Muscle Energy-Technique-for-Shoulder Rotator Cuff Pain Chapmans Reflexes

Muscle Energy Technique (MET) for Shoulder Rotator Cuff Pain


Learn Muscle Energy Technique Shoulder Rotator Cuff Pain today. If you’re suffering from rotator cuff pain, don’t worry! It’s completely treatable. For those with shoulder pain due to rotator cuff tendonitis, inflammation, or impingement, applying a Muscle Energy Technique (MET) may be just what you need to treat your condition and get back to your daily activities without pain interfering with your quality of life. In fact, our recommended treatment is one of the most effective non-surgical solutions available today.

Muscle Energy Technique for Shoulder Rotator Cuff Pain- Chapmans Reflexes Blog Image

Related Article: Neck and Shoulder Office Exercise

Why do we need rotator cuff muscles?

According to Athwal (2017), the rotator cuff is a set of four muscles that form a "cuff" over the head of the humerus via tendons. The scapula leads to the four muscles that make up the following muscles:

Rotator Cuff Muscles and four parts- Chapmans Reflexes Blog Image

Photo courtesy of A.D.A.M., INC.

The larger and lesser tuberosities are where the rotator cuff tendons join to the humeral head. These muscles altogether allow the rotator cuff to perform its important role of arm lifting and rotation as well as the stabilization of the shoulder's ball within the joint (Maruvada et al., 2021)

What is a Muscle Energy Technique (MET)?

Muscle Energy Technique (MET) is a type of soft tissue manipulation used to treat muscle imbalances and other issues. This was developed by Fred Mitchell, Sr. and Fred Mitchell, Jr. In MET, small contractions are used to stretch a tight muscle while they’re in their shortened state. The purpose of MET is to gain control over trigger points and improve mobility in muscles with limited range of motion. MET is an active approach in which the patient acts as in active participation, as opposed to static stretching, which is a passive technique in which the therapist does all of the work.

MET can be beneficial for improving stability in both shoulders. Athletes who perform overhead movements, like baseball pitchers or swimmers, tend to experience shoulder pain due to injuries like rotator cuff tears or labral problems. While steroids injections can help reduce shoulder pain and inflammation caused by these conditions. They only treat symptoms—not underlying causes of shoulder pain. In addition, it may have negative side effects if not administered correctly by professionals.

Related Article: Muscle Energy Technique Your Therapist Does For You

When should you use muscle energy technique (MET)?

Muscle Energy Techniques can be utilized for any issue where the goal is to relax and lengthen muscles while also improving joint range of motion (ROM). Almost any joint in the body can be safely treated with METs. A lot of athletes employ MET as a prophylactic treatment to avoid muscle and joint injury in the future. It is mostly utilized by those who have limited range of motion in their neck and back owing to facet joint dysfunction. Likewise, for larger issues including shoulder discomfort, scoliosis, sciatica, asymmetrical legs, hips, arms. It could also treat persistent muscular pain, stiffness, or injury.

Muscle Energy Technique (MET) for Shoulder Rotator Cuff Pain

How do you perform Muscle Energy Technique (MET)?

Muscle energy technique is effective for shoulder pain relief and it's easy to learn which is why its use in recent years have increased. Here's how you can do it for your patients. 

Physical Examination (Muscle Energy Technique Shoulder)

You will have to look at the natural range or passive range of movement of the patient. Have your client lie supine and you move their arm into abduction to a 90° angle.

External rotation of the shoulder, natural range or passive range of motion ROM should be between 80 and 90° degrees-Chapsman Reflexes Blog Image

Bend the elbow and passively check for external rotation of the shoulder as seen in the photo below. You are assessing their current ROM or the limits to their range of motion, normal range should be between 80 and 90°. If the range of external rotation is less than these numbers it can indicate that either the pectoralis major, the latissimus dorsi, and/or the teres major may be inhibited and shortened, which decreases this range performed within the upper extremity.

Next, check the internal range of the arm. Move the arm passively into internal rotation. The normal range is 70° to 90° with any limitations perhaps coming from dysfunctions in either or both the subscapularis or teres minor muscles. We also note for any ‘hard end feel’ which may indicate bony issues which means we would do further joint assessments.

internal rotation, internal range of the arm should be between 70 and 90° degrees- Chapsman Reflexes Blog Image

Performing Muscle Energy Treatment (MET) Shoulder

Move their forearm into an external rotation to perform MET. It is important that you stop at the first point where you feel restriction of the tissues. This is called Point of Bind and is at this length of the tissues that we get optimum results. They contract back towards internal rotation at 40% of the effort and no more; it is an isometric contraction where you are stabilizing the wrist and elbow to keep the joints motionless. This contraction is held for approximately 7 to 10 seconds. Ask your patient to take a deep cleansing breath and as they exhale they stop applying pressure of the muscle contraction. Keep in mind that it's important that their arm doesn't move. You will still be holding the wrist and elbow through the entire procedure and finding a new point of bind after each of the post-contraction relaxation phases.

Post-contraction Relaxation Phase

This time called Post-contraction Relaxation is when the tissues that had been contracting relax even further. We stay in limb ‘stiffness’ for up to 90 seconds and in this time the muscles relax even further so that we find the new passive end range or apply our new point of bind. Ask the patient to apply the contraction into internal rotation, still at 30% to 40% of their effort. This contraction again should be a minimum of 7 - 10 seconds. We get them to take cleansing breaths on each exhalation to improve the parasympathetic effect on the tissues; they can relax their muscle contraction as they breathe out.

Important Notes

Do the technique 3 times to see the most effective changes. Tell them to take a deep cleansing breath and that they relax the muscle contractions as they exhale. We reassess the ROM of external rotation after the third contraction and relaxation phase and we should see greater evidence of improved length through that range of motion.

This is a gentle technique for patients that feel pain and/or for those with issues in their range of motion. You might not want to use this treatment when there's a bony block when you test out the ranges. Be aware that if there's a joint restriction, we'd apply a mobilization technique or we'll adjust something deeper into that joint capsule.

Related Article: Best Pain-Free Subscapularis Massage for Shoulder Pain

Watch this Video

Here's the most effective video where you can see how to do this Muscle Energy Technique. It's a simple yet effective way to address the restrictions created by hypertonic internal rotators and gives more balance to their external rotator counterparts! Watch to go through these steps so you can practice from your clinic and also what homecare you can offer your patients when they are not in your practice.


Athwal, G. S. (2017, March). Rotator Cuff Tears. American Academy of Orthopaedic Surgeons. Retrieved February 20, 2022, from

Maruvada, S., Madrazo-Ibarra, A., & Varacallo, M. (2021, May 8). Anatomy, Rotator Cuff - StatPearls. NCBI. Retrieved February 20, 2022, from


Myotherapy: Glenohumeral Joint Pain Treatment

Patients can come in with pain and stiffness from the neck that can refer to and causes elbow wrist and shoulder pain- acromioclavicular (AC) joint and the glenohumeral (GH) joint. Typically, it impedes movements such as lifting of the arms, brushing the teeth, or holding a golf club. It may be described as a moderate pain or a chronic pain that could affect sleep especially if it’s the shoulder you sleep on.

Shoulder Anatomy

You can help them by applying a variety of techniques to relieve uncomfortable pain or sensations in and around that area. But first, let's understand the shoulder anatomy. Since it is one of the most unstable joints in the body with the most movement, it can be complex to understand its structure and functionality.

Shoulder Structure and the three kind of bones, glenohumeral joint- Chapmans Reflexes Blog Image

The two shoulder joints that are prone to injury are the acromioclavicular (AC) joint and the glenohumeral (GH) joint. 

  • The acromioclavicular joint is situated where the clavicle is in contact with the acromion and the scapula. 
  • The glenohumeral joint is where the socket of the scapula connects with the rounded head of the humerus. It is responsible for the wide range of motion of the shoulder including flexion, extension, internal and external rotation, adduction and abduction and circumduction. 

There are  eight muscles attached to the bones of the shoulder. They are responsible for the form we see of the shoulder and underarm, they aid in its range of movement, and help protect the GH joint which is the main primary joint involved in function.

The deltoid muscle, which you may also know as the deltoideus muscle, is the shoulder muscle considered to be the largest and responsible for stabilization of the shoulder joint for the prevention of dislocations. 

The other muscles which work with the deltoid for shoulder movement and its functions include:

  • Infraspinatus - for arm raise and lowering
  • Triceps brachii - arm straightening
  • Pectoralis major - connects to the sternum
  • Pectoralis minor - stabilizes the scapula
  • Teres major - arm rotation 
  • Biceps brachii - rotates the forearm; flexes the elbow
  • Latissimus dorsi - helps with arm rotation and movement away from and close to the body
  • Subscapularis - aids to rotate the humerus 
  • Supraspinatus - help to raise arm away from the body

Shoulder Pains and Problems

Muscle Energy Technique

When any of the aforementioned muscles become dysfunctional, inhibited and reduced in their passive resting length, they tend to pull the humerus forward. According to OrthoInfo, shoulder problems that patients can experience fall into these categories:

  • Tendon inflammation - can be bursitis or tendinitis
  • Shoulder Instability - stretched lining of the shoulder joint, labrum, or ligaments 
  • Arthritis - joint tenderness and swelling
  • Fracture - can be caused by trauma or injury from a fall, sports activities, vehicular accident, or a direct hit to the shoulder

Other causes for shoulder pain that are less common include infections, tumors, and nerve related problems.

See Related Video: Shoulder Pathologies: Different Causes and Cool Tubing Treatments

In this article, we are going to focus on glenohumeral joint pain and an amazing muscle energy technique that could improve the humerus’s resting position. This will improve the quality and range of motion and reduce the notable pain felt by your patient. 

Almost any joint in the body can be safely treated with these techniques. Many sportsmen utilize them to avoid future muscle and joint injuries. It's primarily used by people who have restricted range of motion in their neck and back due to facet joint dysfunction found in the neck and back, for those who have broader issues like shoulder pain, sciatica, scoliosis, unsymmetrical legs, hips, or arms, and to treat chronic muscle pain, stiffness, or injury.

See Related Video: BEST exercises for the majority of shoulder problems using the water

Conducting the Assessment

You can clearly see how  far forward the humerus of the patient is. To conduct the test, ask them to be seated comfortably. Stand behind the patient and place your hand over their shoulder. Press your thumb into the tissue, as is in the picture below, until you can palpate the humerus. Note how far forward the humerus is, you can apply a second finger along with your thumb for a more clearer view.

Conducting the assessment for shoulder pain, glenohumeral joint and problems-Chapmans Reflexes Blog Image

Upon confirming that the humerus is anteriorized and checking if any symptoms of pain locally, and/or radiating up in the neck down to the elbow and wrists are present, you can go ahead with this simple muscle energy technique that will improve length of restricted tissue and bring the humerus back into the glenohumeral joint.

Related article: Shoulder Pathologies: Different Causes and Cool Tubing Treatments


Let’s begin with the treatment steps. Here’s what you can do:

  1. Have your patient lie on their back (supine).
  2. Put your four fingers behind the humerus while your thumb and wrist sits on top of the humerus.
  3. Slide your thumb down until you get into a firm position.
  4. Push the top end of the humerus down, letting it press onto the table. At the same time, let your other hand elevate the elbow. Continue to do this seesaw-like motion that gently moves the humerus in the capsule a couple of times. Since it can be quite tender, remember not to apply too much force. 
  5. Apply gentle pressure until you can feel the bony end range and ask the patient to push their elbow to the floor and hold it for about 10 seconds. 
  6. Let the patient take a deep breath and when they release their breath you reduce the pressure applied to the limb whilst ensuring that the joint remains in an isometric position. 
  7. Repeat steps four to seven: You apply a rhythmic rocking back and forth motion of the humerus within the joint space for approximately 30 - 45 seconds or until it has a softer feel on the movement, it will start to have a smoother end feel. Continue with the gentle push while the patient takes a deep breath. When they breathe out, stop applying pressure as a counterforce on their humerus. When you apply the muscle energy technique, here are several tips to remember. When pushing down gently, hold it for about 10 seconds and ask the patient to exert 30% to 40% of their effort. Let them take a deep cleansing breath in and when they breathe out, that's when they stop contracting. You can do this three times before reassessing the joint position again. This should make headway into better movement patterns and reduced myofascial pain of the shoulder and surrounding compromised structures.

Watch This Video

Here's a short video where you can see how the steps are carried out. Watch to learn more how to follow through with the muscle energy technique. Try it from your clinic and you will see positive changes in your patients pain and function.

both hands massaging man's shoulders

Best Pain-Free Myotherapy for Sore Shoulders

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. 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.
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