Subscapularis Manual Static Release

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Learn optimal technique for subscapularis static manual release (a.k.a. soft tissue mobilization, ischemic compression, trigger point release) in this comprehensive step-by-step instructional video from the Brookbush Institute. This evidence-based video provides detailed guidance on assessment, positioning, tissue differentiation, and pressure application to release subscapularis trigger points, reduce muscle overactivity, alleviate shoulder pain, and restore optimal glenohumeral joint function. Perfect for clinicians and movement professionals, including physical therapists, massage therapists, athletic trainers, occupational therapists, and chiropractors, seeking to enhance their manual therapy skills for shoulder health, rehabilitation, and performance.

Differentiation

The subscapularis covers nearly the entire anterior face of the scapula. This is the side of the scapula that is pressed against the ribs.
To access the anterior face, protract and upwardly rotate the scapula. This can be achieved by passively pulling the arm toward the ceiling and flexing the shoulder, or having the patient actively reach for the ceiling and then place their hand behind their head.
In this position, the anterior face of the scapula is the "floor" of the axilla (armpit). You can follow the rib cage down into the floor of the axilla and gently press through the soft tissues until you reach the hard, bony anterior face of the scapula.
Alternatively, medial fibers of the subscapularis can be accessed by palpating underneath the inferior angle of the scapula at the "triangle of auscultation".
It will be difficult to feel fascicles through the multiple layers of soft tissue, but it is often possible to identify "denser regions" and regions the patient communicates as being sensitive.

Potentially Sensitive Tissues

The long thoracic nerve may be compressed along the entire length of the muscle. Closer to the superior aspect of the muscle the axillary artery, brachial plexus, and lymph nodes may also be compressed. Any burning, radiating or sharp pain should be considered an indication to adjust the fingers.

Trigger Points

The most common subscapularis trigger points are in the middle of the length of the muscle, and additional trigger points may be located closer to the glenoid fossa.

Release Technique

This technique is most comfortable with the patient lying in supine and the practitioner standing on the affected side.
To access the subscapularis , protract and upwardly rotate the scapula. This can be achieved by having the patient actively reach for the ceiling and then place their hand behind their head. However, the more common method is the practitioner using their off-hand to control the arm; gently pulling the arm toward the ceiling and flexing the shoulder.
The practitioner can then use the other thumb to palpate down to the anterior surface of the scapula.
Attempt to locate dense regions or taut bands using short vertical strokes. Pick up the finger after each short stroke to reduce the risk of painfully dragging and stretching soft tissues with your fingers along the length of the scapula.
Once a taut band is located, some exploring from medial to lateral may aid in locating dense nodules. Note it may not be possible to "reach" the medial portion of the subscapularis from the axilla.
The direction of force and the amount of protraction/upward rotation may be adjusted to aid in pinning and compressing dense/sensitive tissue. Generally, pressing down toward the table is sufficient, but cranial force may aid in pinning tissue.
Consistent pressure is held until the nodule softens under the practitioner's fingers, or tissue density/sensitivity is significantly reduced (generally 30 - 120 seconds).

Medial fibers:

Have your patient roll on to their side, affected side up, facing away from you.
Place the nails and distal knuckle of a flexed finger or two, just medial the inferior angle of the scapula, in the "triangle of auscultation" (finger pads facing you).
Begin to move your fingers as if you were trying to slide underneath the scapula. Try to gently hook the "lip" of the inferior angle.
Gently pull the patient's shoulder back with the opposite hand, resulting in scapular retraction, and the scapula moving over your fingers.
Move the fingers deeper underneath the scapula, and then apply pressure back towards you, directly into the anterior face of the scapula.
If possible search the region for dense/sensitive areas and nodules.
Consistent pressure is held until the nodule softens under the practitioner's fingers, or tissue density/sensitivity is significantly reduced (generally 30 - 120 seconds).

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