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Massage Aha!

Professional therapeutic massage therapy in Kansas City, MO by Aaron Harris, BCTMB

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The Subscapularis Muscle

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The Subscapularis Muscle lies on the anterior (front) side of the scapula (shoulder blade), making it difficult to see and challenging to reach. Along with Infraspinatus, Supraspinatus, and Teres Minor, it is one of the “rotator cuff” muscles that is a common source of shoulder pain.

Location of Subscapularis
Location of the Subscapularis Muscle.

This muscle is one of the main causes of a painful condition known as “frozen shoulder syndrome” that severely reduces mobility of the entire shoulder joint.

What Does Subscapularis Do?

“Subscap” attaches the scapula to the medial (closer to the body) side of the humerus (long bone of the upper arm). It is responsible for internal rotation and adduction (bringing closer to the body) of the upper arm. The adduction action helps stabilize the head of the humerus in the “socket” of the shoulder.

Trigger Points in Subscapularis

There are three common trigger points in subscap. Each point is a bit harder to reach than the previous. These points refer pain to the posterior (back side) of the shoulder into the scapula. Pain often spills down the length of the back side of the arm and both sides of the wrist.

Subscapularis Trigger Points
Common trigger points in subscapularis (marked by X) and the pain referral pattern (shown in blue).

These trigger points are frequently described as causing a deep, stabbing pain as if you are being pierced from the front to back. Clients often seek massage for other parts of the shoulder because the source of the pain is hard to identify.

On rare occasions, pain in the left subscap can mimic the classic shoulder pain symptom of a heart attack. This has sent more than one client to the emergency room.

Massage of the Subscapularis Muscle

As previously mentioned, this muscle can be difficult to reach, so it takes some patience and work on surrounding muscles to gain access to it.

Accessing Subscap

When you are lying face down, I will place your arm across the small of your back. This will cause your scapula to “wing” out. This gives access to the medial edge of the anterior scapula. While you are in this winged position, I can also rotate and stretch the soft tissues of the scapula. This can help reduce tension in the subscapularis.

Winging the scapula for access to the Subscapularis Muscle
A patient demonstrating the scapula winging technique to access the Subscapularis Muscle

Once you have been repositioned onto your side or back, I will carefully raise your arm and place your hand behind your head. From this position, I can access the trigger points in subscap from your armpit.

Accessing the subscapularis from the supine position.
Accessing the subscapularis muscle while the client lies on her back.

Frozen Shoulder Syndrome

If you are suffering from frozen shoulder syndrome, it’s possible that an entire massage session will be spent focused on loosening up the supportive muscles of the shoulder and arm. All of this just to gain access to Subscapularis.

The good news is that the trigger points responsible for frozen shoulder syndrome generally respond quickly to therapy. A significant range of motion can be restored in just one session.

Swedish massage is rarely as effective in treatment of subscap as Deep Tissue and Shiatsu are.

I have seen almost miraculous improvement in clients with frozen shoulder syndrome and trigger points in Subscapularis. One of my regular clients came to our first session unable to raise his hand more than a few inches away from his waist. He could not even raise it with help from his other hand. By the end of that session, he was able remove his jacket from the wall hook without pain. After two more mobile massage sessions, he could raise his arm above his head without pain or assistance.

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