???

If I ask you to perform a task such as raise your arm, you will recruit many muscles to perform that action. If I ONLY want ONE muscle to work then I need to get you to perform the EXACT movement that this muscle is required to do BEFORE the synergists turn on to assist in the action.

So a low load action is one that is very small and very gentle. It required the therapist to know what the action of the muscle is and to have the client in the exact position for that muscle to fire first.

Our subscapularis performs two movement patterns for long and short-range so we need to improve the firing sequence of the muscle at these two ranges for effective treatment gains. When the action or strength of contraction of the muscle returns, so too does the resting length improve. This means the stronger the muscle the longer it sits at rest. When it is at a better resting length there is far less compression into the joint capsule and therefore less work for the other muscles working in the rotator cuff.

Before we start this best pain-free Subscapularis Massage for shoulder pain, let’s consider draping and privacy issues. Both males and females should have appropriate covers for the breast tissue (wear appropriate crop tops) before you do the low-load muscle activation. If your client has lower back pain, put a pillow or bolster under the knees to keep the back flat.

Start in short-range as it’s easier for the shoulder if there are signs of impingement through end range.

As the therapist slide your fingers along the rib line and drop in behind the anterior part of the scapula and until you can palpate the muscles of subscapularis.

Pop your fingers down to that area and link in so that you can feel the movement when the patient is doing a contraction.

For Short Range

  • The subscapularis is going to adduct the arm, so the elbow comes in towards the body at the same time as the forearm medially rotates. This is a very gentle contraction for a few seconds only and then FULLY relax and repeat for approximately 20 repetitions. You will start to feel your palpating fingers sliding and gliding down between the spaces of the ribs and under the scapula as the muscle starts to soften and lengthen.

For Long-Range

  • Do an isometric contraction. Take your client’s arm into their overhead end range and hold it there, have them perform the similar to “spiking” a volleyball. That is returning the straight arm down to their side by using the armpit muscles to perform the action. The subscapularis is now drawing the arm forward and down. Repeat the “up, down, relax” contraction until you see that the arm is starting to go further into extension without impingement.
  1. Stand and repeat to see the results.

Do the FABRE or Apley’s scratch position again to measure your range of internal rotation once done and compare it with the previous one.

As you can see, treating shoulder pain doesn’t need to be as painful as you believed. This is really one of the simplest ways to apply a treatment for improving a weakened or damaged muscle for the client and removes the pain and fear response attached to the treatment.

Don’t forget to watch this Best Pain-Free Subscapularis Massage for Shoulder Pain video

CLICK ON THE VIDEO (Best Pain-Free Subscapularis Massage for Shoulder Pain) for the best way to see them in action and remember what I’ve taught you, take note of these processes so that you’ll never worry about painfully treating the shoulder. If you want to know more, visit my YouTube channel where I teach you how to do treat related concerns.

 

 

Paula Nutting Director Your Musculoskeletal Specialist
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