By Cristian Arroyo
Often when therapists think about shoulder pain or shoulder dysfunction, we seem to gravitate toward the glenohumeral joint, the scapula and their associated musculature as potential structures that need help. Restoring functionality of the gleonohumeral joint and the scapula by working on the soft tissue that supports their role is an important component of treating pain/injury and dysfunction of the shoulder. Additionally, it’s important to look at the function and musculature associated with the thoracic spine.
The T-spine, as I like to call it, is responsible for assisting the shoulder joint in movement, especially shoulder flexion. In addition, it plays a role in the alignment of the scapula to the rib cage. If the T-spine is in a state of dysfunction, we typically see a thoracic spine stuck in hyper flexion (kyphosis). This particular dysfunction affects the body in several ways: 1. Limited range of motion in the shoulder, especially with flexion expression of the glenohumeral joint. 2. Muscular imbalance (upper cross syndrome) of muscles in front of the ribcage that tend to be locked short and muscles on the posterior ribcage that are locked long. 3. Misalignment of the scapula in relation to the ribcage (protracted scapula). And 4. Decreased trunk rotation. These four issues can lead to common shoulder pathologies like Thoracic Outlet Syndrome, rotator cuff tears, upper back pain, frozen shoulder, scapula instability, and “bad posture,” just to name a few. I’ve been working with a client that was in a severe mountain biking accident. He broke his clavicle, which set in motion an array of dysfunctional holding patterns (rounded shoulders, decreased mobility in the scapula, and hyper flexion in the T-spine). Not only was he in pain and discomfort, he also couldn’t express flexion, abduction and external rotation of the glenohumoral joint efficiently. During our sessions, I began to address the pectoral muscles, serratus anterior, subscapularis and other important structures that are commonly affected with this particular dysfunction. The one thing that seemed to complement and improve overall symptoms and movement restrictions was working with the mobility issue (hyper flexion) of the T-Spine, of which many muscles are attached: erector spinae, interspinales, intertransversaii, multifidus, rotatores, semispinalis, serratus posterior superior/inferior, rhomboids, latissimus dorsi, splenius capitus, splenius cervicus, and trapezius.
Over the years, I’ve learned and developed techniques that allow the specific contact of these structure. “Springing” is a gentle technique that can allow the muscles and the vertebral joints in the T-Spine to move more efficiently. Additionally, stretching the pectoral muscles on one side while simultaneously offering specific contact to the deep musculature of the T-Spine in the side-lying position has proven to have had tremendous positive results on the release of congestion of the tissue being contacted and supports the reintroduction of movement back to the T-Spine.
After eight weekly one-hour sessions, I began to notice improvement in the overall movement of the glenohumeral joint, especially in flexion and abduction (external rotation took a few more sessions to show significant improvement). My client’s holding patterns of elevated and protracted shoulders also changed to look more balanced and less concave, and the T-Spine began to move into extension more so than previously assessed during his initial visit. Now that my client has better mobility and significantly less pain, he’s working with a physical therapist three times a week to continue the strengthening and mobility of the shoulder and supporting structures.
If you’re interested in learning more about working with shoulder pain and dysfunction and other common and not-so-common soft tissue issues, join us at FSM for our six-weekend Orthopedic Sports Massage Certification. Our first weekend class will be October 14th and 15th: Understanding Shoulder Pain and Dysfunction. See the Advanced Certification Page for more information.
