Massage Tutorial: Pain under the shoulder blade, myofascial release
Hi everybody, I'm Ian Harvey, massage therapist, this is my friend Jen. Hi. Today we're going to be talking about pain that feels like it's under the scapula, otherwise known as the shoulder blade. I tried to do this once before and I didn't actually film it.
So, today, with the red light on, I'm going to show you what might be going on here. Some things to consider, is that pain that feels like it's deep to the scapula, is probably not actually deep to the scapula, we're probably dealing with referred pain. This often comes from the trapezius. So let's start by palpating the trapezius, if you're already good at this, then please cover your eyes and pretend I'm doing something interesting.
The trapezius is a kite shaped muscle, it comes up from the thoracic spine, down about here, crosses over onto the scapula and hooks into the spine of the scapula, and then it goes up and hooks into the cervical vertebrae and into the fascia that attaches to the base of the skull. If someone's having pain or headache that emerges from the base of the skull, I'm thinking trapezius, but that's neither here nor there, we're talking about pain deep to the scapula. Let's start by palpating the inferolateral border of trapezius. So “infero” means inferior, “lateral” means “lateral” and so it's this bottom part of the kite.
If you've never palpated this part of the trapezius, you might mistake it for knotted up tissue, but no, there is this barrier here that you can bump across, and it's supposed to be there, you can't get rid of it and you shouldn't try. Now this is palpable in most clients, you might see me bumping over this right now, and now, and and I’m going over it now. How do we deal with trapezius pain that's referring to under the scapula? Well first of all, warm up this entire area, if you'd like to see how I deal with the back just as a whole, just my general routine, you can click up in the corner right here. It looks something like this, I'll do a lot of nice strokes down the back, I'll do some strokes out laterally, kind of thinking of steamrolling this tissue.
What I'm doing is, I'm hooking into the superficial fascia, I'm applying some weight once I pass the spine, I'm not putting knuckle pressure directly on the spine, I'm sinking in, continuing to create some traction out laterally. This kind of irons out trapezius and everything that's going on here including rhomboids and I'm getting into rotator cuff and all of these paraspinal muscles, all of your spinal erectors. I can do plenty of good myofascial release, just think that 45 degree angle, rather than directly down. If I find an especially sensitive spot I can stay hooked in there and simply maintain my pressure as my client takes deep easy breaths. The trigger points that will most often refer to deep to the scapula, you'll find right near the scapula, right where it crosses over that border.
I'm going to pluck it up right here, this is where that trigger point tends to live. You may find it on the scapula itself, I've now crossed over onto the blade of the scapula, just under the spine. You can of course do traditional trigger point work, which would involve pinning that trigger point area down, and applying pressure directly down toward the rib cage, and just hold that for 10 to 20 seconds, have your client breathe, and see if you can feel a bit of softening happen under your fingertips. Stay in good communication with your client and once that sensation has lessened, you can move on, try to see if there's other trigger points further along that muscle. You can look for other trigger points in the belly of the muscle, and keep in mind that anything that hooks onto the scapula could be creating that sensation. I also want to come out laterally to that inferolateral border of the trapezius, and now I'm working with rhomboids a bit. I don't like to get too aggressive with rhomboids, because rhomboids tends to be an innocent bystander in this whole affair, because this pain deep to the scapula is caused by irritation to the trapezius, which is often caused by posture.
It's caused by the shoulders being pulled forward, this trapezius is having to be long and work hard at the same time, and it doesn't like that, it goes into spasm, and that's felt as pain here, it's felt as pain here, it can even be felt as mid back pain, because it also latches in down there, but I'm not going to ignore anything that hooks into the scapula. That means that I'm also going to be working with the rotator cuff. If you'd like to see my full video on the rotator cuff, you can click up in the corner there, but I'm going to be doing the same stuff, I'm going to be working with this fascia. Something that I try to do is, even if I think that the pain is coming from somewhere else ... Let's say your client comes in with elbow pain, I'm not going to not touch the elbow, even though I think that the pain is coming from somewhere else, I'm going to do some work on where the pain is, on where that complaint is, otherwise your client will feel like you're not listening to them, and it can't hurt, unless you overdo it in that sensitive area. Be gentle, be kind, but lets get under the scapula. I've got this hand hooked under the superior angle of the scapula, if you've never palpated that superior angle of the scapula, come anterior to this trapezius and feel for a knob of bone.
It'll feel like a little bony finger. If you can't feel it, I want you to nestle your hand underneath that scapula, here at this inferior angle, and push it upwards, push it superiorly and now that little knob of bone should be pressing into these fingers. So that's the superior angle, and now I'm going to hook it, I'm going to get in front of it and pull it toward me so I'm pulling it up, and this movement I'm doing with my body mechanics. I'm sinking into my heels a bit, rather than trying to muscle through it. I'm going to pull this toward myself while this hand stays stationary and these fingers press upward, and this hook presses downward, I'll eventually be able to wiggle the scapula free of the ribcage, and eventually I can scoop it up a bit and give them a stretch that they can't otherwise do.
With this hook up here, if I depress the scapula and then work superiorly like this, I can work my way under the scapula. Go slowly with this. If you're having difficulty getting under the scapula, you can scoop up the entire shoulder girdle, right now I'm under the head of the humerus ... That's getting me nicely under that scapula. If you're still having trouble, you can always place their hand down in their low back and that will cause the scapula to wing outward, at which point you can really get under there, just try not to give them too much of a stretch through here, because this is often overstretched already. You really have to know your body to do this one, to know your hands and what they're capable of, but you can also use a trailing thumb to accomplish this. It looks something like this. If you can make that just a good stretch for your thumb, rather than trying to muscle through it, using these somewhat tiny muscles, then that's just fine, but if you find this causing any strain at any of your thumb joints, then leave off, there's better ways.
Any time that the lower trapezius is irritated I never want to forget about the upper trapezius. Right now I'm just doing a gentle myofascial hold. Now I'm working at the upper attachment sites.
Finally, don't forget about the front line, don't forget about this chest and pec fascia. If you were to do a breast draping, you could work a little bit more with the sternum and maybe with the lateral ribs, but most important in my mind, is to spread out this upper chest fascia right near the collar bone, and by externally rotating like this, I'm doing a bit of a moving pin and stretch. And finally I can work with the arm up above the head, working down toward the sternum. Okay, let me know what you think, consider subscribing and I'll see you next time.
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