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Subscapularis Manual Static Release

Take control of shoulder pains with this detailed video on performing a manual static release on the subscapularis muscle. Our guide will help you safely reduce shoulder tension & discomfort.

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Transcript

00:04 - 00:06This is Brent of the Brookbush Institute, and in
00:06 - 00:07this video we're going over static
00:07 - 00:10manual release of the subscapularis. Now,
00:10 - 00:11if you're watching this video, I'm
00:11 - 00:12assuming you're watching it for
00:12 - 00:14educational purposes and that you are a
00:14 - 00:16license to manual therapist. That is, in
00:16 - 00:19your state or region, it is legal for you
00:19 - 00:21to do manual techniques. That is
00:21 - 00:23chiropractors, athletic trainers, physical
00:23 - 00:25therapists, massage therapists, osteopaths.
00:25 - 00:27I'm sure I'm missing a couple, but if you
00:27 - 00:30are unsure, please look up the laws in
00:30 - 00:31your state. Personal trainers, this
00:31 - 00:33probably does not fall within your scope
00:33 - 00:35of practice, although you could use the
00:35 - 00:38patient portion of this video in an
00:38 - 00:39educational setting to help you learn
00:39 - 00:41your anatomy. I'm going to have my friend,
00:41 - 00:42Crystal, come out. She's going to help me
00:42 - 00:45demonstrate this technique. If I'm going to
00:45 - 00:46put my hands on Crystal, if I'm going to do
00:46 - 00:49some sort of manual intervention, I'm
00:49 - 00:51going to be pretty sure that that manual
00:51 - 00:53technique is going to have an effect on
00:53 - 00:55either the symptoms she was complaining
00:55 - 00:57of or her performance. The only way
00:57 - 00:59to get there is through assessment. So,
00:59 - 01:01we're going to assume in Crystal's case
01:01 - 01:03that she came in with a little anterior
01:03 - 01:07shoulder pain from working out, and it's most
01:07 - 01:09prevalent when she works out. We did
01:09 - 01:11her overhead squat assessment and her
01:11 - 01:14arms fall forward. We did some goniometry,
01:14 - 01:15and she had some restrictions in
01:15 - 01:18external rotation and flexion. Subscapularis
01:18 - 01:21will restrict flexion a little bit. And
01:21 - 01:22even when I did my manual muscle
01:22 - 01:24test, she tested a little weakness and
01:24 - 01:26external rotation. I know that
01:26 - 01:29overactivity of my subscapularis can
01:29 - 01:32reciprocally inhibit my infraspinatus
01:32 - 01:35and teres minor. So, I got my good working
01:35 - 01:37hypothesis going, and now I just have to
01:37 - 01:39think about my protocol for manual
01:39 - 01:41techniques. They basically all come
01:41 - 01:46down to palpate and compress. Now, we do
01:46 - 01:49want to get a little bit more detail
01:49 - 01:50than that.
01:50 - 01:53So if I first start off with, "How do I
01:53 - 01:55palpate the subscapularis?" Well, my
01:55 - 01:58subscapularis is on the anterior face,
01:58 - 02:00the entire anterior face of my scapula.
02:00 - 02:03So, with the portion of my scapula that
02:03 - 02:06is under my rib cage, I need to get my
02:06 - 02:08scapula out from under my rib cage. The
02:08 - 02:10way to do that, guys, is you're going to pull
02:10 - 02:11them into
02:11 - 02:14protraction, and then if you take the
02:14 - 02:15shoulder into flexion, the scapula
02:15 - 02:17will generally upwardly rotate. You can
02:17 - 02:19mess around with a little abduction and see
02:19 - 02:22if that gets you a little better upward
02:22 - 02:26rotation. And now this, her axilla, is showing.
02:26 - 02:29Her armpit is showing. If I take my
02:29 - 02:32thumb and I press straight down into her
02:32 - 02:34axilla with my thumb against her
02:34 - 02:37rib cage, I'll actually press through some
02:37 - 02:38soft tissue, press through some soft
02:38 - 02:40tissue, press through some soft tissue,
02:40 - 02:43but eventually I hit bone. I can feel
02:43 - 02:44it.
02:44 - 02:48That is the anterior face of her scapula. I know if I'm on the anterior face
02:48 - 02:49I know that if I'm on the anterior face of her scapula, I have to be on her
02:49 - 02:53subscapularis. Now, this whole portion
02:53 - 02:56here, this tissue that you can see my
02:56 - 02:59thumb disappear behind, is not her
02:59 - 03:02subscapularis. This tube of muscle is her
03:02 - 03:05latissimus dorsi, her teres major, and her
03:05 - 03:07teres minor. I want to make sure I'm
03:07 - 03:12medial to that musculature, so make
03:12 - 03:16sure you're in between that border of
03:16 - 03:19muscle and the rib cage. Now, the next
03:19 - 03:20things I need to think about now that I
03:20 - 03:24know how to palpate my subscapularis is
03:24 - 03:26where are my trigger points? The trigger
03:26 - 03:28points for my subscapularis are
03:28 - 03:32generally in the middle of the length of
03:32 - 03:34my scapula. So, this is her inferior angle
03:34 - 03:38and this is the glenoid fossa here, so if
03:38 - 03:40I press down right in the middle of that,
03:40 - 03:42usually there's some dense fascicles
03:42 - 03:45there, and then the other trigger point
03:45 - 03:48is usually right up near the glenoid
03:48 - 03:52fossa there and the superior fibers of
03:52 - 03:54the subscapularis. This kind of brings
03:54 - 03:56us to our next point. I do need to also
03:56 - 03:58be aware of
03:58 - 04:00are there any tissues around her
04:00 - 04:02subscapularis that I could offend or
04:02 - 04:04insult or injure with compression? I
04:04 - 04:06have to think that her
04:06 - 04:08long, thoracic nerve runs along the
04:08 - 04:10anterior face of her scapula, so if I get
04:10 - 04:12that burning, searing, tingling,
04:12 - 04:15I want to get off that. Usually I can
04:15 - 04:18move my thumb just medial or lateral and
04:18 - 04:20be off that tissue. As I get up into here,
04:20 - 04:23I definitely need to consider that my
04:23 - 04:25lymph nodes, my axillary artery, and some of
04:25 - 04:27those other nerves coming off the
04:27 - 04:29brachial plexus as it passes out from
04:29 - 04:32underneath the pectoralis minor are up in
04:32 - 04:34there. So, again, if there are any symptoms
04:34 - 04:37that are not that tenderness associated
04:37 - 04:40with trigger point compression, get off it.
04:40 - 04:42Move around a little bit.
04:42 - 04:44Chances are, all of these structures are
04:44 - 04:46like a millimeter or two millimeters wide, so
04:46 - 04:48you should be able to move a little bit and
04:48 - 04:50get that same trigger point without
04:50 - 04:54doing any compression or making the
04:54 - 04:55patient or client uncomfortable by
04:55 - 04:59compressing those tissues. So, now we
04:59 - 05:01know how to palpate the subscapularis.
05:01 - 05:04You know where the trigger points are. We
05:04 - 05:07know where some of those other tissues
05:07 - 05:09are. I mentioned in some of the other
05:09 - 05:12videos the way we find the appropriate
05:12 - 05:17tissues is with these broad strokes.
05:17 - 05:19The subscapularis is no different, other
05:19 - 05:20than we're just not going to take our
05:20 - 05:23thumb and run it from inferior angle all
05:23 - 05:24the way up into her armpit, because
05:24 - 05:26that's obviously going to be
05:26 - 05:27uncomfortable.
05:27 - 05:29We're going to take a lot of skin, a lot
05:29 - 05:30of soft tissue with us if we go from
05:30 - 05:32here to here. This is pretty delicate
05:32 - 05:35tissue already, and we really don't want to
05:35 - 05:36do anything to make this any more
05:36 - 05:39uncomfortable. So, we're still going to go
05:39 - 05:41cranial- oh, I'm sorry-
05:41 - 05:44kajal to cranial with our strokes, but
05:44 - 05:46we're going to do little short strokes.
05:46 - 05:49You guys can see here that I can start
05:49 - 05:51at inferior angle and do this little short
05:51 - 05:54stroke to see if I feel anything.
05:54 - 05:56No dense fascicles there. I pick up my
05:56 - 05:58finger and go a little higher. No dense
05:58 - 06:00fascicles there. I pick up my finger and
06:00 - 06:02move a little- ah, there we go. We've got
06:02 - 06:04some dense fascicles right there. Once
06:04 - 06:05I find dense fascicles, I
06:05 - 06:09can then compress and hold for 30 to 120
06:09 - 06:12seconds until I get a release. Then, I
06:12 - 06:14can keep going looking for those other
06:14 - 06:17trigger points that are closer to the
06:17 - 06:21glenoid fossa. Now, there is one other subscapular
06:21 - 06:24trigger point, but we need to get
06:24 - 06:26Crystal into a little different position
06:26 - 06:27here. I'm going to have you roll over and
06:27 - 06:30face me.
06:30 - 06:32It's actually closer to the vertebral
06:32 - 06:35border of her scapula but on the
06:35 - 06:38superior portion. Now, what I wouldn't do
06:38 - 06:40is try to get underneath the scapula
06:40 - 06:44starting up here. Here's a little trick:
06:44 - 06:47start at the triangle of auscultation.
06:47 - 06:50It's this little point medial to the
06:50 - 06:53inferior angle of the scapula, where my
06:53 - 06:58rhomboids, lower traps, and my left
06:58 - 07:02lortissimus dorsi don't actually cover. I
07:02 - 07:03can actually take my fingers like this
07:03 - 07:08and almost just push her scapula right
07:08 - 07:10over the top of my fingers. Now I'm
07:10 - 07:14underneath, and I can do my searching
07:14 - 07:17without having to go straight through
07:17 - 07:19all of this tissue, which is
07:19 - 07:21her middle traps and rhomboids. If
07:21 - 07:22you're on a muscular person, that's going
07:22 - 07:26to be really tough. Once I'm
07:26 - 07:28already underneath, then I can look for
07:28 - 07:31that trigger point and I can hold it for
07:31 - 07:3530 to 120 seconds. Now, the last thing that you
07:35 - 07:36need to think about, and this is very
07:36 - 07:39important, is what is your appropriate
07:39 - 07:42body position so that you are
07:42 - 07:44comfortable. What I just showed you
07:44 - 07:46wasn't it.
07:46 - 07:48I was leaning over. I don't want to be
07:48 - 07:50leaning over my patient and be using
07:50 - 07:52my hand strength. I want to be standing
07:52 - 07:54straight up and using my body weight to
07:54 - 07:56apply pressure. So, I'm going to go ahead
07:56 - 07:59and have Crystal lay on her back. The way
07:59 - 08:02i would do this is, of course, I would be
08:02 - 08:04on the side that I was going to release.
08:04 - 08:07I would take her arm, pull her into
08:07 - 08:10protraction and flexion, and now I can
08:10 - 08:12use this hand, or I can even do this and
08:12 - 08:14have her just kind of hold my side there,
08:14 - 08:15and then I can control
08:15 - 08:19her shoulder, and I can even use my body.
08:19 - 08:21I can do that same stroking motion
08:21 - 08:23with this hand, and then when I need to
08:23 - 08:26apply pressure, this arm's straight and I
08:26 - 08:29just lean forward.
08:29 - 08:30Same thing happens with the other technique.
08:30 - 08:33Rather than leaning across and pulling
08:33 - 08:34up like this,
08:34 - 08:35what I'm going to do is I'm going to
08:35 - 08:38have Crystal go ahead and turn and face
08:38 - 08:44the camera. I'm going to control her
08:44 - 08:47shoulder this way and use this hand to
08:47 - 08:50get underneath the scapula. Then I
08:50 - 08:54can basically just continue to
08:54 - 08:57use this shoulder to push her scapula
08:57 - 08:59over my fingers, rather than using my
08:59 - 09:01fingers dig. Next up, we'll do the close-up
09:01 - 09:05recap. Now, for our close-up recap: I
09:05 - 09:07need to be able to get to the
09:07 - 09:09subscapularis, so the first thing I have
09:09 - 09:11to do is get the scapula out from
09:11 - 09:13underneath the rib cage. The way I'm going to
09:13 - 09:16do that is I'm going to go ahead and protract
09:16 - 09:18Crystal's scapula by pulling her arm up
09:18 - 09:20this way. This is the inferior
09:20 - 09:23angle of the scapula right here. If I
09:23 - 09:25take her arm into flexion and
09:25 - 09:27abduction, I can actually feel the
09:27 - 09:30inferior angle moving out this way. So as
09:30 - 09:33I do that, I'm actually taking her
09:33 - 09:35scapula and moving it under the back of her
09:35 - 09:38axilla here. To actually feel the
09:38 - 09:41subscapularis, my suggestion is start
09:41 - 09:44with your thumb against the rib cage and
09:44 - 09:49push straight down. This thickness of
09:49 - 09:50muscle,
09:50 - 09:52this mass right here, this tube
09:52 - 09:55of muscle on the axillary border,
09:55 - 09:57this is not your subscapularis. This is
09:57 - 10:01lat, teres major, and teres minor, so we
10:01 - 10:05want to get medial to that. The best or
10:05 - 10:07easiest thing to do is just start at the
10:07 - 10:10rib cage and press down.
10:10 - 10:13And if I press, press, press, press, and press, I
10:13 - 10:15can actually feel bone at the bottom of
10:15 - 10:17this palpation. Keep in mind, guys, we
10:17 - 10:19have that long thoracic nerve,
10:19 - 10:21the axillary artery, some of the other
10:21 - 10:23nerves off the brachial plexus, and lymph
10:23 - 10:25nodes to consider here. If Crystal's
10:25 - 10:29feeling anything weird, tingling, burning,
10:29 - 10:32searing type pain, something that's just
10:32 - 10:34really, really uncomfortable and it
10:34 - 10:36doesn't seem to be related to
10:36 - 10:38trigger point pressure, get off it.
10:38 - 10:39Remember, most of these structures are
10:39 - 10:42only a couple millimeters wide, so it
10:42 - 10:44should be easy enough to move your
10:44 - 10:46fingers around a little bit and still
10:46 - 10:47get at that trigger point without
10:47 - 10:51compressing that tissue. I'm going to use,
10:51 - 10:55starting again at the rib cage and pressing
10:55 - 10:58down, I'm going to use those kajal to
10:58 - 11:02cranial short strokes to investigate
11:02 - 11:05which fascicles of the subscapularis are
11:05 - 11:10the most dense, seem overactive, seem to
11:10 - 11:14give up a bit more resistance. I can
11:14 - 11:17feel some right there, which doesn't
11:17 - 11:18surprise me, because as we explained in the
11:18 - 11:22earlier video, from inferior angle to
11:22 - 11:25glenoid fossa about halfway between is a
11:25 - 11:27common sight for a trigger point in the
11:27 - 11:29subscapularis. And there's another one in
11:29 - 11:32the superior fibers of the subscapularis,
11:32 - 11:36deep in her armpit and close to her glenoid
11:36 - 11:38fossa there. That's the one we have to be
11:38 - 11:40really, really careful not to impinge on
11:40 - 11:43any of these other structures. Once again,
11:43 - 11:46short strokes, making sure I'm not taking
11:46 - 11:49too much skin with me. We don't want to
11:49 - 11:50make our clients and patients
11:50 - 11:53uncomfortable for no reason. We're
11:53 - 11:54going to hold for 30 to 120
11:54 - 11:59seconds or until we get a release.
11:59 - 12:01There is, of course, the other subscapular
12:01 - 12:06point. I'm going to have Crystal lay on her side here. I
12:06 - 12:08talked about that triangle of
12:08 - 12:11auscultation. Crystal is so lean that you
12:11 - 12:14can actually almost see this dent right
12:14 - 12:17here. If you guys can see that shadow,
12:17 - 12:20that's where there is no muscle
12:20 - 12:22covering that area. That triangle of
12:22 - 12:24auscultation is a stethoscope-
12:24 - 12:27you can put a stethoscope there and
12:27 - 12:29hear a little bit easier than trying to
12:29 - 12:31hear through muscle. We're going to
12:31 - 12:33use it because it means less tissue to
12:33 - 12:36dig through. If I put my fingers on that
12:36 - 12:37triangle of auscultation, I can take my
12:37 - 12:41other hand, pull back into retraction, and
12:41 - 12:43her scapula actually falls over the top
12:43 - 12:46of my fingers. I can then search through,
12:46 - 12:49search through, and search through until I
12:49 - 12:50get about two-thirds of the way up the
12:50 - 12:52vertebral border. And I actually do feel
12:52 - 12:54an increase in the density of those sub
12:54 - 12:59scapular tissues. I can hold until I
12:59 - 13:01get a release. There you guys have it, a
13:01 - 13:02static manual release of the
13:02 - 13:05subscapularis. Make sure before you put
13:05 - 13:06your hands on anybody that you have a
13:06 - 13:09good working hypothesis on why the
13:09 - 13:11subscapularis might be overactive,
13:11 - 13:13indicating a need for release technique.
13:13 - 13:14The only way you're going to get
13:14 - 13:16there is assessment. If you're not up
13:16 - 13:18on your assessment game, check out those
13:18 - 13:21videos, check out our courses and bring
13:21 - 13:23your assessment game up. Make sure before
13:23 - 13:25you do this technique on a patient or
13:25 - 13:27client, that you've had the chance to
13:27 - 13:29practice. Grab some of your
13:29 - 13:32colleagues. Grab a mentor with good
13:32 - 13:34manual techniques, and go back and forth.
13:34 - 13:36Make sure they're doing the techniques
13:36 - 13:39on you so you know what it feels like,
13:39 - 13:41or should feel like, and you're doing the
13:41 - 13:43technique on them, so that they can give
13:43 - 13:46you some good feedback. There is no
13:46 - 13:51replacing live education and mentorship
13:51 - 13:53when it comes to manual
13:53 - 13:55techniques. I hope you guys enjoyed this
13:55 - 13:58video. Please feel free to leave your
13:58 - 14:00questions below. I'll make sure I answer
14:00 - 14:02them as quickly as possible. I look
14:02 - 14:05forward to hearing from you guys.

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