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 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/.
As the body’s most mobile joints, the shoulders are surrounded by muscles, tissues, and ligaments that help support the shoulders and the rotator cuff in mobility function, thus ensuring the shoulders remain in a stable, normal position. As a complex structure that is made up of three bones: the humerus (upper arm bone), the scapula (shoulder blades), and the clavicle (collarbone), the shoulders provide a wide range of motion without feeling pain. When injuries affect the muscles, tissues, and joints of the shoulders, they can potentially develop tiny knots along the muscle fibers and invoke pain-like symptoms on the upper extremities of the body. To that point, it affects not only the shoulders but also the arms and the hands. Today’s article looks at the infraspinatus muscle, how shoulder joint pain is associated with trigger points, and various treatments to manage trigger points related to the shoulder joint. We refer patients to certified providers who specialize in musculoskeletal treatments to aid individuals suffering from trigger points related to the shoulder joints and the infraspinatus muscles. We also guide our patients by referring them to our associated medical providers based on their examination when appropriate. We ensure to find 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 Infraspinatus Muscle?
Do you feel stiffness along your shoulders or upper arms? Does it hurt when you rotate your shoulders? Or have you been experiencing a tingling or numbing sensation traveling down your arms? Many people who experience shoulder pain might be due to trigger points affecting their infraspinatus muscles. The infraspinatus muscle is a muscle that looks like a thick triangle that covers the front of the scapula. The infraspinatus is a part of the rotator cuff muscles or commonly referred to as SITS:
Supraspinatus
Infraspinatus
Teres minor
Subscapularis
These four muscles provide the functionality to the rotator cuffs in the shoulders to allow the arms full range of motion. Studies reveal that rotator cuff activity from these muscles is crucial for normal shoulder motion. To that point, the infraspinatus plays a vital role by providing dynamic stability while producing external rotation at the shoulder. However, traumatic forces can affect the infraspinatus muscles causing lesions and other conditions to affect the shoulders and rotator cuffs, causing pain-like symptoms to the upper half of the body.
Shoulder Joint Pain Associated With Trigger Points
Since shoulder pain is the third most common musculoskeletal disorder, the underlying causes are rotator cuff disorders and referred pain in the neck. When traumatic factors begin to affect the shoulder muscles and the rotator cuff muscles, it can potentially lead to the development of myofascial pain syndrome or trigger points along the muscle fibers of the shoulders. Referred pain causes pain in one area of the body when in actuality is affecting the other side of the body. For trigger points associated with shoulder joint pain, studies reveal that myofascial pain from trigger points in the infraspinatus may give rise to referred pain in the arms, shoulders, or even the cervical spine in some patients. To that point, trigger point pain associated with the shoulder joint may mimic carpal tunnel symptoms around the wrist. When trigger points mimic other chronic conditions, it often makes it a bit harder to diagnose the symptoms.
Treating Trigger Point Release On The Infraspinatus Muscle-Video
Have you been dealing with pain-like symptoms in your wrist? Do you feel muscle stiffness when rotating your shoulders? Or have you been experiencing numbness or tingling sensations from the shoulders to the fingertips? If you have been experiencing any of these symptoms, it could be referred to pain from trigger point pain associated with the infraspinatus muscle on the shoulder joint. Trigger points form tiny nodules along the taut muscle fibers of the affected muscle area. The video above explains where the trigger points are located on the infraspinatus muscle on the scapula (shoulder blades) and how to release the trigger points. All is not lost, as various treatments can help manage trigger points associated with the shoulder joint. Studies reveal that chronic musculoskeletal disorders in the shoulder joint are often associated with myofascial trigger points, causing referred pain along the arm down to the fingertips. To that point, pain specialists incorporate and apply acupuncture or dry needling on the trigger point can help improve pain and disability for many individuals with shoulder pain.
Treatments Managing Trigger Points Associated With The Shoulder Joint
When many individuals are dealing with trigger point pain associated with the shoulder joint, they sometimes believe that it could be something that is affecting their heart. Now, why would the heart be associated with the shoulder joint? This is due to somato-visceral pain (the affected muscle is causing issues to the corresponding organ) that is causing referred pain to affect the heart. When patients go to their primary doctors, they go through an examination to see what the issue is, and this allows the doctor to go through a clinical process to come up with a diagnosis of what is going on, which in this case is trigger points associated with the shoulder joint. Once the doctor diagnoses the issue, they can refer their patients to a pain specialist like a chiropractor, massage therapist, or a physiotherapist to manage the trigger points in the affected muscle area. Chiropractors, massage therapists, and physiotherapists utilize various techniques to relieve trigger points from the infraspinatus muscle in the shoulder joints. Some of the available treatments that are used to manage trigger points associated with the shoulder joint include:
Stretching
Ice/Heat Compress
Spinal Adjustments
Acupuncture
Trigger Point Injection
Conclusion
The muscle known as the infraspinatus is part of the rotator cuff that works along the shoulder and looks like a thick triangle on the scapula or shoulder. This muscle helps the rotator cuff activity for normal shoulder motion by providing dynamic stability while performing external rotation on the shoulder. When traumatic factors affect the infraspinatus muscle, it can develop trigger points along the muscle fibers of the infraspinatus muscle and cause referred pain along the shoulders and down to the arms. Fortunately, various treatments available can manage trigger points and relieve the pain from producing more issues along the shoulder. To that point, many individuals can have normal shoulder function without pain.
References
Ha, Sung-Min, et al. “Selective Activation of the Infraspinatus Muscle.” Journal of Athletic Training, National Athletic Trainers Association, 2013, www.ncbi.nlm.nih.gov/pmc/articles/PMC3655748/.
Kamali, Fahimeh, et al. “Comparison of Upper Trapezius and Infraspinatus Myofascial Trigger Point Therapy by Dry Needling in Overhead Athletes with Unilateral Shoulder Impingement Syndrome.” Journal of Sport Rehabilitation, U.S. National Library of Medicine, 30 Nov. 2018, pubmed.ncbi.nlm.nih.gov/29364040/.
Meder, Marek A, et al. “Reliability of the Infraspinatus Test in Carpal Tunnel Syndrome: A Clinical Study.” Journal of Clinical and Diagnostic Research : JCDR, JCDR Research and Publications (P) Limited, May 2017, www.ncbi.nlm.nih.gov/pmc/articles/PMC5483796/.
Williams, Jeslin M, et al. “Anatomy, Shoulder and Upper Limb, Infraspinatus Muscle.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 13 Aug. 2021, www.ncbi.nlm.nih.gov/books/NBK513255/.
The shoulder muscle functionality allows support and stability to the flexible joints in the body. The shoulders allow a full range of motion without feeling pain or discomfort, like throwing a ball or reaching an item on the shelf. The shoulders are also supported by many muscles, tendons, and ligaments surrounding the rotator cuffs that allow the shoulders to remain stable. The rotator cuffs consist of four muscle groups that allow the arms to be mobile. However, the range of motion from the shoulders and the rotator cuff can be prone to injuries and become unstable. To that point, the shoulders and their associated muscles are often the sites for many issues to develop. Today’s article looks at the supraspinatus muscles in the rotator cuffs, how trigger points affect the rotator cuffs and various therapies for rotator cuff injuries. We refer patients to certified providers who specialize in musculoskeletal treatments to aid individuals suffering from trigger points related to the shoulders affecting the rotator cuffs and the supraspinatus muscles. We also guide our patients by referring them to our associated medical providers based on their examination when appropriate. We ensure to find that education is the solution to asking our providers insightful questions. Dr. Jimenez DC observes this information as an educational service only. Disclaimer
The Supraspinatus Muscles In The Rotator Cuffs
Do you feel stiffness along your shoulders? Does it hurt when you rotate them? Or have you been experiencing numbness and tenderness traveling your upper arm? Individuals experiencing these symptoms in their shoulders could be dealing with trigger points along the supraspinatus muscles. The supraspinatus muscle resides in the supraspinous fossa of the scapular spine and is superiorly located in the rotator cuff muscles. The supraspinatus muscle is associated with the other muscles that surround and support the rotator cuffs in the shoulder, which include:
Infraspinatus
Teres Minor
Subscapularis
These four muscles closely relate to the deltoid muscles to provide stability, movement, and rotation to the upper arm joint. When issues affect the shoulders or the rotator cuffs, it can cause the rotator cuff muscles to develop trigger points and other associated symptoms along the upper arm.
How Trigger Points Affect The Rotator Cuffs
When the muscles of the rotator cuffs become injured, many issues may cause musculoskeletal complaints. Studies reveal that tendinopathy or tendon injuries are often characterized by pain in and around the tendons in the rotator cuffs and are associated with repetitive actions. When the supraspinatus muscle becomes overused due to repetitive motions, it can develop trigger points to affect the rotator cuffs. Studies reveal that local and referred pain symptoms reproduce active trigger points in the muscles surrounding the shoulders and rotator cuff that many individuals recognize as familiar pain. According to Dr. Janet G. Travell, M.D., the activation of trigger points associated with the supraspinatus muscles are activated from strenuous activities like carrying heavy objects, walking a large dog that is pulling the leash, or lifting an object above shoulder height with the arms outstretched. These strenuous activities allow the trigger points to form along the supraspinatus muscles and cause referred pain symptoms on the shoulders.
Stretching The Supraspinatus Muscles- Video
Have you been feeling stiffness along your shoulders? Do you feel tenderness in certain areas of your shoulders or arms? Or do you experience a numbing sensation running down your arms? If you have been experiencing these issues along your shoulders and upper arms, it could be due to trigger points associated with the supraspinatus muscles. Trigger points are small knots along the taut muscle band of any muscle group that can mimic any overlapping condition that can cause issues to the body. For example, shoulder pain is associated with trigger points along the supraspinatus muscle. The video above shows how to stretch the supraspinatus muscles to reduce future trigger points from forming along the rotator cuff muscles. Individuals who incorporate stretching exercises for shoulder pain associated with the supraspinatus can feel relief in their shoulders as the overall function is restored and the pain is reduced.
Various Therapies For Trigger Points Associated With The Rotator Cuffs
The various therapies for trigger points associated with the rotator cuffs can help reduce the pain-like symptoms along the supraspinatus muscles. Studies reveal that exercises and manual therapy can help decrease pain along the supraspinatus muscles and increase shoulder muscle strength and function. Other treatments like chiropractic care can benefit many patients with shoulder pain or injuries that can help reduce pain, improve ROM (range of motion), increase flexibility, and even restore function to the joint. Depending on how severe the muscle injury is on the shoulders, chiropractors utilize various techniques to assess the pain and help address all the areas of the body to relieve the issue without using drugs.
Conclusion
The supraspinatus muscles are part of the rotator cuff muscle group and work alongside the shoulder muscles to provide mobility and a full range of motion to the upper arm without feeling pain. When strenuous activities or injuries occur to the shoulders or the rotator cuffs, it can cause myofascial pain syndrome or trigger points to develop along the overused muscles in the shoulders and cause pain-associated symptoms. This can affect the mobility of the shoulders and arms from going through a full range of motion. Various therapies are available to help reduce pain, restore functionality to the shoulders and surrounding muscles associated with trigger points, and can help improve motor function. Treatments for shoulder pain associated with trigger points can help prevent future issues from forming and improve shoulder functionality.
References
Hidalgo-Lozano, Amparo, et al. “Muscle Trigger Points and Pressure Pain Hyperalgesia in the Shoulder Muscles in Patients with Unilateral Shoulder Impingement: A Blinded, Controlled Study.” Experimental Brain Research, U.S. National Library of Medicine, May 2010, pubmed.ncbi.nlm.nih.gov/20186400/.
Jeno, Susan H, et al. “Anatomy, Shoulder and Upper Limb, Arm Supraspinatus Muscle.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 7 Aug. 2021, www.ncbi.nlm.nih.gov/books/NBK537202/.
Spargoli, Guido. “Supraspinatus Tendon PATHOMECHANICS: A Current Concepts Review.” International Journal of Sports Physical Therapy, Sports Physical Therapy Section, Dec. 2018, www.ncbi.nlm.nih.gov/pmc/articles/PMC6253746/.
Şenbursa, Gamze, et al. “The Effectiveness of Manual Therapy in Supraspinatus Tendinopathy.” Acta Orthopaedica Et Traumatologica Turcica, U.S. National Library of Medicine, 2011, pubmed.ncbi.nlm.nih.gov/21765229/.
The body is a functional machine that requires many muscles, organs, ligaments, joints, and tissues that provide everyday movements. In the upper extremities, the head, neck, and shoulders have many muscles, ligaments, and tissues that work together with the nerve roots from the nervous system that provides sensory-motor function to make the fingers move, the shoulders rotate, and the head turns from side to side. When injuries or common issues affect the muscles in the head, neck, or shoulders, it can cause small nodules to form along the muscle fibers of the affected muscle area and cause referred pain in different locations of the body. Today’s article looks at the scalene muscles, how trigger points affect the scalene muscles while mimicking shoulder pain, and how to manage chronic pain associated with trigger points. We refer patients to certified providers who specialize in musculoskeletal treatments to aid individuals suffering from trigger points related to the shoulders affecting the scalene muscles. We also guide our patients by referring them to our associated medical providers based on their examination when appropriate. We ensure to find that education is the solution to asking our providers insightful questions. Dr. Jimenez DC observes this information as an educational service only. Disclaimer
What Are The Scalene Muscles?
Have you been experiencing tingling sensations running down your fingertips? Do you feel stiffness when rotating your neck or shoulders? Or do you feel muscle soreness in your shoulders? Many individuals who are feeling any of these symptoms affecting their neck or shoulders could be dealing with trigger point pain along the scalene muscles. The scalene muscles play a crucial part in the head and neck as they are deep muscles positioned laterally on the cervical tract of the spine. These muscles have three different branches: the anterior, medius, and posterior, which play the role of being accessory breathing muscles while being an important contributor to head and neck movement. To that point, it allows stability to the cervical spine. The scalene muscles even help support and elevate the upper rib cage when a person is lifting, pulling, or carrying heavy objects. However, like most muscles in the body, the scalene muscles can be prone to injury and can develop issues that can affect the upper extremities of the body.
Trigger Points Affects The Scalene Muscles Mimicking Shoulder Pain
When common injuries like pulling a muscle when carrying a heavy object or even a traumatic injury like being involved in an auto accident can cause pain in the affected area, over time, if not treated, can cause various symptoms to overlap and affect the muscles. When the scalene muscles are affected by injuries, they can develop tiny nodules along the taut muscle fibers and become hyperirritable to the surrounding areas of the upper half of the body. This is known as trigger point pain and can mimic other chronic issues that affect different body areas. To that point, trigger points affecting the scalene muscles may mimic shoulder pain in the upper half of the body. Studies reveal that scalene myofascial pain is a regional pain syndrome that originates pain in the neck area and radiates pain down to the arm. Since trigger points mimic other chronic issues, it is often misdiagnosed as another neck pain associated with radiculopathy when the scalene muscles are affected. When this happens, the muscles become stiff and weak, causing a reduction in the range of movement.
Studies reveal that when individuals suffer from acute whiplash-associated disorders, the local and referred pain can be elicited from active trigger points to reproduce neck and shoulder pain. This causes a higher disability that exhibits widespread pressure causing the muscles to be hypersensitive and reducing the cervical range of motion. Many individuals often complain about shoulder pain while rubbing the upper parts of their arms. The scalene muscle is affected by active trigger points, thus mimicking shoulder pain.
Scalenes Trigger Points-Video
Have you been feeling muscle stiffness in your neck or shoulders? Have you been experiencing a numbing sensation along your arms? Have you felt tenderness along your shoulders when you touch them? Many of these pain symptoms are associated with trigger points along the scalene muscles. The video above explains where the trigger points are located along the scalene muscles and how they are causing referred pain in the neck and shoulder areas. Many factors can lead to the causation of trigger point pain and overlap with other chronic issues that can affect the upper extremities of the body, using sleep as an example. Studies reveal that poor sleeping posture can affect the neck and shoulders, leading to muscle stiffness along the scalene muscles and developing trigger points over time. Fortunately, various ways to manage referred shoulder pain are associated with trigger points.
Management Of Chronic Shoulder Pain Associated With Trigger Points
Many individuals are referred to pain specialists that can alleviate trigger points along the scalene muscle to reduce the effects of shoulder and neck pain. When referred pain along the scalene muscles causes chronic shoulder pain associated with trigger points, many people often do various movements to alleviate the pain. However, it can cause more pain in the affected area and prevent relief from the neck and shoulders. Studies reveal that various treatments like physiotherapy, trigger point injections, manipulation of the cervical spine, or acupuncture can help relax and lengthen the muscle fibers associated with the scalene muscle. To that point, this allows the neck to extend further without pain and reduces the overlapping symptoms that affect the upper extremities of the body.
Conclusion
The scalene muscles play a crucial part in the head and neck area as deep muscles are positioned laterally on the cervical tract of the spine. These muscles help elevate the upper chest and laterally bend the neck from side to side. When injuries affect the scalene muscles and form tiny nodules known as trigger points, it can cause referred pain to the shoulders and the neck. To that point, symptoms like numbing or tingling sensations can travel down the arms and fingers. Fortunately, available treatments can reduce the symptoms and manage myofascial trigger pain along the shoulders and neck associated with the scalene muscles. This allows a better range of motion to the neck and shoulder and prevents future trigger points from forming in the scalene muscles.
References
Abd Jalil, Nizar, et al. “Scalene Myofascial Pain Syndrome Mimicking Cervical Disc Prolapse: A Report of Two Cases.” The Malaysian Journal of Medical Sciences : MJMS, Penerbit Universiti Sains Malaysia, Jan. 2010, www.ncbi.nlm.nih.gov/pmc/articles/PMC3216145/.
Bordoni, Bruno, and Matthew Varacallo. “Anatomy, Head and Neck, Scalenus Muscle.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 16 Apr. 2022, www.ncbi.nlm.nih.gov/books/NBK519058/.
Fernández-Pérez, Antonio Manuel, et al. “Muscle Trigger Points, Pressure Pain Threshold, and Cervical Range of Motion in Patients with High Level of Disability Related to Acute Whiplash Injury.” The Journal of Orthopaedic and Sports Physical Therapy, U.S. National Library of Medicine, July 2012, pubmed.ncbi.nlm.nih.gov/22677576/.
Lee, Won-Hwee, and Min-Seok Ko. “Effect of Sleep Posture on Neck Muscle Activity.” Journal of Physical Therapy Science, The Society of Physical Therapy Science, June 2017, www.ncbi.nlm.nih.gov/pmc/articles/PMC5468189/.
Thapa, Deepak, et al. “Management of Chronic Shoulder Pain with Restricted Mobility – a Case Series.” Indian Journal of Anaesthesia, Medknow Publications & Media Pvt Ltd, Nov. 2016, www.ncbi.nlm.nih.gov/pmc/articles/PMC5125193/.
Sciatica is common and affects up to 40% of the general population. Different types include acute, chronic, alternating, and bilateral sciatica. The sciatic nerve comprises three specific nerve roots in the lower back. The three nerves originate in the L4 and L5 vertebrae and the sacrum, just below the vertebrae. The nerve then branches off and runs through the back of each thigh. Injury, compression, or irritation of these nerves can cause various symptoms, including numbness, tingling, electrical shooting pain, and muscle spasms in the low back, the leg, and the foot. Chiropractic care can realign the spine, relax the muscles, release compression and relieve sciatica.
Acute, Chronic, Alternating, and Bilateral Sciatica
Acute
Acute pain can be brought on by sudden irritation to the nerves that have become pinched, compressed, or a combination.
Causes a constant burning or shooting sensation through the low back, buttocks, down the leg, and possible hip discomfort.
It becomes worse when sitting.
It can cause immediate and short-term pain lasting for 1-2 weeks.
Chronic
Chronic sciatica can last for months or years on and off or continuously.
It can be caused or worsened by inflammatory conditions like rheumatoid arthritis, injuries, infections, and spinal misalignment issues.
It can resolve but will come back without treatment or lifestyle and activity adjustments.
Bilateral
Sciatica typically takes place in one leg; it has been known to be bilateral and experienced in both legs.
This type of sciatica is rare but can occur from degenerative changes in the vertebrae and/or the discs at several spinal levels.
If there is pain in both legs, it is likely not a herniation but degenerative changes like spinal stenosis.
The symptoms can range from infrequent to irritating to severe and debilitating.
Weakness may be felt in the leg and foot, or a feeling of heaviness, making it difficult to lift the foot off the floor.
Alternating
Alternating sciatica affects both legs alternately. It is usually connected to bilateral sciatica that switches sides.
This type is rare and can result from degenerative problems in the sacroiliac joint, the joint connecting the spine to the hips, or sacroiliac arthritis.
Spinal Sources
Sciatica occurs when L4, L5, and/or S1 nerve roots are affected.
L4 Nerve Root
Pain in the hip, thigh, inner medial areas or the knee, and the calf.
Weakness in the thigh and hip muscles.
Reduced knee-jerk reflex.
Loss of sensation around the calf.
L5 Nerve Root
Pain in the buttock and the outer area of the thigh.
Weakness in the buttock and leg muscles.
Difficulty moving the ankle and lifting the big toe upward.
Loss of sensation between the big toe and the second toe.
S1 Nerve Root
Known as classic sciatica.
Pain in the buttock, back of the calf, and side of the foot.
Fatigue in the buttock and foot muscles.
Difficulty and discomfort raising the heel off the ground or walking on tiptoes.
Loss of sensation in the foot’s outer side, including the third, fourth, and fifth toes.
Chiropractic care can directly address the root cause of the problem, treat the cause, and alleviate the symptoms. Chiropractic manipulation is recommended by the American College of Physiciansas a first line of treatment for back pain before medication, muscle relaxants, injections, and surgery. Treatments to address sciatic nerve impingement:
Ice/Cold Therapy
Reduces inflammation and swelling.
Prepares the patient for massage and adjustments.
Therapeutic Tissue Massage
This therapy promotes muscle relaxation and lessens the muscle spasm/recoil response.
Ultrasound
Soothing heat created by sound waves penetrates the muscles, increases circulation, and relaxes the muscles to alleviate spasms, stiffness, and pain.
Transcutaneous Electrical Nerve Stimulation/Tens Unit
A muscle stimulation machine applies electrical impulses to relax the muscles and untangle muscle knots.
Spinal Manipulation
This process realigns the spine to move properly and restores vertebral health.
Stretches and Exercises
This ensures treatment will last once treatment has or is coming to an end.
Spinal Decompression
Pulls and stretches the body to release any compression on the nerve roots and infuse circulation back into the discs.
The pressure is taken off the sciatic nerve, and routine adjustments will retrain the muscles to maintain their re-alignment. The duration of treatment will vary based on the root cause of sciatica. Each treatment plan is tailored to the individual patient’s situation.
Severe and Complex Sciatica Syndromes
References
Davis D, Maini K, Vasudevan A. Sciatica. [Updated 2022 May 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: www.ncbi.nlm.nih.gov/books/NBK507908/
Hernández C.P., Sanchez N., Navarro-Siguero A., Saldaña M.T. (2013) What is Sciatica and Radicular Pain?. In: Laroche F., Perrot S. (eds) Managing Sciatica and Radicular Pain in Primary Care Practice. Springer Healthcare, Tarporley. doi.org/10.1007/978-1-907673-56-6_1
Kumar, M. Epidemiology, pathophysiology and symptomatic treatment of sciatica: A review. nt. J. Pharm. Bio. Arch. 2011, 2.
Ngnitewe Massa R, Mesfin FB. Herniation, Disc. [Updated 2018 Oct 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: www.ncbi.nlm.nih.gov/books/NBK441822/
Ombregt L. The dural concept. In: A System of Orthopaedic Medicine. Elsevier; 2013:447-472.e4. doi:10.1016/b978-0-7020-3145-8.00033-8
Witenko, Corey, et al. “Considerations for the appropriate use of skeletal muscle relaxants for the management of acute low-back pain.” P & T : a peer-reviewed journal for formulary management vol. 39,6 (2014): 427-35.
Wright R, Inbody SB. Radiculopathy and Degenerative Spine Disease. In: Neurology Secrets. Elsevier; 2010:121-130. doi:10.1016/b978-0-323-05712-7.00007-6
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