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Subscapularis Manual Static Release
Subscapularis Manual Static Release is a manual therapy technique designed to relieve tension in a muscle. It entails identifying tender areas in the subscapularis muscle, and then slowly and gently stretching the areas that are more tense with a manual pressure technique. This technique is typically done with the help of a therapist, but can also be done independently at home. The goal of Subscapularis Manual Static Release is to restore the natural flexibility of the muscle, reduce tension, and
Transcript
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This is Brent of the Brookbush Institute, and in
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...blank
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this video we're going over static
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manual release of the subscapularis. Now,
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if you're watching this video, I'm
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assuming you're watching it for
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educational purposes and that you are a
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license to manual therapist. That is, in
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your state or region, it is legal for you
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to do manual techniques. That is
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chiropractors, athletic trainers, physical
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therapists, massage therapists, osteopaths.
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I'm sure I'm missing a couple, but if you
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are unsure, please look up the laws in
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your state. Personal trainers, this
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probably does not fall within your scope
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of practice, although you could use the
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patient portion of this video in an
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educational setting to help you learn
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your anatomy. I'm going to have my friend,
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Crystal, come out. She's going to help me
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demonstrate this technique. If I'm going to
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put my hands on Crystal, if I'm going to do
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some sort of manual intervention, I'm
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going to be pretty sure that that manual
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technique is going to have an effect on
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either the symptoms she was complaining
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of or her performance. The only way
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to get there is through assessment. So,
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we're going to assume in Crystal's case
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that she came in with a little anterior
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shoulder pain from working out, and it's most
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prevalent when she works out. We did
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her overhead squat assessment and her
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arms fall forward. We did some goniometry,
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and she had some restrictions in
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external rotation and flexion. Subscapularis
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will restrict flexion a little bit. And
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even when I did my manual muscle
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test, she tested a little weakness and
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external rotation. I know that
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overactivity of my subscapularis can
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reciprocally inhibit my infraspinatus
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and teres minor. So, I got my good working
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hypothesis going, and now I just have to
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think about my protocol for manual
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techniques. They basically all come
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down to palpate and compress. Now, we do
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want to get a little bit more detail
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than that.
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So if I first start off with, "How do I
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palpate the subscapularis?" Well, my
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subscapularis is on the anterior face,
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the entire anterior face of my scapula.
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So, with the portion of my scapula that
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is under my rib cage, I need to get my
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scapula out from under my rib cage. The
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way to do that, guys, is you're going to pull
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them into
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protraction, and then if you take the
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shoulder into flexion, the scapula
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will generally upwardly rotate. You can
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mess around with a little abduction and see
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if that gets you a little better upward
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rotation. And now this, her axilla, is showing.
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Her armpit is showing. If I take my
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thumb and I press straight down into her
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axilla with my thumb against her
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rib cage, I'll actually press through some
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soft tissue, press through some soft
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tissue, press through some soft tissue,
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but eventually I hit bone. I can feel
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it.
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That is the anterior face of her scapula. I know if I'm on the anterior face
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I know that if I'm on the anterior face of her scapula, I have to be on her
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subscapularis. Now, this whole portion
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here, this tissue that you can see my
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thumb disappear behind, is not her
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subscapularis. This tube of muscle is her
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latissimus dorsi, her teres major, and her
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teres minor. I want to make sure I'm
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medial to that musculature, so make
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sure you're in between that border of
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muscle and the rib cage. Now, the next
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things I need to think about now that I
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know how to palpate my subscapularis is
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where are my trigger points? The trigger
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points for my subscapularis are
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generally in the middle of the length of
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my scapula. So, this is her inferior angle
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and this is the glenoid fossa here, so if
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I press down right in the middle of that,
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usually there's some dense fascicles
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there, and then the other trigger point
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is usually right up near the glenoid
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fossa there and the superior fibers of
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the subscapularis. This kind of brings
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us to our next point. I do need to also
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be aware of
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are there any tissues around her
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subscapularis that I could offend or
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insult or injure with compression? I
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have to think that her
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long, thoracic nerve runs along the
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anterior face of her scapula, so if I get
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that burning, searing, tingling,
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I want to get off that. Usually I can
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move my thumb just medial or lateral and
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be off that tissue. As I get up into here,
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I definitely need to consider that my
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lymph nodes, my axillary artery, and some of
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those other nerves coming off the
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brachial plexus as it passes out from
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underneath the pectoralis minor are up in
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there. So, again, if there are any symptoms
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that are not that tenderness associated
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with trigger point compression, get off it.
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Move around a little bit.
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Chances are, all of these structures are
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like a millimeter or two millimeters wide, so
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you should be able to move a little bit and
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get that same trigger point without
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doing any compression or making the
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patient or client uncomfortable by
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compressing those tissues. So, now we
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know how to palpate the subscapularis.
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You know where the trigger points are. We
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know where some of those other tissues
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are. I mentioned in some of the other
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videos the way we find the appropriate
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tissues is with these broad strokes.
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The subscapularis is no different, other
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than we're just not going to take our
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thumb and run it from inferior angle all
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the way up into her armpit, because
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that's obviously going to be
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uncomfortable.
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We're going to take a lot of skin, a lot
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of soft tissue with us if we go from
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here to here. This is pretty delicate
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tissue already, and we really don't want to
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do anything to make this any more
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uncomfortable. So, we're still going to go
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cranial- oh, I'm sorry-
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kajal to cranial with our strokes, but
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we're going to do little short strokes.
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You guys can see here that I can start
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at inferior angle and do this little short
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stroke to see if I feel anything.
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No dense fascicles there. I pick up my
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finger and go a little higher. No dense
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fascicles there. I pick up my finger and
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move a little- ah, there we go. We've got
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some dense fascicles right there. Once
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I find dense fascicles, I
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can then compress and hold for 30 to 120
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seconds until I get a release. Then, I
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can keep going looking for those other
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trigger points that are closer to the
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glenoid fossa. Now, there is one other subscapular
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trigger point, but we need to get
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Crystal into a little different position
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here. I'm going to have you roll over and
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face me.
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It's actually closer to the vertebral
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border of her scapula but on the
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superior portion. Now, what I wouldn't do
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is try to get underneath the scapula
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starting up here. Here's a little trick:
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start at the triangle of auscultation.
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It's this little point medial to the
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inferior angle of the scapula, where my
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rhomboids, lower traps, and my left
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lortissimus dorsi don't actually cover. I
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can actually take my fingers like this
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and almost just push her scapula right
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over the top of my fingers. Now I'm
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underneath, and I can do my searching
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without having to go straight through
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all of this tissue, which is
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her middle traps and rhomboids. If
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you're on a muscular person, that's going
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to be really tough. Once I'm
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already underneath, then I can look for
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that trigger point and I can hold it for
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30 to 120 seconds. Now, the last thing that you
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need to think about, and this is very
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important, is what is your appropriate
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body position so that you are
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comfortable. What I just showed you
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wasn't it.
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I was leaning over. I don't want to be
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leaning over my patient and be using
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my hand strength. I want to be standing
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straight up and using my body weight to
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apply pressure. So, I'm going to go ahead
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and have Crystal lay on her back. The way
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i would do this is, of course, I would be
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on the side that I was going to release.
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I would take her arm, pull her into
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protraction and flexion, and now I can
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use this hand, or I can even do this and
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have her just kind of hold my side there,
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and then I can control
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her shoulder, and I can even use my body.
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I can do that same stroking motion
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with this hand, and then when I need to
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apply pressure, this arm's straight and I
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just lean forward.
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Same thing happens with the other technique.
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Rather than leaning across and pulling
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up like this,
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what I'm going to do is I'm going to
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have Crystal go ahead and turn and face
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the camera. I'm going to control her
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shoulder this way and use this hand to
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get underneath the scapula. Then I
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can basically just continue to
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use this shoulder to push her scapula
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over my fingers, rather than using my
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fingers dig. Next up, we'll do the close-up
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recap. Now, for our close-up recap: I
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need to be able to get to the
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subscapularis, so the first thing I have
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to do is get the scapula out from
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underneath the rib cage. The way I'm going to
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do that is I'm going to go ahead and protract
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Crystal's scapula by pulling her arm up
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this way. This is the inferior
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angle of the scapula right here. If I
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take her arm into flexion and
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abduction, I can actually feel the
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inferior angle moving out this way. So as
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I do that, I'm actually taking her
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scapula and moving it under the back of her
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axilla here. To actually feel the
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subscapularis, my suggestion is start
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with your thumb against the rib cage and
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push straight down. This thickness of
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muscle,
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this mass right here, this tube
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of muscle on the axillary border,
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this is not your subscapularis. This is
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lat, teres major, and teres minor, so we
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want to get medial to that. The best or
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easiest thing to do is just start at the
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rib cage and press down.
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And if I press, press, press, press, and press, I
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can actually feel bone at the bottom of
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this palpation. Keep in mind, guys, we
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have that long thoracic nerve,
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the axillary artery, some of the other
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nerves off the brachial plexus, and lymph
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nodes to consider here. If Crystal's
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feeling anything weird, tingling, burning,
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searing type pain, something that's just
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really, really uncomfortable and it
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doesn't seem to be related to
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trigger point pressure, get off it.
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Remember, most of these structures are
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only a couple millimeters wide, so it
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should be easy enough to move your
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fingers around a little bit and still
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get at that trigger point without
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compressing that tissue. I'm going to use,
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starting again at the rib cage and pressing
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down, I'm going to use those kajal to
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cranial short strokes to investigate
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which fascicles of the subscapularis are
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the most dense, seem overactive, seem to
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give up a bit more resistance. I can
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feel some right there, which doesn't
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surprise me, because as we explained in the
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earlier video, from inferior angle to
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glenoid fossa about halfway between is a
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common sight for a trigger point in the
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subscapularis. And there's another one in
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the superior fibers of the subscapularis,
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deep in her armpit and close to her glenoid
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fossa there. That's the one we have to be
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really, really careful not to impinge on
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any of these other structures. Once again,
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short strokes, making sure I'm not taking
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too much skin with me. We don't want to
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make our clients and patients
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uncomfortable for no reason. We're
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going to hold for 30 to 120
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seconds or until we get a release.
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There is, of course, the other subscapular
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point. I'm going to have Crystal lay on her side here. I
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talked about that triangle of
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auscultation. Crystal is so lean that you
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can actually almost see this dent right
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here. If you guys can see that shadow,
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that's where there is no muscle
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covering that area. That triangle of
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auscultation is a stethoscope-
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you can put a stethoscope there and
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hear a little bit easier than trying to
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hear through muscle. We're going to
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use it because it means less tissue to
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dig through. If I put my fingers on that
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triangle of auscultation, I can take my
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other hand, pull back into retraction, and
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her scapula actually falls over the top
00:12:4300:12:46
of my fingers. I can then search through,
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search through, and search through until I
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get about two-thirds of the way up the
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vertebral border. And I actually do feel
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an increase in the density of those sub
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scapular tissues. I can hold until I
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get a release. There you guys have it, a
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static manual release of the
00:13:0200:13:05
subscapularis. Make sure before you put
00:13:0500:13:06
your hands on anybody that you have a
00:13:0600:13:09
good working hypothesis on why the
00:13:0900:13:11
subscapularis might be overactive,
00:13:1100:13:13
indicating a need for release technique.
00:13:1300:13:14
The only way you're going to get
00:13:1400:13:16
there is assessment. If you're not up
00:13:1600:13:18
on your assessment game, check out those
00:13:1800:13:21
videos, check out our courses and bring
00:13:2100:13:23
your assessment game up. Make sure before
00:13:2300:13:25
you do this technique on a patient or
00:13:2500:13:27
client, that you've had the chance to
00:13:2700:13:29
practice. Grab some of your
00:13:2900:13:32
colleagues. Grab a mentor with good
00:13:3200:13:34
manual techniques, and go back and forth.
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Make sure they're doing the techniques
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on you so you know what it feels like,
00:13:3900:13:41
or should feel like, and you're doing the
00:13:4100:13:43
technique on them, so that they can give
00:13:4300:13:46
you some good feedback. There is no
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replacing live education and mentorship
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when it comes to manual
00:13:5300:13:55
techniques. I hope you guys enjoyed this
00:13:5500:13:58
video. Please feel free to leave your
00:13:5800:14:00
questions below. I'll make sure I answer
00:14:0000:14:02
them as quickly as possible. I look
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