Staff Post 10/29/15 Last Updated 2/09/18
Trigger Point massage for self-treatment shoulder pain relief has evolved over the last decade to be taught and utilized by a broad range of therapeutic professionals. This article will focus on several muscles of the shoulder girdle that can develop trigger points that will refer pain into the anterior and posterior shoulder. From a postural perspective the mass majority of individuals has developed a forward head posture with rounded shoulders. These structural deviations often lead to shoulder and neck pain.
There are multiple daily postures that we as individuals living in a modern civilized society are prone to stay in for hours and hours on end. Such as sitting in front of a computer, standing in the same place or working in a manicured yard or preparing food in a kitchen with average counter top heights. Any or all of these postures can produce a shortened and contracted anterior chest muscle namely the pectoralis major.
Trigger Points within the pectoralis major can cause pain in the front of the shoulder, chest and run down the inside of either arm. When pain runs down the inside of the left arm it is often considered a sign of a cardiac issue and should be treated as cardiac pain until ruled out by a Cardiologist. Shorting and contractures within the pectoralis major can feel like tightening around the chest with referred pain similar to angina pectoris and should be seen by a Cardiologist to rule out any heart related pain referral.
The Pectoralis Major can develop multiple trigger points near the muscles sternal or the breast bone attachment as seen in the following short animation. There is often a dramatic trigger point at the clavicular muscular attachment. This second location is often referred to as the collar bone. The clavicular trigger point refers pain to the anterior shoulder in the location of the anterior deltoid, were as the sternal trigger points will refer pain down the inside of the arm all the way to the middle, ring and small fingers.
Self-treatment for shoulder pain relief that refers from the pectoralis major will require a racket ball or a lacrosse ball and a free standing wall. The goal of the self-treatment shoulder pain work is to place the ball under the collar bone as near to the shoulder joint as possible. The following video by Kai Wheeler provides a wonderful demonstration of DIY trigger point therapy designed to reduce anterior shoulder pain referring from the pectoralis major.
Next we are going to look at trigger points found in the subscapularis. The subscapularis can have trigger points that refer pain to the posterior aspect of the shoulder. This muscle often presents with two to three trigger points with the most commonly treated point on the outer edge of the muscle along the axilla or armpit.
The trigger point found on the outer edge of the subscapularis is known to refer pain to the posterior shoulder, out across the scapula and down the back of the arm. The referral area often includes the back or posterior surface of the wrist. The most common cause of trigger points is muscular overload caused by repetitive motions.
Other causes for developing a trigger point in this muscle can include sleeping with your arm outstretched and supporting your head while under your pillow or pushed forward and under the body. Chronic tightening of subscapularis can lead to frozen shoulder and may be the result of prolonged immobilization in a cast or sling due to trauma or injury. Repetitive motions while playing sports such as tennis, racket ball, swimming, or throwing a baseball can also lead to trigger point development.
Additional indications of a subscapular trigger point can include the inability to lift the arm above 45 degrees, pain in the posterior aspect of the shoulder joint, or the inability to cross the arm over the anterior torso. A severe presentation of reduced function within this muscle would include frozen shoulder and adhesive capsulitis. If a diagnosis of adhesive capsulitis has been determined than several other muscles of the shoulder will require treatment, these include the supraspinatus and deltoid muscles.
Self-treatment shoulder pain can be done DIY by using your thumb of the opposite arm from the one being treated. The goal of this self-treatment shoulder pain technique is to place the thumb in the axilla as seen in the following video or if you prefer use the tips of all four fingers within the armpit in the same manner. Get Massage Smart offers the following two videos on how to treat subscapularis.
The next muscle that we will take a look at refers pain across the upper shoulder out toward the shoulder joint, as well as up the neck into the lateral side of the head. It is the most commonly massaged muscle of the shoulders and neck. Trapezius has numerous trigger points and is made up of three muscle bundles referred to as upper trapezius, middle trapezius and lower trapezius. The following short animation offers a visualization of the referred pain pattern found with trapezius trigger points.
There is a distinctive connection between trigger point pain referral within the trapezius and pectoralis major. This connection is the rounded shoulders and forward head posture that results from sitting and working with a computer for long periods of time. As a result, it is important to treat both the upper and middle trapezius along with pectoralis major.
When the pectoralis major is shortened the middle trapezius will be stressed resulting in trigger points. These trigger points will refer pain along the shoulder blade which is often described as a painful burning sensation between the shoulder blades when both shoulders are affected. The next video is a wonderful visual presentation on how to treat the middle trapezius with a ball and the entire middle back to shoulder with a foam roller.
The last muscles that we will discuss in this article are the infraspinatus and teres minor. We are leaving out the supraspinatus as it is not a muscle that lends itself to self-treatment. If you are experiencing ongoing and unrelenting shoulder pain than please do find a professional physical therapist or massage therapist to work with you.
By now the roll the ball over the muscle, while applying the pressure method has probable sunk in and showing it to you one more time may seem redundant. It is but it would be remiss if the importance of these two muscles when it comes to shoulder pain and neck pain was not emphasized. Many individuals are already rolling the tennis ball across their shoulders and down the spine between the shoulder blades. It is as important to use a ball to apply pressure and friction across the shoulder bald itself and along its outer edge.
As can be seen in the animation of the infraspinatus and image of the trigger point referral pattern for the teres minor these two muscles refer pain into the anterior and posterior aspect of the shoulder joint. They both perform lateral rotation of the shoulder joint while the subscapularis and pectoralis major perform medial rotation of the shoulder joint. Muscular overloading of these muscles can be caused by walking a dog that pulls heavily on the leash, working on a computer without elbow support, placing both hands on the top of a steering wheel for long periods of time and placing the arms behind the body to brace for a slip and fall.
In conclusion, it is important to treat both shoulders even if you are having pain in only one shoulder. The more you work with your own musculature the more familiar you will become with which muscles are tight or short and which muscles are over stretched or to long. The shortened muscles are the ones you will spend more time applying pressure and friction. The ones that are elongated require stimulation that is more soothing in nature and exercise with resistance bands to strengthen them.
The forward head posture and forward rolled shoulder posture are common to all of us. As 99% of everything we do as humans' takes place in front of us where we can see what we are doing and our arms work best. Balancing the muscles of the shoulder can reduce and eliminate shoulder, neck and head pain such as tension headaches.
Shoulder pain due to impingement of the supraspinatus tendon is much more localized and often sharper than muscle pain solely due to forward head posture. It is favorable to differentiate between the two types of shoulder pain, to allow for proper care. DIY Trigger Point Therapy on a shoulder with supraspinatus tendonitis may increase pain or simply provide no relief. If impingement is involved a skill practitioner would be your best answer for therapy.
Understanding the pattern of the shoulder pain can provide clues. Shoulder impingement is a localized pain. Individuals suffering with this pain, have no pain when the shoulder is at rest. Pain is experienced when they reach overhead, out to the side or behind.
The pain is sharp and intense, localized at the top of the joint. Upon touching the area heat may be felt emanating from the tendon and joint capsule. Sleeping on the shoulder makes it worse and the pain continues to worsen over time.
Forward head posture and forward rolled shoulders may play a role. This ongoing posture can lead to shoulder impingement. There are specific types of activities that increase the likelihood that shoulder impingement may be a source of pain. Individuals that use their arms over their head for work such as painters, carpenters, chefs, dish washers and other types of work such as electrical installation, sports or gardening.
Testing your shoulder to see if suprasinatus is a factor for you. Sit in a stationary chair with your back straight and your feet flat on the floor. The first step is to check in with your current level of pain. So, raise the arm of the painful shoulder slowly over your head. Be aware of ease of movement and pain level.
Now, that a baseline has been established, reach down with the painful shoulder and grab the seat of the chair with your hand. Now lean to the opposite side slowly, allowing your head to move in that direction, increasing the stretch. A downward pull or stretch, will re-position the head of the humerus in the socket and relieve some pressure on the supraspinatus tendon.
The sensation of pulling, tugging or stretching should not cause pain or numbness within the shoulder. If it does, stop. Make an appointment with your primary health care practitioner. Move out to as far as you can go, with comfort and hold for about 2 seconds, repeat between 5 to 10 times.
Upon completion, raise your arm over your head again. How does it feel? Is there an increased in range of motion with reduced pain? If your answer is yes, then you have some degree of shoulder impingement syndrome.
If the downward pulling stretch, improved your overall symptoms, then you may want to make an appointment with a manual therapist. If for any reason they increased your symptoms, please make an appointment with your primary physician. If left untreated the joint may calcify, possibly causing tearing within the tissue, leading to more pain and the need for more involved treatment options, such as surgery.
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