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.
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.
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.
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).
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.
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.
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.
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.