|Stretching the Serratus Anterior effectively can be a difficult task, especially if a client has limited mobility or pain in the shoulder. Many stretching tutorials will have the patient raise the arm over the head and lean laterally in order to lengthen the muscle. While this does partially stretch the muscle, it can be difficult for some to extend the arm over the head. Also, this motion does not stretch serratus anterior optimally. If we look at the action of the muscle, aka scapular protraction, a part of the movement we need to incorporate to gain the most lengthening is scapular retraction; not flexion of the shoulder. By doing retraction, we will greatly intensify the stretch and create much more mobility.
The key when stretching the Serratus Anterior effectively is to use multiple movements to achieve optimal lengthening. First, we will use medial scapular translation in order to retract the scapula and move the insertion of the muscle. Then we will use the movement of the rib cage to move the origin of the muscle, optimizing the lengthening.
Some of you may have experienced weeks where you seem to see the same conditions over and over again. Its as if you should title your work “hip fixing week” or “headache day”. For me, more often than not, it is “pain in my shoulder…fix me” week. Shoulder joints are one of the most treated areas in my practice, which has provided me with a pretty good idea as to some of the common denominators for why they go funky. Obviously, every client is unique and you cannot generalize because each injury or pain condition is its own process. However, recognizing some of the typical traits of shoulder dysfunction can help you assess some areas which can be treated to help restore shoulder function. And by doing this, we can treat a good number of shoulder pain cases.
The condition which is one of the most frequent that I see, and which I want to cover is shoulder impingement syndrome. Although I said that you should not generalize for proper assessment sake, many cases of shoulder pain are due to impingement syndrome. Yes, there are plenty of other conditions which occur in the shoulder, but for the sake of this post, I want to focus on impingement as it is a condition which pops up a lot, and is highly applicable to massage therapy. Continue reading “Shoulder Impingement”
I can’t tell you the number of times I have seen a client and the first thing they say to me is “can you work on my shoulder blades or wings…or whatever they are called?” I don’t know about you but if I had wings back there I would be pretty excited. Also, I don’t remember being trained in wing massage….hmmm. All kidding aside, the upper thoracic and scapular region do get a lot of attention from massage therapist because it is a source or a great deal of discomfort for many clients. This area affects just about every human it seems (which is a lot of people) especially anyone who tends to spend a lot of time in front of a computer. It is also an area where we tend to gather tension related to stress which adds to the discomfort. Combine all of these factors and it is definitely an area most people are going to want work done on.
I would like to take this common treatment area and open up the reasons why it is such a prominent area of pain. I would also like to delve a bit deeper and see if we can figure out why so many people have, not only soreness here, but many times ongoing acute and chronic pain. What is that “burning” and “aching” feeling that is described to us therapists so often? Also, why does it always seem to come back even after treating it? Hopefully, I can answer those questions and give you a better knowledge of how to treat what seems to be everyone’s bane. Continue reading “Shoulder Blade Pain…Everyone’s Bane”
|Pectoralis Minor is probably one the hardest muscles in the body to stretch. It is commonly done in an exact manner as pectoralis major which, in my opinion, can be improved upon. Because of its attachments, it does not have the ability to move through a large range of motion which, of course, limits how we can move it to stretch it. The main issue with singling out pectoralis minor is that pectoralis major usually comes to tension before we can stretch minor, or shoulder mobility does not allow for enough movement. So, in order to reach pectoralis minor, we will need to take these factors out of the equation. Instead of focusing on glenohumeral movement, we are going to focus more on scapular motion (retraction) to gain the lengthening we require.|
|Now some of you may ask why we are not going to incorporate more elevation of the scapula since the pectoralis minor depresses the shoulder. I answer this by saying that elevation, at least the way we need it, is almost impossible to accomplish when stretching on your own (someone assisting you is a different story). Also, we can accomplish more lengthening and single out pectoralis minor much more effectively with shoulder retraction in this circumstance. If you look back and look at Figure 1, I want you to imagine a simple pulley system on top of the shoulder. Pectoralis minor is a rope on the front side of the pulley and the scapula is the back side of the system. By depressing the scapula while at the same time retracting it, we are, in essence, “hoisting” the insertion of pectoralis minor up and drawing it away from its origin in the ribs.|
Although Pectoralis Minor does not have an attachment on the humerus (unlike Pectoralis Major), we will use it to affect how we want the scapula to move. We will also use the ribs where the Pectoralis Minor originates to help lengthen the muscle from the other direction.
|In certain areas of the body, muscles function in such close proximity to each other that they can become stuck to one another. This of course does not allow those muscles to love and stretch in the way they are intended. This can be very limiting when it comes to range of motion. This is especially true in the shoulder, and, specifically, with the teres muscles, triceps brachii and latissimus dorsi. Stretching these four muscles with this theory in mind can allow for better increases in mobility when only stretching independently is unsuccessful.|
Teres Minor and Major
- Begin by standing about two feet away from the wall at a 90-degree angle.
- Extend shoulder over the head and place elbow on the wall.
- Lean toward wall allowing the elbow to move toward your head. The stretch will we felt on the underside portion of the shoulder more laterally and posterior.
Adding Triceps Brachii and Latissimus Dorsi
Once the teres major and minor are stretched, we can add triceps brachii and latissimus dorsi to make a combination stretch. This is important in this specific area because the different muscles that are in very close proximity to each other. These muscles need to be able to function in their own range of motions without being restricted by other muscles. We want to be able to create differentiation between these muscles so they can love and glide independently of each other. We can do this by using the force of the stretch.
- Maintain our lengthened and stretched position of teres major and minor (in step 3 of teres stretch), so this position will be our anchoring point.
- Keeping the shoulder in place, bend the elbow slowly and bring your hand behind your head. The stretch should be felt in the back of the arm through the triceps brachii and also intensify the stretch of teres major and minor.
- To maximize the stretch and increase lengthening of all four muscles including latissimus dorsi, lean your torso closer to the wall and slightly laterally flex away.
Note: Adding the triceps brachii and latissimus dorsi lengthening will only intensify the stretch if you do not have good movement between these structures. If your mobility is already good, only a minor pull will be felt in the triceps itself.
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|This muscle is very popular to stretch and for good reason. It is a main contributor to upper cross syndrome and anterior shoulder posture. It can also be a major player in shoulder impingement. Obviously, a good one to know how to stretch! The key with the muscle is making sure we are stretching ALL the different fiber directions due to the broad attachments into the ribs. we can easily miss fully lengthening this muscle simply by not stretching at the right angle.
If discomfort is felt in the shoulder joint while stretching, or if instability is a concern, practice stabilizing the scapula while stretching by activating your lower trapezius and rhomboid. This should help with discomfort as well as allow for correct stretching form.