Back Clinic Chiropractic. This is a form of alternative treatment that focuses on the diagnosis and treatment of various musculoskeletal injuries and conditions, especially those associated with the spine. Dr. Alex Jimenez discusses how spinal adjustments and manual manipulations regularly can greatly help both improve and eliminate many symptoms that could be causing discomfort to the individual. Chiropractors believe among the main reasons for pain and disease are the vertebrae’s misalignment in the spinal column (this is known as a chiropractic subluxation).
Through the usage of manual detection (or palpation), carefully applied pressure, massage, and manual manipulation of the vertebrae and joints (called adjustments), chiropractors can alleviate pressure and irritation on the nerves, restore joint mobility, and help return the body’s homeostasis. From subluxations, or spinal misalignments, to sciatica, a set of symptoms along the sciatic nerve caused by nerve impingement, chiropractic care can gradually restore the individual’s natural state of being. Dr. Jimenez compiles a group of concepts on chiropractic to best educate individuals on the variety of injuries and conditions affecting the human body.
The upper extremities of the body, which include the head, neck, shoulders, chest, and arms, all have a specific job of keeping the body functioning and helping move from place to place. The head and neck work together to allow the host to have the mobility to turn, rotate from side to side, and lean from one side. The shoulders work with the arms to let the muscles have a full range of motion and even help stabilize the upper body. The shoulders have various muscles, tendons, and ligaments to protect the skeletal joints and even work to do everyday activities like carrying or lifting items. When injuries begin to affect the muscle groups of the upper body, it can lead to pain-like symptoms that can lead to chronic conditions developing over time if not treated right away. One of the muscles in the upper body is called the coracobrachialis muscle, which can be affected by injuries. Today’s article observes the coracobrachialis muscle, how trigger points affect the upper arm muscles, and how to manage trigger points associated with the coracobrachialis muscle. We refer patients to certified providers who specialize in shoulder pain treatments to aid individuals suffering from trigger points associated with the coracobrachialis muscles along the upper arms. We also guide and inform our patients by referring them to our associated medical providers based on their examination when appropriate. We established that education is a great solution to asking our providers profound questions the patient requests. Dr. Jimenez DC takes note of this information as an educational service only. Disclaimer
What Is The Coracobrachialis Muscle?
Have you been dealing with pain from the upper arms to the hands? Do simple arm and shoulder stretches seem to be difficult to do? Or have you been dealing with symptoms of pain, stiffness, or tenderness in your upper arms? Experiencing these pain-like symptoms could overlap other conditions affecting the upper arms and develop trigger points along the muscles, including the coracobrachialis. The coracobrachialis is the smallest muscle located in the front of the upper arm’s anterior that originated in the shoulder coracoid process. This small muscle is connected to the tendon located at the short head of the bicep brachii, and according to Dr. Janet Travell, M.D., the coracobrachialis muscle function helps flex and adduct the arms at the shoulders while working together with the surrounding muscles of the upper arm and shoulders. This allows the arms to move forward slightly and inward. This means that the coracobrachialis muscle will enable individuals to place their arms behind their back without pain. However, like any muscle in the body, injuries can occur in the upper arms and lead to the development of trigger points along the upper arm muscles affecting the coracobrachialis muscle.
How Trigger Points Affect The Upper Arm Muscles?
When the upper arm and the coracobrachialis muscle suffer from pain, tiny nodules along the muscle fiber bands known as trigger points can cause referred pain to the upper arms. Now trigger points are tricky to diagnose due to mimicking overlapping conditions affecting the upper arms. Studies reveal that non-specific arm pain could potentially be one of the causes that trigger points mimic due to strenuous physical activities or work-related activities that can overuse the upper arm muscles.
Studies reveal that individuals with idiopathic arm pain deal with high variable upper-extremity dysfunction, which could play a factor in pain-like symptoms along the surrounding muscles of the arms and shoulders. Many people often experience pain when reaching behind their back for the coracobrachialis affected by trigger points. Since the coracobrachialis works with the surrounding muscles in the shoulders and upper arms, trigger points associated with the coracobrachialis correspond to those muscles causing overlapping risk profiles. Trigger points affecting the coracobrachialis muscle can also mimic nerve entrapment since the coracobrachialis helps the bicep muscles when flexing. Pain associated with trigger points could potentially irritate the surrounding nerves in the muscle fibers, which causes radiating pain along the arms.
Treating The Coracobrachialis Muscle-Video
Does your arm feel stiff when trying to reach behind your back? Do your shoulders ache for no apparent reason? Or have you experienced sharp, shooting pain down your arm? Many people experience pain along their shoulders and arms, affecting their mobility to hold and carry items. They deal with overlapping symptoms associated with trigger points along the coracobrachialis muscle. Trigger points along the coracobrachialis muscle are developed when the upper arm muscles have been overused and irritate the surrounding nerves. This causes radiating referred pain down the arms and can affect a person’s ability to hold items. Thankfully there are ways to manage trigger points along the coracobrachialis and its surrounding muscles. The video above demonstrates a massage technique that works along the coracobrachialis muscle to release nerve entrapment and manage trigger points along the surrounding muscles.
Ways To Manage Trigger Points Affecting The Coracobrachialis
There are various techniques that many specialists, like chiropractors, massage therapists, and physiotherapists, can use to identify and manage trigger points in the body. Since trigger points are tricky to diagnose due to causing referred pain along the surrounding muscles, treatments like stretching, massages, acupuncture, and chiropractic adjustments can help alleviate the pain and reduce future trigger points from forming. Studies reveal that pain specialists could manage trigger points associated with shoulder pain along the coracobrachialis through treatments of manual compression and other various techniques. Once treatments have been incorporated to relieve trigger point pain along the affected muscle, many people can further prevent the symptoms from returning by not lifting or carrying heavy objects and not forcing their coracobrachialis to be a substitute for their bicep muscles.
Conclusion
The coracobrachialis is a short muscle that works with the bicep muscle and helps with mobility and motor functions for the arms and shoulders. This muscle allows the arms to move forward and can be placed in the back without pain. When muscle injuries affect the surrounding muscles that work with the coracobrachialis, it can develop trigger points associated with pain along the upper arms. When this happens, it can lead to symptoms of stiffness, pain, and tenderness in the upper arms, causing mobility issues. Pain specialists for trigger points can utilize various treatments to relieve the pain and reduce the effects that trigger points cause on the affected muscle. This allows the upper arms to gain mobility back and the host to do various activities without feeling pain.
References
Bron, Carel, et al. “Treatment of Myofascial Trigger Points in Patients with Chronic Shoulder Pain: A Randomized, Controlled Trial.” BMC Medicine, BioMed Central, 24 Jan. 2011, www.ncbi.nlm.nih.gov/pmc/articles/PMC3039607/.
Moradi, Ali, et al. “Nonspecific Arm Pain.” The Archives of Bone and Joint Surgery, Archives of Bone and Joint Surgery Co., Dec. 2013, www.ncbi.nlm.nih.gov/pmc/articles/PMC4151410/.
Ring, David, et al. “Idiopathic Arm Pain.” The Journal of Bone and Joint Surgery. American Volume, U.S. National Library of Medicine, July 2004, pubmed.ncbi.nlm.nih.gov/15252084/.
The shoulders help stabilize the upper extremities of the body and provide a wide range of movements for the arms. The shoulders have many muscles, ligaments, and tendons that help support the joints from injuries and utilize the motor function to do everyday actions like throwing a ball or stretching for long distances. Even though the shoulders help stabilize the upper extremities, they are still prone to injuries since the shoulder muscles are constantly used throughout the day. One of the shoulder muscles that are continuously utilized is the deltoid muscle, which can lead to the development of trigger points when it becomes injured. Today’s article examines the deltoid muscles, how trigger points affect the deltoids and shoulders, and managing trigger points associated with the deltoid muscles. We refer patients to certified providers specializing in shoulder pain treatments to aid individuals suffering from trigger points associated with the deltoid muscles along the shoulders. We also guide and inform our patients by referring them to our associated medical providers based on their examination when appropriate. We ensure that education is a great solution to asking our providers insightful questions the patient requests. Dr. Jimenez DC observes this information as an educational service only. Disclaimer
What Is The Deltoid Muscle?
Have you been feeling pain on the top of your shoulders? Do your shoulders feel stiff when rotating them? Or do you feel radiating pain along your upper arms? Individuals with shoulder pain may be experiencing trigger points affecting their deltoid muscles. The deltoids are large triangular-shaped muscles that are associated with the shoulder girdle. The deltoids sit on top of the shoulder girdle and have anterior and posterior sections that work together with the rotator cuff muscles that provide a full range of motion to the arms. Studies reveal that the deltoid muscles have a more complex structure since the intramuscular tendons from the deltoids help provide different functions when it comes to the shoulders and arms’ motor function. According to Dr. Janet G. Travell, M.D., the anterior sections of the deltoid muscles are used in sports activities. In contrast, the posterior section works with the rotator cuff muscles for mobility. Injuring the deltoid muscles can lead to the development of trigger points associated with shoulder pain.
How Do Trigger Points Affect The Deltoids & Shoulders?
Regarding the shoulders, they can succumb to various injuries that can become an issue over time, lead to the development of trigger points in the shoulder muscles, and cause referred pain to the upper arms. Trigger points or myofascial pain syndrome along the deltoid muscles may invoke referred pain to the shoulders. Studies reveal that myofascial pain syndrome is often described as the sensory, motor, and autonomic symptoms caused by trigger points that cause tender spots on the hardened muscle to produce pain. Trigger points are a bit tricky to diagnose since they mimic other chronic conditions in the body. The deltoid muscles are superficial, and trigger points can cause referred pain to the muscles that mimic arthritis in the shoulder joints. Some of the other symptoms associated with trigger points along the shoulders and deltoids include:
Limited range of mobility
Tenderness in the shoulder muscles
Muscle spasms
Muscle pain
Stiffness in the deltoid muscles
Pain in the shoulders can cause the body to become unstable and cause many individuals to develop a hunched position over time to reduce the pain they are feeling; fortunately, there are various ways to manage the pain associated with trigger points along the shoulders and deltoid muscles.
Trigger Point Release On The Deltoid Muscle- Video
Have you been feeling stiffness along the shoulders or the deltoid muscles? Have you experienced muscle tenderness in your upper arms? Or do you feel like being hunched over reduces the pain in your shoulders? If you have been experiencing any of these symptoms, it could be the development of trigger points associated with shoulder pain along the deltoid muscles. Trigger points cause referred pain to the affected muscle area and are developed when the muscles are overused. For the deltoid muscles, when active trigger points affect the deltoids’ anterior or posterior sections, it can cause the muscles to twitch and later cause moderate tension. The video above explains where the trigger points are located on the deltoid muscles and how to release them through palpations and massages. This is one of the techniques that can help manage trigger points from affecting the shoulders and deltoid muscles.
Managing Trigger Points Associated With The Deltoid Muscles
When dealing with trigger points associated with the deltoid muscles can be managed through various techniques that many people can utilize to reduce the pain symptoms along the upper arms and shoulders. Studies reveal that dry needling is one of the techniques that can relieve trigger points to ease the pain intensity and irritability to the shoulders. Other techniques that many people can utilize are to correct how they carry heavy objects to reduce the load on their shoulders, stretch the arms and shoulders to minimize soreness and alleviate tight muscles, and even take a hot shower to relax the shoulder muscles, can reduce the chances of trigger points from forming in the future.
Conclusion
The deltoid is located on top of the shoulder girdle and is a large triangular-shaped muscle that works together with the rest of the shoulder and the rotator cuff muscles. The shoulders have many muscles, ligaments, and tendons that provide stability and perform everyday functionality to the body. When the shoulders become injured, the affected muscles could potentially develop trigger points to cause referred pain to the shoulders and upper arms. When trigger points affect the deltoid muscles, it can cause them to have symptoms of stiffness, tenderness, and pain that mimic other chronic conditions affecting the shoulders and arms. Thankfully, various techniques relieve referred pain from the arms and help manage trigger points along the deltoid muscle. This allows the deltoid muscle to relax and reduce trigger points from developing further on the shoulders.
References
Bron, Carel, and Jan D Dommerholt. “Etiology of Myofascial Trigger Points.” Current Pain and Headache Reports, Current Science Inc., Oct. 2012, www.ncbi.nlm.nih.gov/pmc/articles/PMC3440564/.
Calvo-Lobo, César, et al. “Dry Needling on the Infraspinatus Latent and Active Myofascial Trigger Points in Older Adults with Nonspecific Shoulder Pain: A Randomized Clinical Trial.” Journal of Geriatric Physical Therapy (2001), Wolters Kluwer Health, Inc., 2018, www.ncbi.nlm.nih.gov/pmc/articles/PMC5728593/.
Elzanie, Adel, and Matthew Varacallo. “Anatomy, Shoulder and Upper Limb, Deltoid Muscle.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 15 May 2022, www.ncbi.nlm.nih.gov/books/NBK537056/.
Uneven hips can throw the back out of natural alignment and cause back stiffness, tightness, discomfort, and pain. Hips that are off-balance unhealthily affect standing, sitting, sleeping posture, walking gait, and overall movements. Biomechanics issues cause the core and spine stabilizing muscles to become weakened and fatigued from overcompensating to keep the body up and moving. Over time this can lead to chronic pain in the back, hips, knees, and feet. Chiropractic care can restore proper hip and spinal alignment and wellness.
Uneven Hips
Misaligned hips can be caused by work or sports injury, exercise, vehicle collision, and/or general wear and tear. When hips are out of alignment, they have shifted from their centered position. They could be rotated forward or backward, forcing the spine and the lower limbs to compensate, resulting in the spine tilting that can make the legs appear uneven. Discomfort may be one-sided low back pain near the sacroiliac joint, causing a stiff/tight back, limited motion, and/or pain symptoms. Because the spine and lower limbs have to compensate for the unevenness, the shoulders and upper back, connected to the pelvis through the spine, are also affected and result in:
Back pain.
Hip and gluteal muscle pain.
Uneven leg length.
Knee, ankle, and foot issues and pain.
Uneven shoulders.
The shoulder blades can stick out on the side of the lower hip.
Rib discomfort and pain.
The rib cage could protrude out on one side. However, this could be due to advanced scoliosis.
Therapy
Staying active is recommended and includes stretching and core strengthening. General stretches recommended to optimize hip equity include:
Hamstring stretch
For this stretch, lie on a flat surface with your legs extended straight out.
Bend the right leg at the knee, placing the right foot on the ground.
Use a towel, belt, or band to grab and wrap around the left foot.
Keep the hip/buttock on the left side planted on the floor.
Slowly raise the left leg upward as far as possible until you feel the stretch.
Once you feel a stretch or restriction in the hamstring, hold the position for 30 seconds.
Repeat on the other side.
Perform 2 to3 times.
Hip flexor stretch
Kneel on the affected leg and bend the healthy leg out in front with the foot flat on the floor.
Back straight.
Slowly push the hips forward until you feel the stretch in the upper thigh and hip.
Hold the stretch for around 15 to 30 seconds.
Chiropractic Care
Chiropractic treatment is a highly recommended non-surgical option for uneven hips and pelvic tilt. Depending on the severity of the misalignment, underlying issues, and body scanning images, hip alignment treatment could include:
Soft tissue therapeutic massage
Chiropractic muscle release for tight hip flexors, quadriceps, hamstrings, and glutes.
Kiapour, Ali et al. “Biomechanics of the Sacroiliac Joint: Anatomy, Function, Biomechanics, Sexual Dimorphism, and Causes of Pain.” International journal of spine surgery vol. 14, Suppl 1 3-13. 10 Feb. 2020, doi:10.14444/6077
Lee, Jeong-Hoon, et al. “The effect of Graston technique on the pain and range of motion in patients with chronic low back pain.” Journal of physical therapy science vol. 28,6 (2016): 1852-5. doi:10.1589/jpts.28.1852
Patel, Rikin V et al. “Pelvic Tilt and Range of Motion in Hips With Femoroacetabular Impingement Syndrome.” The Journal of the American Academy of Orthopaedic Surgeons vol. 28,10 (2020): e427-e432. doi:10.5435/JAAOS-D-19-00155
Rivière, C et al. “Spine-hip relations add understandings to the pathophysiology of femoro-acetabular impingement: A systematic review.” Orthopaedics & traumatology, surgery & research : OTSR vol. 103,4 (2017): 549-557. doi:10.1016/j.otsr.2017.03.010
Suits, William H. “Clinical Measures of Pelvic Tilt in Physical Therapy.” International journal of sports physical therapy vol. 16,5 1366-1375. 1 Oct. 2021, doi:10.26603/001c.27978
Many individuals do not realize they are in pain until they begin to feel symptoms of stiffness or tenderness in certain areas of their body. Many people have two most common complaints: back and shoulder pain. The shoulder and the back have a casual relationship that stabilizes the upper body and protects the spine’s thoracic region. When injuries or ordinary factors affect not only the shoulders but the back, it can lead to symptoms of pain and stiffness along the muscles, causing the development of trigger points along the upper back and shoulder muscles. One of the muscles affected by trigger points is the rhomboid muscles located in the upper back behind the scapula (shoulder blades). Today’s article looks at the rhomboid muscle, how superficial backaches and round shoulders can affect the rhomboid muscle, and managing trigger points associated with the rhomboid muscle. We refer patients to certified providers specializing in back pain treatments to aid individuals suffering from trigger points associated with the upper back along the rhomboid muscles. We also guide our patients by referring them to our associated medical providers based on their examination when appropriate. We ensure that education is a great solution to asking our providers insightful questions. Dr. Jimenez DC observes this information as an educational service only. Disclaimer
What Is The Rhomboid Muscle?
Do muscle stiffness in your shoulders seem to be causing you pain? Have you noticed that your shoulders seem more rounded than usual? What about the unexplainable upper backaches after being in a hunched position for a long period? Many individuals with these pain symptoms could be associated with the rhomboid muscles. The rhomboid muscles are a collective group of muscles important for upper limb movement and stability for the shoulder’s girdle and scapula. The rhomboid muscles consist of two separate muscles: the rhomboid minor and the rhomboid major, deep within the trapezius muscle and behind the scapula (shoulder blades). The functionality of the rhomboid is that they provide stability to the shoulder and when they are active, the upper arms move back and forth while walking.
How Superficial Backaches & Round Shoulders Affect The Rhomboid
While the rhomboid muscles provide stability to the shoulders, they can succumb to pain like any muscles in different body sections. Ordinary factors like a bad sitting posture can cause the upper back and shoulder muscles to contract and strain. Studies reveal that the effects of bad sitting posture can lead to the development of a forwarding head posture with rounded shoulders, causing pain in the rhomboid muscles. When the shoulder muscles, like the rhomboid muscles, experience this sort of change over time, it can increase muscle tone and continuous stress in the neck and shoulders. To that point, it can lead to various symptoms like pain, numbness, loss of functionality in the upper limbs, and nerve root symptoms. Other issues like back pain can also be one of the symptoms that can lead to referred pain in the rhomboid muscles and can potentially lead to the development of trigger points along the shoulders and rhomboid muscles.
Other issues that can affect the rhomboid muscles are trigger points. Trigger points can be latent or active as they are tiny knots formed in the body’s muscle fibers. For the rhomboid muscles according to Dr. Janet G. Travell, M.D., when a person hears snapping and crunching noises during the movement of the shoulder blades, it may be due to the trigger points in the rhomboid muscles. Studies reveal that since trigger points can be either active or latent and elicit local referred pain, that can lead to muscle imbalance, weak and impaired motor function, and expose the joints to suboptimal loading. This means that trigger points in the rhomboid muscles can cause referred pain to the shoulder and mimic other chronic symptoms.
Stretching The Rhomboid Muscle & Managing Trigger Points-Video
Do you hear any snapping or crunching noises when rotating your shoulders? What about muscle stiffness along your shoulders or upper back? Or do you feel muscle aches from being hunched over for a long time? These symptoms could potentially involve trigger points associated with the rhomboid muscles. The rhomboid muscles help stabilize the shoulders and provide movement to the arms. When people overuse their shoulder muscles, it can cause the surrounding muscles to develop trigger points and inflict pain-like symptoms on the shoulders and upper back. Thankfully, all is not lost, as various treatments are available to relieve shoulder and upper back pain associated with trigger points along the rhomboid muscles. The video above explains where the trigger points are located on the rhomboid muscles and how to stretch that muscle to relieve trigger points from causing referred pain to the shoulders.
Managing Trigger Points Associated With The Rhomboid Muscle
Since the rhomboid muscles can become stiff due to overuse and could develop trigger points to inflict pain along the upper back and shoulders, this can cause many symptoms associated with pain and make the individual feel hopeless. Thankfully, various treatments can help manage trigger point pain associated with the rhomboid muscles. Studies reveal that thoracic spinal manipulation can relieve pain pressure sensitivity of the rhomboid muscles. Chiropractors are excellent when finding trigger points along the musculoskeletal system by utilizing spinal manipulation on the thoracic spine to loosen up the stiff muscles along the shoulders and upper back. Another way to manage trigger points associated with the rhomboid muscle is to stretch the shoulder muscles after a hot shower. This allows the muscles to relax and prevent future trigger points from forming along the rhomboid muscles.
Conclusion
The rhomboid muscles are a collective muscle group that has an important function in stabilizing the shoulder’s girdle and scapula (shoulder blades) while providing upper limb movement. The rhomboid muscles consist of two separate muscles: rhomboid minor and rhomboid major, which are behind the shoulder blades and deep within the trapezius muscles. When ordinary factors like poor posture or shoulder injuries affect the rhomboid muscles, it can develop trigger points that can cause stiffness in the rhomboid muscles. Various techniques can alleviate the referred pain along the shoulders, causing trigger points to develop along the rhomboid muscles. When these treatments are utilized on the rhomboid muscles, they can help prevent future shoulder issues.
References
Farrell, Connor, and John Kiel. “Anatomy, Back, Rhomboid Muscles.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 20 May 2022, www.ncbi.nlm.nih.gov/books/NBK534856/.
Haleema, Bibi, and Huma Riaz. “Effects of Thoracic Spine Manipulation on Pressure Pain Sensitivity of Rhomboid Muscle Active Trigger Points: A Randomized Controlled Trial.” JPMA. The Journal of the Pakistan Medical Association, U.S. National Library of Medicine, July 2021, pubmed.ncbi.nlm.nih.gov/34410234/.
Ribeiro, Daniel Cury, et al. “The Prevalence of Myofascial Trigger Points in Neck and Shoulder-Related Disorders: A Systematic Review of the Literature.” BMC Musculoskeletal Disorders, BioMed Central, 25 July 2018, www.ncbi.nlm.nih.gov/pmc/articles/PMC6060458/.
Yoo, Won-Gyu. “Effects of Pulling Direction on Upper Trapezius and Rhomboid Muscle Activity.” Journal of Physical Therapy Science, The Society of Physical Therapy Science, June 2017, www.ncbi.nlm.nih.gov/pmc/articles/PMC5468195/.
The body has various muscle groups that work together to make each section of the body move. The arms, shoulders, and neck muscles in the upper half of the body allow mobility and range of motion without discomfort. The muscles in the midsection protect the vital organs and spine while assisting in rotation. And the low half of the body, which includes the hips, legs, and feet, helps the body to move from place to place. However, just like all muscles, injuries can occur to the body and cause issues if they are not taken care of immediately. This allows the muscle fibers to develop myofascial pain syndrome or trigger points, causing overlapping risk profiles at risk of developing pain in the affected area. For the upper body, when trigger points affect the shoulders, it can lead to referred pain that can affect the arms. Today’s article examines the shoulder muscle known as the subscapularis muscle, how trigger points are associated with the subscapularis, and ways to manage trigger point pain on the subscapularis muscle in the shoulder. We refer patients to certified providers specializing in musculoskeletal pain treatments to aid individuals suffering from trigger points associated with the subscapularis muscles. We also guide our patients by referring them to our associated medical providers based on their examination when appropriate. We ensure that education is a great solution to asking our providers insightful questions. Dr. Jimenez DC observes this information as an educational service only. Disclaimer
What Is The Subscapularis Muscle?
Have you been feeling a constant ache in your shoulder muscles? Does your wrist seem to hurt, making it hard to grasp objects? Or Do you feel pain in your triceps or shoulder muscles? Individuals experiencing these symptoms might risk developing trigger points associated with shoulder pain along the subscapularis muscle. The subscapularis is the largest, strongest muscle of the rotator cuff that lies in the anterior or front of the scapular surface and provides shoulder movement while helping maintain glenohumeral joint stability. The best way to describe how it looks is that it seems like a chicken wing. The subscapularis is also part of the rotator cuff muscles, which includes the teres minor, supraspinatus, and infraspinatus muscles, and is active when a person swings their arms forward. When issues affect the shoulders, it can lead to referred pain affecting the upper extremities, including the hands, arms, and even the shoulders.
Trigger Point Associated With The Subscapularis Muscle
When injuries affect the shoulders, the muscle fibers that help stabilize the shoulders begin to develop small nodules, known as trigger points, that can invoke pain from the shoulders to the wrist, causing referred pain. The subscapularis and its tendons become affected when it becomes injured and can be prone to tearing. Studies reveal that when the subscapularis tendon has partial tears in the rotator cuff, it would be considered forgotten with “hidden lesions” that can overlap pain symptoms in the shoulders.
Active trigger points in the subscapularis muscle can mimic other pre-existing conditions affecting the shoulders. Once the subscapularis tendon has partial tears in the muscle, it can develop trigger points along the subscapularis muscle and become active, causing various shoulder conditions. One of those conditions is frozen shoulders, and studies reveal a strong association between the subscapularis trigger points and the frozen shoulder. The “frozen shoulder” or adhesive capsulitis of the body is a common shoulder condition often characterized by pain, restricted range of motion, and a high morbidity rate. When a person is dealing with a frozen shoulder, it is often mistaken for shoulder stiffness as it doesn’t respond to non-invasive treatments. All is not lost, as there are various ways of manage active trigger points associated with the subscapularis muscle.
Massage Technique For The Subscapularis Muscle-Video
Have you been experiencing a limited range in your shoulders? Do your hands and wrist ache all the time when grasping items? Or does the pain seem to affect your biceps and shoulders constantly? These symptoms are signs associated with triggering points affecting the shoulders and the subscapularis muscle. The subscapularis muscle resembles a chicken wing, is in front of the scapula, and is part of the rotator cuff muscle group. When the shoulder gets injured or suffers from a traumatic event, it can later develop tiny knots known as trigger points to cause pain and stiffness to the muscle and affect a person’s mobility. To that point, it can mimic other chronic conditions that had pre-existed before the shoulders were affected. Thankfully, there are ways to manage trigger points associated with the subscapularis muscle along the shoulders. The video above explains how pain can be reduced along the subscapularis muscle through a massage technique.
Ways To Manage Trigger Point Pain On The Subscapularis Muscle
Since trigger points mimic other conditions, they can be difficult to diagnose and cause referred pain down the arms. Fortunately, there are ways to manage pain associated with trigger points on the subscapularis muscle. Studies reveal that clinical approaches like mobilizations, stretching, or massaging may help decrease shoulder stiffness while improving pain symptoms in patients with stiff shoulders and posterior shoulder tightness. Incorporating these techniques allows the tight, inflexible muscles to become loose and reduce the effects of referred pain caused by trigger points. To that point, it provides mobility and range of motion back to the shoulders and the subscapularis muscle.
Conclusion
The subscapularis muscle is located in the front of the scapula and resembles a chicken wing. This subscapularis is the largest and strongest of the rotator cuff muscles, providing shoulder movement and joint stability. When issues affect the shoulders, it can lead to referred pain that affects the hands, arms, and shoulders. These are trigger points and can cause overlapping symptoms of stiffness and pain in the shoulders and subscapularis muscles. Fortunately, there are therapeutic ways to manage the pain associated with trigger points along the shoulders and subscapularis muscles. When patients incorporate stretching, massaging, or mobilization techniques, a pain specialist can help reduce the trigger point pain and bring back mobility to their shoulders.
References
Aguirre, Kenneth, et al. “Anatomy, Shoulder and Upper Limb, Subscapularis Muscle.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 7 Aug. 2021, www.ncbi.nlm.nih.gov/books/NBK513344/.
Arjun, M V, and S Rajaseker. “Association between Subscapularis Trigger Point and Frozen Shoulder: A Cross Sectional Study.” Journal of Bodywork and Movement Therapies, U.S. National Library of Medicine, Oct. 2021, pubmed.ncbi.nlm.nih.gov/34776170/.
Look how young children position their backs. There is a natural S curve, and their movements are effortless. As the body ages, too much sitting, slouching, and inactivity can cause muscle fatigue and tension leading to posture issues. Rounded shoulders describe a resting position that has shifted the shoulders out of the body’s natural alignment, which can worsen if left untreated. Chiropractic care can realign the shoulders, as well as the spine, and restore musculoskeletal health to optimum levels.
Rounded Shoulders
Rounded shoulders are an excessive thoracic kyphosis referring to an uneven forward rounding or curvature of the middle and upper back. Rounded shoulders shift out of proper alignment with the spine, causing posture-related problems like shoulder/neck/back discomfort, tightness, stiffness, and pain. Overall unhealthy posture contributes to the following:
The head constantly being in a forward or backward position
Headaches
Body aches and pains
Muscle fatigue
Chronic back soreness
Bent knees when standing or walking
Body movement dysfunction
Joint problems
Potbelly
Rounded shoulders
Body responses to rounded shoulders include:
Chronic musculoskeletal aches and pains
Breathing problems
Limited body function
Impaired mobility performance
Increased mental and musculoskeletal stress
Causes
Rounded shoulders are typically caused by unhealthy posture, but can also be caused by muscle imbalances from, for example, overfocusing on building chest strength but neglecting the core and upper back. Other causes include:
Standing and sitting for long periods
Stress
Lack of physical activity
Environmental factors
Too much exercise, sports, and physical activities
Musculoskeletal Imbalance
Postural imbalances anywhere in the body can cause rounded shoulders.
For example, when an individual tilts their head forward to look at their phone, the upper back has to round forward to hold the head. Constantly tilting can begin to generate an unhealthy muscle memory causing the neck and shoulder muscles to remain in a semi-flexed position that starts to become the norm.
Another example is when the arms are held out and in front for prolonged periods, like driving, typing, and cooking, the chest muscles get shortened. As time goes on, this causes the shoulder blades to move forward on the ribcage, making the upper back and shoulder area hunch awkwardly and unhealthily.
Stress
When the brain perceives a threat, the body physically prepares to take action through the fight or flight response. Common reactions include:
Jaw tensing
Tightening the abdominal muscles
Holding one’s breath
Rounding the shoulders
Stressors can include:
Job worries
Money issues
Relationship problems
Family responsibilities
All can cause changes in the body that result in rounded shoulders.
Environmental Factors
Respiratory conditions like asthma, COPD, and allergies can affect the body’s breathing and the ability of the diaphragm to contract and relax correctly.
Ribcage restrictions caused by chronic breathing problems can result in the thoracic/middle back tightening up, causing excessive shoulder rounding.
Exercise and Physical Activities
Exercise and physical activities can contribute to rounded shoulders because of the long periods of spinal flexion. These can include:
Bike riding, martial arts, and swimming.
Knitting requires the arms to be out in front.
Gardening requires kneeling and being hunched over.
Chiropractic Treatment
Chiropractic adjustments, therapeutic massage, and decompression therapy can unlock tight shoulder and chest muscles. A chiropractor uses gentle targeted adjustments to relieve pain, restore function, and retrain the muscles.
The doctor will look at the individual’s resting position while standing.
An individual with slumped shoulders can slouch, even when standing up straight.
Their hands will likely face behind them, with their thumbs pointed at each other.
Once the adjustments are made, a correct standing posture will make the hands face the body with the thumbs facing ahead.
Exercises will be recommended to strengthen the core and stretches to maintain the adjustments.
Posture Chiropractic
References
Fathollahnejad, Kiana, et al. “The effect of manual therapy and stabilizing exercises on forward head and rounded shoulder postures: a six-week intervention with a one-month follow-up study.” BMC musculoskeletal disorders vol. 20,1 86. 18 Feb. 2019, doi:10.1186/s12891-019-2438-y
Go, Seong-Uk, and Byoung-Hee Lee. “Effects of scapular stability exercise on shoulder stability and rehabilitative ultrasound images in office workers.” Journal of physical therapy science vol. 28,11 (2016): 2999-3002. doi:10.1589/jpts.28.2999
Kwon, Jung Won, et al. “Changes in upper-extremity muscle activities due to head position in subjects with a forward head posture and rounded shoulders.” Journal of physical therapy science vol. 27,6 (2015): 1739-42. doi:10.1589/jpts.27.1739
Lee, Do Youn, et al. “Changes in rounded shoulder and forward head posture according to exercise methods.” Journal of physical therapy science vol. 29,10 (2017): 1824-1827. doi:10.1589/jpts.29.1824
Park, Sang-In, et al. “Effects of shoulder stabilization exercise on pain and functional recovery of shoulder impingement syndrome patients.” Journal of physical therapy science vol. 25,11 (2013): 1359-62. doi:10.1589/jpts.25.1359
The rotator cuff works together with the shoulder, providing movement and a full range of motion. The shoulders are one of the largest and most complex joints that can succumb to injuries that can make the shoulders unstable and cause unwanted pain-like symptoms to affect not only the shoulders but also the arms and the neck. These pain-like symptoms are caused by myofascial pain syndrome or trigger points. Trigger points can create small knots along the muscle fibers in any muscle group and causes referred pain to different locations in the upper body. One of the muscles that can be affected by trigger points is the teres minor muscle. Today’s article examines this muscle, how trigger points affect the teres minor muscle, and managing trigger points associated with the teres minor muscle. We refer patients to certified providers who specialize in musculoskeletal treatments to aid individuals suffering from trigger points associated with shoulder joints and the teres minor muscles. We also guide our patients by referring them to our associated medical providers based on their examination when appropriate. We ensure that education is the solution to asking our providers insightful questions. Dr. Jimenez DC observes this information as an educational service only. Disclaimer
What Is The Teres Minor Muscle?
Have you been experiencing shoulder pain? Do you feel a tingling sensation that runs down to your fingertips? What about spasms or stiffness in your shoulders? Most of these symptoms are caused by trigger points associated with shoulder pain along the teres minor muscles. The teres minor muscles are part of the muscle group that supports the rotator cuffs. These muscles include the subscapularis, teres minor, supraspinatus, and infraspinatus and together assist in stabilizing the shoulder joint and even help perform arm movement. For the teres minor, this muscle is a narrow intrinsic shoulder muscle that extends from the lateral border of the scapula (shoulder blade). The teres minor is deep to the deltoid muscle as it has functions parallel to the other rotator cuff muscles, especially the infraspinatus. Studies reveal that even though the teres minor is often overlooked in normal shoulder function. To that point, the teres minor muscle becomes a key component for maintaining shoulder function when the other rotator cuff tendons fail from pathology that affects the shoulder and the rotator cuff joint.
How Do Trigger Points Affect The Teres Minor Muscle?
When pathology begins to affect the body, it affects the shoulders and the rotator cuffs. When pain affects the rotator cuffs, trigger points can develop and cause associated pain-like symptoms along the shoulders. Shoulder pain is the third common disorder in the musculoskeletal system. When the corresponding muscles in the shoulder are affected, trigger points can mimic other conditions that make it difficult to diagnose. According to Dr. Janet G. Travell, M.D., many patients often complain more of the pain rather than the restricted motion of their shoulders. This is due to the infraspinatus muscle being affected by active trigger points, causing referred shoulder pain. To that point, infraspinatus-referred pain dominates and releases tension to the parallel muscle fibers, the teres minor. Other issues like hypertrophy can also affect the teres minor when there are rotator cuff tears. Studies reveal that when the rotator cuff suffers damage and begins to tear, it could potentially lead to teres minor hypertrophy and cause referred pain-like symptoms along the upper arm. Fortunately, there are ways to manage trigger points associated with the teres minor to alleviate the pain.
Treating Myofascial Teres Minor Pain- Video
Feeling aches and pain when you are rotating or lifting your shoulders? What about feeling pain in your upper arm? Or do you feel tenderness on your shoulders or upper arm? Many people experiencing pain along their shoulders might be due to trigger points affecting the teres minor muscle. The teres minor muscle is part of the rotator cuff and helps stabilize the shoulders to prevent instability. When factors cause dysfunction in the rotator cuff can lead to the development of trigger points associated with the teres minor muscle, causing overlapping referred pain to the shoulders. Studies reveal that individuals who overuse their shoulder muscles can make them hypersensitive to mechanical pain. To that point, this allows active trigger points to play a role in the development of shoulder pain along the teres minor muscle. The video above shows where the teres minor muscle is located and how to release the trigger points from the muscle to reduce pain in the shoulders and the upper arms while preventing disability.
Managing Trigger Points Associated With The Teres Minor Muscle
When many individuals suffer from shoulder pain associated with trigger points, they often explain and show their primary doctor where the pain is. Their doctors then examine their patients to pinpoint where the issue is before diagnosing the symptoms that are affecting them. Once the symptom is diagnosed as trigger points associated with shoulder pain, doctors would refer their patients to pain specialists like chiropractors or massage therapists to manage and reduce trigger points affecting their shoulders. Many pain specialists will use various techniques to relieve shoulder pain associated with trigger points. Studies reveal that the effects of dry needling on active trigger points in the teres muscle are effective for improving pain intensity, inter rotation range of motion, and extensibility on the shoulder. Other ways to manage trigger points associated with the teres minor muscle include:
Reducing or avoiding excessive or repetitive load on the muscle
Have a correct sleeping position to prevent shortening the shoulder muscles
Applying a hot compress on the muscle to relax the stiff muscle and reduce trigger points from forming further
Doing stretching exercises to relieve shoulder tension
Incorporating these can help restore shoulder mobility and prevent future trigger points from forming and causing shoulder pain.
Conclusion
The teres minor is part of a muscle group that supports the rotator cuffs in the shoulder. These muscles stabilize the shoulder joint and help perform arm movement. The teres minor is a narrow muscle extending the scapula’s lateral border (shoulder blade). When pathologies begin to affect the muscles in the shoulder area, it can lead to the development of trigger points along the teres minor muscle and cause referred pain along the shoulders and upper arms. To that point, many individuals will regain their range of motion in their shoulders without pain. Various treatments can help reduce the effects of referred pain along the shoulders and manage trigger point pain associated with the teres minor muscles.
References
Ceballos-Laita, Luis, et al. “Effects of Dry Needling in Teres Major Muscle in Elite Handball Athletes. A Randomised Controlled Trial.” Journal of Clinical Medicine, MDPI, 20 Sept. 2021, www.ncbi.nlm.nih.gov/pmc/articles/PMC8466529/.
Juneja, Pallavi, and John B Hubbard. “Anatomy, Shoulder and Upper Limb, Arm Teres Minor Muscle.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 15 May 2022, www.ncbi.nlm.nih.gov/books/NBK513324/.
Ortega-Santiago, Ricardo, et al. “Pressure Pain Hypersensitivity and Referred Pain from Muscle Trigger Points in Elite Male Wheelchair Basketball Players.” Brazilian Journal of Physical Therapy, Associação Brasileira De Pesquisa e Pós-Graduação Em Fisioterapia, 2020, www.ncbi.nlm.nih.gov/pmc/articles/PMC7351965/.
Tokish, John M., et al. “Teres Minor Hypertrophy Is a Common and Negative Predictor of Outcomes after Rotator Cuff Repair.” Orthopaedic Journal of Sports Medicine, SAGE Publications, 29 July 2016, www.ncbi.nlm.nih.gov/pmc/articles/PMC4968368/.
Williams, Matthew D, et al. “Understanding the Importance of the Teres Minor for Shoulder Function: Functional Anatomy and Pathology.” The Journal of the American Academy of Orthopaedic Surgeons, U.S. National Library of Medicine, 1 Mar. 2018, pubmed.ncbi.nlm.nih.gov/29473831/.
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