Need ideas about treating shoulder

[TomTom]

Hello, I am having difficulty with a client and was hoping for new ideas. He is an athlete and the major issue is his right shoulder doesn't move as easily as he would like. I had success in realeasing the the scapula, lats, & pecs. His upper traps and levator scap, however, returns to exactly the same week after week. When I push down on the top of his shoulder there is no give, I release the muscles and he has great movement for a few days, but returns the same by the end of the week. These are his prior injuries- rt shoulder dislocation and broken bone on the lft side many yrs ago. He doesn't remember which bone, but pointed to his clavicle area. Thanks for helping a stumped MT.

 

[Top_Gear_Biggest_Fan]

Need ideas about treating shoulder

What kind of athlete is he? Is he pitching with the right arm, lead with the right while swimming, etc?

 

[Ottawa Mike]

Need ideas about treating shoulder

Assuming he has been cleared for a tear, correct?

Upper thoracic rib/spine issues often appear as shoulder pain/restriction. Depending on your comfort level and training, deeper palpation of the upper thoracic ribs and spine may refer out to the shoulder. If you hit any positive findings, treat that area with deeper sustained work. I just came across a few papers that confirmed what I've been casually seeing for years:

http://ptjournal.apta.org/content/90/1/26.full.pdf+html

While this article refers to manipulation as the modality, adapting this information to your modality is possible. Shoulders can be tough, as it is not always the shoulder that is the source.

 

[westo]

Need ideas about treating shoulder

Thanks for the replies. He is a swimmer, not sure which arm he leads with.
After releasing the other arm, I realized last week how off his anterior rt shoulder is. I did some work to release it and will continue next week as we were restricted by time. Hopefully that will take us somewhere.
Thanks walt for the info, I am thinking that is not the problem here, but that info will definitely come in handy.

 

[tomboy]

Need ideas about treating shoulder

Ask how many miles he is swimming in a week. It will give you some insight as to what he may be doing to aggravate the problem.

I have worked on a few swimmers and another thing you should check is to make sure he is not hypermobile. He can have tight muscles and still have hypermobile joints. I had one of my swimmers with this problem and she eventually had to have surgery to tighten and re-attach the muscles.

Of course, she was swimming something like 3,000 meters a week and was a competitive athlete, so it all depends. But, I would just put it out there as something else to ask about.


02-16-11 - corrected for typo

 

[Pompal 09.]

Need ideas about treating shoulder

In addition to what has already been stated...

This athlete needs to strengthen upper back and shoulder muscles that will help maintain normal shoulder positioning both in and out of the water. Simply relaxing his tight muscles won't do the job if the opposing muscles are too weak or inhibited to properly stabilize his scapulae. That is why things keep going back to square one after a few days.

As a massage therapist, this type of strengthening is largely outside your scope of practice, so you should refer him to a (preferably) physical therapist familiar with swimmers or (at least) to a personal trainer with specific expertise in corrective exercise for shoulder instability. If this client is unwilling to do the necessary work, he will continue to have chronic shoulder problems and an elevated risk of serious shoulder injuries... possibly for the rest of his life. Investing some of his time and money now will pay off big over the long run, so be very strong in your recommendations and consider refusing to see him again until he has started to meet with a PT or trainer.

 

[jee bus]

Need ideas about treating shoulder

Thanks all for the help. I questioned him further on our last session and found it wasn't a shoulder dislocation but Rather repeatedly separating his ac joint. There also has been much trauma to the deltoid/ ant chest area. I am releasing the area, but I know it will take some to sort it out as this has been going on for 20 years now and this man isn't very gentle with his body.

Jason, your comment left me wondering if he properly rehabilitated his shoulder after his injuries. I am looking into referring him to someone regarding that.

 

[Zok]

Need ideas about treating shoulder

Thanks all for the help. I questioned him further on our last session and found it wasn't a shoulder dislocation but Rather repeatedly separating his ac joint. There also has been much trauma to the deltoid/ ant chest area. I am releasing the area, but I know it will take some to sort it out as this has been going on for 20 years now and this man isn't very gentle with his body.

Jason, your comment left me wondering if he properly rehabilitated his shoulder after his injuries. I am looking into referring him to someone regarding that.

Based on the info you just provided, I am strengthening my recommendation that you send him to a PT and/or trainer for assistance with strengthening and stabilizing the joint. The work you do will always be no better than short-term relief until he rehabs it properly.

 

[viablerenewables]

Need ideas about treating shoulder

Consider working on his anterior neck as well.

If you don't know a good PT, look up some of the orthopedic offices in your area and find out what they are really good at and if they have PT's on site. That will then help you find a pretty good fit for his rehab. BTW, it is a great opportunity to meet and greet some of the MD's and PT's in your area, if you play it right.

 

[Michael K]

Need ideas about treating shoulder

This athlete needs to strengthen upper back and shoulder muscles that will help maintain normal shoulder positioning both in and out of the water.

Turkish Get Up may be the answer...

 

[Lotus]

Need ideas about treating shoulder

I also do a lot of work while people are sitting on the floor. I am discovering floor work to be great for people with all kinds of upper body issues

 

[Ramon]

Need ideas about treating shoulder

Muscle therapy is often ineffective (Swedish, deep tissue, shiatsu etc). A switch in technique might be more helpful. You might consider doing connective tissue bodywork instead. Athletes especially have an enormous amount of connective tissue that needs to be broken down and softened. This will greatly enhance one's range of motion.

 

[Big Head 22]

Need ideas about treating shoulder

You mentioned tense superior traps that would not "let go":
The nervous system will create tension in the superior traps in response to compression on the brachial plexus, due to tightness in the muscles of the anterior chest and shoulders. Because the sup. traps attach on the clavicle, the brain will create tension there to help lift the clavicle off the brachial plexus. No matter how much you bang on the traps, that tension will not let go. By working the pecs, subclavius, long head of biceps, ant. deltoid, scalenes and even the sternocleidomastoid muscles the tension on the clavicle to compress the plexus will be reduced and therefore the sup. traps can finally relax.

 

[Nan Hawthorne]

Need ideas about treating shoulder

You mentioned tense superior traps that would not "let go":
The nervous system will create tension in the superior traps in response to compression on the brachial plexus, due to tightness in the muscles of the anterior chest and shoulders. Because the sup. traps attach on the clavicle, the brain will create tension there to help lift the clavicle off the brachial plexus. No matter how much you bang on the traps, that tension will not let go. By working the pecs, subclavius, long head of biceps, ant. deltoid, scalenes and even the sternocleidomastoid muscles the tension on the clavicle to compress the plexus will be reduced and therefore the sup. traps can finally relax.

This is almost exactly the approach I usually take with this type of problem. The specific methods vary for each client, but the overall strategy is the same. I also include some strengthening because I am a personal trainer that has spent some years doing corrective exercise with many clients. Even so, I also often refer them to see a PT for further evaluation and treatment, as most MTs should.

 

[redhot]

Need ideas about treating shoulder

Where is the "like" button?!

 

[tanja3703]

Need ideas about treating shoulder

I have great success in using the technique called Rossiter. Deep Active Myofascial Release with movement is key.

You want to know more give me a call, 510-366-9767.

John Prior
Senior Rossiter Instructor and Coach

 

[Shanks]

Need ideas about treating shoulder

This athlete needs to strengthen upper back and shoulder muscles that will help maintain normal shoulder positioning both in and out of the water.

Turkish Get Up may be the answer...

No. The Turkish Get Up is contraindicated for someone with shoulder stabilization problems.

It's a great exercise to build strength when your shoulder already works fine.