By Laura Gordon
Do you have a family member like I do who has discomfort in his shoulder when he lifts his arm above his head? Or maybe you have client that has this problem. I’m writing this blog in hopes my research on the subject will help you out with information, suggested massage techniques and exercises to improve painless range of motion in the shoulder area, aka rotator cuff area.
INFORMATION
A tear, or multiple tears, to the tendon(s) at the point of insertion on the humeral head is the most common rotator cuff problem. The four muscles of these tendons are: supraspinatus (the most frequently compromised of the four), infraspinatus, teres minor and the subscapularis. These muscles and tendons of the rotator cuff are small in size relative other structural muscles in the body. Because these small muscles and tendons are the primary players in stabilizing the shoulder joint, they are responsible for all movement of the upper arm. Injury can occur when these muscles are not properly strengthened and conditioned whether it’s for sports, exercise, or to do jobs around the home or office.
Over use of these shoulder muscles, as well as weak neck and back muscles due to poor posture can further lead to tears in the tendons and adhesions in the muscles. Another pain factor can be a previous shoulder injury not properly healed or rehabilitated. Tendons are slow to heal because the thin sheathes of fibrous tissue do not have blood or fluid bringing them nutrients and removing waste material like the muscle fibers that are attached to them. Further, over the age of 40 the average person has less blood supply to these muscles adding to the risk of injury and, in the case of injury, lengthening the healing time.
MASSAGE TECHNIQUES
The purpose for using myofascial release along with neuromuscular techniques is to treat trigger points and adhesions making the muscles stronger and in better condition to stabilize the shoulder joint.
This explanation of technique will cover the following three major muscles and their tendons in the rotator cuff.
Begin with stretching the tissues for Myofasical Release in multiple directions following the underlying muscle fibers.
The Supraspinatus
Strip superior to the scapular spine along the soft muscle tissue of the supraspinatus from the base of the neck (origin) to the hard end of bone (acromion process and clavical) three times. Close by cross fiber friction the supraspinatus tendon attachment found between the acromin process and the greater tubercle of the humerus (insertion).
The Infraspinatus
Follow the infraspinatus fossa from origin to insertion (medial to lateral) three times in three positions superior to inferior, and finish with cross fiber friction of the infraspinatus tendon. Return to any trigger points (or tender spots) in the area worked and apply pressure for a release of the tenderness or trigger point.
The Subscapularis
This muscle is the most challenging to reach and the most tender of the three major muscles.
Begin with the arm positioned either at a 90 degree angle from the body or hyperabducted over the head. Place fingers along the lateral boarder of the subscapular fossa and slowly sink deep into the muscle. Cross fiber by moving the fingers superior and inferior three times then slowly lift the fingers from the body and finish with cross fiber friction to the tendon attachment at the humeral head.
EXERCISES
These exercises are good to give your clients after a massage. It’s also great for those who are reading this and do not receive massage on a regular basis. Here is a tool to will help your shoulder in the healing process. The idea of these exercises is to increase the flexibility of the shoulder joint capsule. Codman’s exercises, aka Pendulum exercises, are three passive motion exercises that build up momentum by gentle arm swinging without use of the shoulder or surrounding muscles.
Side to Side Swing
With one hand placed on the surface of a table or chair bring both legs to a parallel position to each other,
bend the knees, and lean the torso forward letting the free arm dangle toward the floor.Begin to use the body to swing the arm side to side. As stated above, note this is to be done without use of the shoulder or surrounding muscles.
Back and Forth Swing
With one hand placed on the surface of a table or chair reach one leg back and bend the other knee and torso forward letting the free arm dangle toward the floor begin to move the body so that the free arm swings forward and backward.
Circular Swing
Using the same position as the back and forth swing shown above, begin to move the body so that the free arm swings in a circle.
Try out these three exercises to experience the sensation of creating passive arm movements. Can you localize the feeling of movement in the rotor cuff?
BUT WAIT THERE’S MORE!
In addition to massage and exercise hot and cold packs used on the rotator cuff are great home remedies that can also be added to the massage session. Hot packs are wonderful for going deep into the tissue to relax tight muscles when there is no inflammation of the tissue around the shoulder joints. If there is inflammation, cold packs aid in the reduction of swelling and bring relief to the muscle tissue and joints. Check out your local drug store for products that offer these benefits, or, if you want to do it yourself, you can put a folded damp hand towel in the freezer half an hour for cool relief or 1 minute in the microwave for warm relief.
Resources:
www.youtube.com/watch?v=3yI1JI1vTzM
www.youtube.com/watch?v=dYQsTDnnCdQ
I love the exercises. They will make a great addition to my client homework! I incorporate these techniques all the time in my massage. Ross teaches these during Deep Tissue Extremities week.
This is great information in understanding the issues I have with my left shoulder. I look forward to using the exercises for some relief.
Thanks, Clark. Glad we could help
This is very good information my brother has done something to his shoulder, I have massaged on rare occassions which seems to help, but I am going to send him this blog for the exercises. I am going to use them to.
I’ll try these exercise myself cause I am doing a lot of arm and shoulder movement at work and it sometimes causes sore and stiffness in my shoulders toward the end of the night so maybe this will keep me from being as sore at night.
This is really good for players like baseball and softball to do when they are hurting are need a good stretch.
I feel this would be great for anyone who may have shoulder issues. I am going to attempt this after my back work outs to see if it helps my muscles from hurting so bad the next day.
Good idea
Hey Clark. Your were the inspiration. Hope it helps.
My dad and I both have past shoulder injuries and I will test these exercises out on my arms. I will also try and get my dad to do it. Also, I didn’t know that tendons don’t receive nutrients from their muscles, and that the can take up such a long time to heal themselves.
I read this thinking THANK WHOEVER/WHATEVER SPIRITUAL BEING!, then was a bit disappointed. I was really hoping for a self massage technique for the shoulder, but im sure i could convert it into one. Tho, its a nice set of techniques for clients, but im not going to lie here, my shoulders are killing me. The exercises are nice tho. i never thought of actually doing those to cause relief in that area. Usually, its more of the big circles to the front back thing. So im very excited to learn these exercises, and im actually doing one in the middle of this paragraph, seems to work pretty well. Im going to have to say tho, this does give me a couple points up to my massages, which is always a welcomed plus. That, and im sure my family and friends would appreciate this technique 100{dd4fd4792e0eb33cfcd896730531ad5ee27f408bd2ce28da7f8125f8188131a8}
I think the shoulder muscles are daunting to think about massaging, they give a lot of people problems and I don’t think I understand the shoulder muscles enough to where I would be able to actually help someone fix any problems in their shoulder
I wish I would have had this info when my dad tore his rotater cuff. I remember him doing some of the exercises for physical therapy, but I bet massage would have helped him a bunch too.
A couple years ago I separated my AC joint and got a partial tear in supraspinatus. Part of my rehab was a group of exercises very similar to these. We added in cryo- and thermotherapy as well as ultrasound. Once I had some strength back we incorporated resistance and weight to these exercises. I haven’t really had any problems since unless I sleep weird and then just doing these exercises in the morning usually takes care of it.
Oh my goodness this is just what I need right now! My shoulders have been so sore and tense and I’ve been dying for somebody to do this massage on me. I guess I will just have to do the stretches for now. Thank you!
This is a very awesome blog! my mother’s shoulder has been hurting her for some time now and this is just a great blog for me to read over and actually be able to preform these exercises on her.
I am thankful for this information I already do some massaging on my Aesthetic clients neck and shoulders and I have one lady that has some shoulder issues so now I can help her and give her some tools to use at home. It always helps to build more business when you have the right answers for someone and they know that you are looking out for them. All of my clients really appreciate the homework assignments I give them to help aid in their healing process. Besides It makes me look really good:)
I Used this practice on my brother and he ended up falling asleep, when he awoke he told me it hasn’t felt so good since he fell at the skate park 3 days ago. I also practiced cryotherapy and it helped the situation a lot.
My grandma has a tear in her shoulder & won’t let her doctor do the surgery she needs, but I’m going to tell her about these exercises and I hope they can help her out. Thanks for the info
I’m defiantly going to have to try some of these massages who knew that so many things can affect your shoulders. This is defiantly going to help me during my profession to help my clients even more.
I remember this blog I like the passive exercises will utilize them in my own routine, I need to do this considering all the heavy stuff , I carry to school everyday. I like the cold damp towel in the freezer will use that.
Great tips. All my brothers are athletes and problems with their shoulders are pretty common. This will be very useful 🙂
Glad you like it. Hope it will help them. We do have to take care of our brothers…even if they were brats when we were kids!
Thank you for the info. My friend hurt herself at work and they said she surgery would not be helpful. So I can help her with this.
Now I have an addiction to grabbing people’s scapulae. Lol
I love being able to give my clients homework. It makes me look so smart! Thanks Laura for giving us this information i have already dealt with many clients that have shoulder problems and it is so nice to know every muscle and know how to find the problem and help to fix it!
Great tips, thank you for sharing them with us!!! I know a few people who have bad shoulders, hopefully I’ll be able to help them at least a little bit.
Thanks for this information it seems like it will be very helpful in the future.
Thanks for this information. I will be sharing this with my future clients as well as friends and family!!
ive actually have been doing the exercises more since i read this post last, and i actually has helped my right shoulder. definitely not near as stiff as it use to be
Great to hear that Dontae. Thanks for letting me know.
I feel like these will be great for anyone with shoulder problems.
This is great information to know. For my self and to share with others.