Treatment for shoulder and arm pain caused by an impingement focuses at first on releasing tension in the supraspinatus muscle with concomitant treatment of the other three rotator cuff muscles.
The little supraspinatus lies at the top of the shoulder under the traps, nestled in a hollow of bone, it’s tendon passing under the bony tip of the shoulder and attaching at the knobby top of the upper arm. When the muscle contracts it lifts the arm out to the side up to shoulder height.
When the four rotator cuff muscles that hold and move the arm in the joint become chronically tense, the joint tightens up and the pressure of bone against bone can pinch the tendon of the supraspinatus and create irritating friction in the shoulder joint. Loosening all four muscles of the rotator cuff, specifically the supraspinatus, eases movement by releasing the pressure in the joint and on this tendon, and removes the major source of the shoulder and arm pain.
Treating the rotator cuff muscles can immediately bring pain relief and more freedom of movement. As a Neuromuscular Therapist practicing in the Boston area, I use the following treatment protocol:
1) Deep, sustained pressure with a “pressure bar” on contracted tissue in the supraspinatus, preceeded by work on the upper and middle trapezius muscles that overlie and assist it. Treatment addresses hyperactive Trigger Points that refer pain into the deltoid and local pain caused by ischemia (lack of blood and oxygen) and irritating waste products.
2) Examination of the infraspinatus muscle that covers the back of the shoulder blade for Trigger Points that refer strongly into the front of the shoulder. Pressure on contraction knots and tender Trigger Point nodules. Pressure and sometimes cross-fiber friction to treat the tendon, (often the locus of a rotator cuff tear) for inflammation from chronic tension and overuse. Deep slow “gliding” or “milking” strokes along the length of the muscle fibers to flush the tissue of wastes and increase blood and lymph flow.
3) Treatment with compression of the small teres minor (part of the cuff) and the teres major and latissimus dorsi muscles for their part in adding tension to the shoulder girdle. Release tension around the nerve and blood vessel exiting from the quadrilateral space.
4) Deep treatment with pressure on the inside of the scapula bone against the subscapularis (part of the cuff), the muscle that works in opposition to the infraspinatus. Examination for ischemic tissue, and for Trigger Points that refer to the posterior shoulder while externally rotating the arm.
5) Pressure on the upper pectoral muscles to release tension in the anterior shoulder girdle. Check for pain at the pectoralis major attachment. Examine for Trigger Points in pectorals and subclavius referring to anterior arm and shoulder.
6) Use effleurage strokes to increase blood and lymph flow to bring healing cells and to take away heat and waste.
7) Stretch the muscles using Active Isolated Stretching protocol and teach stretches for homework.
Therapist tip: Remember that other muscles that lift the shoulder are usually overused. When the arm-lifters aren’t working well, the shoulder-lifters get recruited to help lift the arm. So, check upper trap and mid deltoid that work in the functional unit and the levator scapula that assists. Treatment may also include all of the muscles that move the shoulder and arm in other ways.