Releasing the subscapularis

[Occulty!]

I've got a client whose scap is glued down. Won't hardly budge. The other one is free moving. As you can imagine he has restricted ROM in that shoulder. ROM is limited to 90 degree lateral extension, forward extension is for the most part unrestricted. He can't bring his arm very far posterior.

He is a golfer, Type A personality, mid-50s. He had arthroscopic surgery to clean out some bone spurs about 4 weeks ago (he thought he had a torn rotator cuff). The doctor got in there and found only bone spurs. He is working with a PT doing a lot of stretching. I do a lot with him as well. I've worked with his pecs and gotten about 75% of the TPs released, with some of the ROM improved. There are no TPs in the infraspinatus, teres minor or supraspinatus. I have noticed some adhesion in the upper traps but he says it's not particularly sore. I did locate TPs in the subscap but he said it was more me digging in (I swear I wasn't). His rhomboids and LS aren't tender or affected.

I'm attending James Waslaski's OrthoMassage 5-day intensive in 2 weeks (can't wait). In fact, my club newsletter article mention of it is what got him onto my table to begin with. But I would like to get him some more relief before then.

Anything you can recommend?

 

[Shay ley ley]

Subscap work

I just finished Whitney Lowe's OM 3 class on the shoulder. This may be helpful:
Have the client sidelying and try to scoop under the scapula with thumb and fingers. Any work to try and get more space between the ribs and scapula is great.
Try to pin and stretch the serratus anterior. Pin in and move the arm in forward, upward, and backward motions. This is really powerful work.
Try to stretch the muscle by going to the barrier and wait for the muscle to release.
have the client do stretching at home.
Hope this helps.
Rubmyster

 

[rivi]

Hi.

Here are a few pics and links I located on the net for other ideas you may or may not have used up to this point.

I'd like to expand on the pic that shows up in this thread, by adding a video I found (link below pic) which goes into more detail in a very similar way to which I work, for getting under the posterior region of the scap. I go all the way in, more like the video, instead of working around the area like the picture suggests. Sometimes it takes time to get to this point, but if you are gentle and persitent, the fingers will slip under the scapula after a while.

Deep_Tissue_Massage_Therapy_of_the_Upper_and_Lower_Back.mov View a before and after video of a deep tissue massage of the lower and upper back; including the neck and shoulders. Watch as deep tissue techniques ... Jason Howell,LMT selfbookit.com

This next link has some added info about subscap that you may like, and the link to the "Trigger Point Workbook" (which I have no familiararity with) has a few other pictures. There is one picture that suggests working from the side. I have worked into the armpit before, by putting a sheet into the pit, holding the arm up with one hand and pressing into the region with the fingers of the other hand. It can be somewhat uncomfortable, yet effective. It is similar to the first picture you see in the sidelying picture on this page, but I work with the client supine and with the shoulder in forward flexion / arm relaxed, instead of with the shoulder abducted.

http://www.keala.org/sc/anato/Palpation_List_Final.htm - scroll down to subscap for pic.

http://www.triggerpointbook.com/clinical.htm - scroll down to New Treatment Protocol for subscap info.

Let me know if you need further explanation and I'll do my best.

 

[orlenda]

Great links, pueppi. Thanks

 

[Pompal 09.]

I've got the Trigger Point Workbook by Claire Davies. If I can ever get the gentleman to slow down on the way out the door, I plan on showing him how to work on his own subscap. I've also worked the it by going between the serratus anterior and lats in the axilla. That was how I found out that it had so many active TPs. It is almost too tender for me to even get in there that way.

I've attempted to get under the scap like the picture and popping up the scap from the anterior but it is really locked down.

I'll check out the websites. Thanks.

 

[Riley]

Awesome post, Pueppi!

I've attended the Waslaski workshop. Frozen shoulder is his specialty, so this man will be an excellent "practice" client for you, to master the Waslaski techniques. I have also used the Trigger Point Workbook subscap release and found it to be quite effective.

One other modality that's surprisingly effective with frozen shoulder is Lymph Drainage Therapy. I don't know if you have any training in this modality? If you do, drain the neck, axilla, and all sides of the shoulder (prone & supine). Often, the shoulder will simply unfreeze.

Good luck!

 

[Rachel B]

The picture that pueppi posted is what I do to release subscap. the only thing is I don't use my thumb i use my fingers instead. When I happen to use my thumb it hyperextends, so I just stick with using my fingers. I have there hand resting on their lower back (police hold is what I call it).

 

[tongue]

My client can't raise his elbow far enough laterally to put his hand on his back. Police hold is out the question, at least for the time being.

 

[Miss-Cheif]

My client can't raise his elbow far enough laterally to put his hand on his back. Police hold is out the question, at least for the time being.

No problem there. You can just put one hand in front of the shoulder complex while the client is prone, and lift somewhat. You don't have to lift high, just some to get the scap to open a little. Then get those fingers/or thumbs from your other hand into the groove (notated by the pic) and then hold them there (firm pressure laterally (toward the outside of the body) and wait until the fingers or thumbs "sink" under the shoulder blade. If the muscles tighten up and don't want to let you in, just keep doing this with the firm pressure - hod and push laterally method (giving the lift anteriorly with your opposite hand) and hopefully eventually it will open up when the body trusts you.

I make it my goal to get under the blade like the video. It doesn't have to be exactly like the video (everyones technique is different), but that gives you something to aim at. You don't necessarily have to move it around so much if your client is currently not too mobile, but you get the general idea of what I am suggesting, I hope.

 

[Stephen Jess]

No problem there. You can just put one hand in front of the shoulder complex while the client is prone, and lift somewhat. You don't have to lift high, just some to get the scap to open a little.

Right...I get my elbow onto the table, my arm is next to theirs...kinda like doing a curl with their shoulder as the weight. You can kind of pulse it up and down, tooo. If there is great resistance to the fingers moving under the scap, be gentle and very slow, like you said, it is glued down.

You may want to start supine and pull the arm...(MFR alert)...just pull gently feeling through and past the arm, feeling into the shoulder, to the scap. You pull toward the feet, and move the arm thru the ROM, very slowly. I will move the arm so itis pointing at the ceiling, usually bend at the elbow and lift straight up for a while. The arm pull continues by you moving to the other side of the table and pulling the arm across their body, eventually you will hook the scap with your fingers and pull on both. Feels great. If you have more questions, come for a visit.

 

[sayed]

There's a side lying technique we learned in school for subscap work- client sidelying head on pillow for comfort. Uppermost arm extends over ribcage toward side of table, elbow bent, hand with fingers pointing toward head resting on table itself. You are then able to reach in under the scap along the ribcage itself and work the outer trigger points directly rather than indirectly.

Have used this technique numerous times on clients of varying sizes, weights, physiques, and it works like a charm every time and one doesn't have to worry so much about the client's ability to move the arm in rotation....

just a thought,
J

 

[Sheilla W]

There's a side lying technique we learned in school for subscap work- client sidelying head on pillow for comfort. Uppermost arm extends over ribcage toward side of table, elbow bent, hand with fingers pointing toward head resting on table itself. You are then able to reach in under the scap along the ribcage itself and work the outer trigger points directly rather than indirectly.

Have used this technique numerous times on clients of varying sizes, weights, physiques, and it works like a charm every time and one doesn't have to worry so much about the client's ability to move the arm in rotation....

just a thought,
J

Nice thought. Will definitely keep this one in mind!

 

[pdsmonki0809]

Anastasia, we learnt that one in MFR school, thanks for the reminder! This is a good technique...if your table is low enough, a hydraulic table would be nice to have. You will need proplerly short nails too...

 

[JackHoleJaike]

How is his internal and external rotation for ROM? Sounds like the start of a capsular pattern of restriction and possible frozen shoulder. If he's had shoulder surgery Subscap is going to compensate but maybe try getting into the joint capsule and frictioning it to release it? gentle at first and you may need to release teres first. Scapular mobilizations and tons of fascial work may help as well....joint play too!