If you’re reading this, chances are you are in pain and have probably already seen a doctor or therapist who hasn’t helped you much. You’ve probably even had injections… even surgery with little or no improvement!

A Frozen Shoulder is an extremely painful and debilitating condition characterised by intense pain and stiffness of the shoulder and has the medical profession stumped.  There’s lots of theories about the cause and pain killers are prescribed by the bucket load, but from my experience, nothing works. If there was a medicinal cure for Frozen Shoulders, the chemist shops would have walls covered with the stuff.

Some doctors say “Leave a Frozen Shoulder alone for 18 months or so and it will get better on its own”. I’ve heard of others saying “You have what’s called a Frozen Shoulder.  Get used to it, because you’ll have it for two years.”
It will eventually get better on it’s own… but never completely.  In reality, a Frozen Shoulder will take a bit longer than that to heal itself.
X-rays can’t reveal the cause of shoulder stiffness in most cases of primary adhesive capsulitis, and an MRI (Magnetic Resonance Image) shows soft tissue and may be used in cases in which another disorder is suspected, such as a torn Rotator Cuff.   So when nothing shows up, it’s frustrating to be told there’s nothing wrong with your shoulder when it’s really hurting like blazes.

At this point, let me say that I was sent for a MRI when I had the condition.  I listened to the technicians discussing their findings and heard the boss say “Write your report and say muscles appear to be normal, and leave it at that.”
The technician then went on to say he did find a thickening in the Synovial Fluid around the Gleno-Humeral Joint.
The response?  An off-handed  “So what?”
That told me everything I needed to hear… that’s what.  I was then sure of what I was dealing with!

Signs and symptoms of Frozen Shoulder.

The pain of a Frozen Shoulder can be horrendous. Ask a sufferer what the pain would be on a scale between 1 and 10 and you’ll often hear 20.

The major symptoms of Frozen Shoulder are:

• Pain and loss of motion:

• Night pain and especially when trying to lay on the affected side.

• Severe sharp catching pain at the front of the shoulder when you inadvertently extend the arm and lasting up to a minute or so. (You have to protectively hold the shoulder tightly.)

• Pain reaching for the hip pocket, (not necessarily a bad thing if it’s your shout), putting on or taking off a coat, brushing the hair and inability to do up a bra.

• Pain down the outer upper side of the arm.

• Inability to drive.

• Swelling of tendons causes severe limitation in movement, especially reaching up behind the back.

Immobility / Stiffness

This is the key diagnosis of a Frozen Shoulder. You can’t move the arm and neither can anyone else if they attempt to lift the arm for you. If they do try, it’s very painful and you want to kill them for their effort.

From when you first notice the pain, the shoulder becomes stiff or stuck for a period that could be between 48 hours to a month and it’s all downhill from there. If your shoulder is not ‘stuck’ you may not have a true Frozen Shoulder. Many people are forced to give up work as a result of the pain and stiffness that commonly persist for many years.

The inability to work and the constant pain and stiffness can have a considerable impact on you psychologically as well as financially, and you can become extremely depressed and anxious as a result.

Frozen Shoulder Facts:

• 2-5% of the population suffer from it. This doesn’t mean 98-95% enjoy it.

• It is more common in women (60%)

• It is five times more common in diabetics

• It is common, but not limited to people with Dupuytren’s contracture (an uncommon hand condition where the connective tissue under the skin of the palm contracts and hardens over time.

• It may be genetic. i.e it can run in the family.

• It seems to affect 40-70 year olds.

• About 15% of people get it on both sides.

There are three phases to Frozen Shoulder, (which lasts an average of 30 months. Some say longer).

1.    Freezing (1 – 8 months) You notice some things you normally do are starting to hurt.
2.    Frozen (9 – 16 months) It’s full on! Any movement using the arm is incredibly painful.
3.    Thawing (12 – 24 months) Slowly gets back to normal and pain free use of the arm.

Not much to look forward to, is it.

The pain and loss of function associated with this condition can become so severe that it can significantly affect the quality of life, and prevent some people from sleeping well or working.

What causes a Frozen Shoulder?

There’s no explanation for the development of Frozen Shoulder in most patients. The majority of cases seem to be more prevalent in women. Some who develop Frozen Shoulder have sustained an injury and developed stiffness as a result. The trauma can be quite mild or severe, and the body’s response to the event is probably more important than the event itself.

What is happens inside a Frozen Shoulder?

The shoulder joint is a ball and socket (Gleno-humeral) joint. The ball is at the top of the Humerus (arm bone), and the socket is a shallow cup on the end of the Scapula (shoulder blade).

Surrounding the Gleno-Humeral joint (shoulder joint) is a bag called the Capsule. When the arm is raised above the head, this Capsule is fully stretched. When the arm is lowered to the side, the capsule hangs down like a small pouch.

To improve the stability of the shoulder a group of four muscles called the Rotator Cuff braces the joint as well as an elaborate bunch internal ligaments.

Inflammation.
In a Frozen Shoulder Syndrome the Lax Capsular Sack and the Synovial Fluid it contains becomes sticky and thick and can sometimes form adhesions. The stickiness is brought on through inflammation. This can occur after a small injury, but often you may not remember anything about it. Once established, this inflammation spreads into other shoulder soft-tissues and can cause swelling in other shoulder sacks (bursae).
Stiffness.
The stiffness is an ‘overreaction’, or the shoulders attempt to counteract the inflammation within the Biceps groove. The body seems to ‘switch off’ muscles in a coordinated sequence. This sequence is the same for everyone.  Arm movements start to diminish, and within a few weeks the arm literally becomes frozen and for many, cannot be raised more than 40° in any direction. The muscles of the Rotator Cuff become weak and start slowly to waste away, leaving the arm to hang stiff and immobile.

The shoulder may not be completely stiff for several months and both active and passive movements are stiff and neither you nor anyone else can lift it because it’s too painful!

At this point, you’re probably saying “He’s talking about me!”

Traditional treatments may include:

Cortisone Injections:
Cortisone injections are often tried during both the freezing and frozen phases. It is usual to have up to four injections. Cortisone injections may give brief periods of pain relief, but mostly, they seem to give only a few days or weeks of symbolic respite. Cortisone, which is a steroid, is a crystalline substance and is injected into the joint capsule.

Suprascapular Nerve Block:
The suprascapular nerve is the major sensory supply to the shoulder joint and motor supply to the Supraspinatus and infraspinatus muscles.

A Suprascapular Nerve Block has been used in patients with severe pain associated with Frozen Shoulder syndrome. This injection technique is usually performed 3 times over as many weeks. It has given some relief for pain, but has no effect on the stiffness in the shoulder.  This injection consists of a local anesthetic and steroid, and is done with x-ray guidance and involves inserting a needle through skin and deeper tissues.

The procedure is not without pain.  However, the skin and deeper tissues are numbed with a local anesthetic. Most of the patients also receive intravenous sedation which makes the procedure easier to tolerate.

Manipulation:
Under anesthetic, manipulation can be performed in the freezing phase (after about 6 months).  It is performed under general anaesthetic and followed up by several months of physiotherapy. Complications arising from this include fractures and dislocations of the Humerus, Rotator Cuff tears, increased inflammation and scarring. Nerve damage can also occur, especially to the Radial Nerve.

Physiotherapy:
Physiotherapy is commonly advised  by doctors during the ‘Frozen’ stage and is mainly aimed at keeping the shoulder mobile through stretching and pushing the joint.  However, it rarely seems to hasten the recovery of the condition.

Halleujah.
The good news is that even very severe types of Frozen Shoulder syndrome can be treated effectively. Treating Frozen Shoulders is massage based and naturally utilises the body’s own healing mechanisms. No drugs, no surgery. It utilises a specific sequence of manipulations to the shoulder joints and soft-tissues.

In a Frozen Shoulder there are masses of inflammation and on top of this the brain starts to recruit the ‘wrong’ muscles to move the shoulder.

The body and the brain is tricked into healing itself by addressing the two main components of the problem … pain and stiffness. Initially the aim is to significantly reduce the pain by treating the swelling around various shoulder tendons, especially the biceps tendon.

Following this, the technique moves on to rapidly ‘thaw’ and improve the range of shoulder motion by stimulating a unique sequence of reflexes hidden within the muscles. One reflex is triggered against another in sequence and the arm is not forced. Instead it’s kept still whilst applying the pressure.

Patients treated in this massage based technique will notice a definite improvement with each treatment session. These should be twice a week for twenty to thirty minutes a session and complete relief should be within twelve weeks.

There is a couple of testimonials regarding Frozen Shoulders you might care to visit, and if you believe you might be displaying the symptoms of this condition… call me to talk about it.

Frozen Shoulders CAN be fixed… but it won’t happen with medication.

This occurs most commonly from a car accident, but can also be brought on through contact sports or a fall onto the head. Whiplash is known as injury to the neck, caused by a rapid forwards and backwards motion of the head.  The speed of the cars involved in the accident or the amount of physical damage to the car may not relate to the intensity of neck injury as speeds as low as 15 miles per hour can produce enough energy to cause whiplash in occupants, whether they wear seat belts or not.

Common causes of whiplash include contact sport injuries and blows to the head from a falling object  assault.

Whiplash is essentially a muscle strain and/or ligament sprain in the neck muscles. The muscles injured most often include the Levator Scapulae and the Sternocleidomastoid. In more severe cases, there can also be nerve damage and fractures of various processes of the Cervical Vertebrae.

Symptoms of Whiplash?

• Pain and stiffness in the neck which might not appear at once, but develop over the next day or two.  There could be swelling as well.

• Reduced range of movement in the neck (Cervical Spine).

• Muscle spasms in the side or back of your neck.

• Difficulty moving your neck around

• Pain shooting from your neck into either shoulder or arm.

• Feeling dizzy.

• Headaches.

• Blurred vision. This should not last long, if it persists see your doctor.

• Pain and stiffness may last a few weeks, depending on the severity.

• Child abuse, particularly the shaking of a child, can also result in this injury as well as in more serious injuries to the child’s brain or spinal cord.

If you feel:

• Severe pain in the back of the head…

• Pins and needles or numbness in the shoulders or arms…

• Loss of memory…

• Loss of consciousness…

You could have a more serious injury, and possibly concussion.   If you have any of these symptoms, see your doctor without delay.

The amount of time that elapses between injury and the onset of symptoms can predict the severity of injury. A shorter time signifies a potentially severe injury with more continual long-term complications.

Treatment of Whiplash.

Try to gently move your neck in all directions as soon as you feel up to it and try it every couple of hours or so.
If possible and if it’s not too painful, increase the range of movement each time.

Stretching can be beneficial for the neck as well starting about three days after the injury to restore flexibility, but stop if it’s painful.

Deep Tissue Massage will help get you back to normal and an experienced therapist will know how much you can tolerate, but it’s advisable to see a doctor first to check for spinal damage.

The Rotator Cuff is an amazing piece of kit that allows the arm to raise and rotate at the shoulder and helps to stabilise the shoulder joint during movement.  Although each Rotator Cuff muscle moves the arm from the shoulder joint in a specific direction, they all work together to stabilise the shoulder joint.

A strain or tear in the Rotator Cuff may occur suddenly from trauma like a fall or happen gradually from overuse.

Strengthening exercises for the muscles that control the Shoulder Blade is also important, as the Shoulder Blade (Scapula) helps the Rotator Cuff to dynamically stabilise the shoulder.

The Importance of Strengthening the Rotator Cuff

Many muscles are involved in shoulder movement and all work together, but strengthening the Rotator Cuff is especially important. The Rotator Cuff is the main stabiliser of the shoulder joint during movement of the shoulder.

If the ball of the upper arm is not kept centered, abnormal stress is placed on surrounding tissue and may cause gradual injury. Strengthening the Rotator Cuff helps prevents common Rotator Cuff injuries including Tendonitis, Rotator Cuff tears, and Shoulder Impingement Syndrome.

As we get older, Rotator Cuff tendons reduce in elasticity and become more susceptible to injury. There is also a gradual loss of muscle mass that occurs, but this can be counteracted with strengthening exercises.

Rotator Cuff Muscles

The Supraspinatus is located at the top of the shoulder and abducts the shoulder – it raises the upper arm and moves it away from the body.

The Subscapularis is at the front of the shoulder… same side as your face.  It internally rotates the shoulder.
The Infraspinatus and Teres Minor are in the back of the shoulder – they externally rotate the shoulder.

Though each Rotator Cuff muscle moves the shoulder in a separate direction, though they all work together to stabilise the shoulder joint.

Strengthening the muscles of the Rotator Cuff is important.
The two small external Rotator Cuff muscles are often weaker than the larger internal Rotator Cuff muscle.

The Rotator Cuff muscle involved in abduction (taking the arm away from the body) is the Supraspinatus, and is the one most often injured of the Cuff muscles due to its position between two bones which often squeeze this tendon during overhead movement.

Other Shoulder Stabilisers:
The Scapula or Shoulder Blade helps the Rotator Cuff to stabilise the shoulder joint as it moves. The Rotator Cuff muscles rise from the Scapula and attach to the head of the upper arm bone or Humerus.

If the Shoulder Blade isn’t stable, pressure may be placed on the Rotator Cuff, so strengthening the muscles that support the Scapula are important.

The Bicep Tendon is the one that runs over the top of the Humerus and connects at the top of the shoulder joint helping stabilise it. Overloading the Biceps by lifting something too heavy can result in Biceps Tendonitis (also known as Shoulder Tendonitis).

Strengthening the Biceps helps prevent injury.

Exercise after Shoulder Injury

The question is… how long should the shoulder be rested?
The amount of time to rest an injured shoulder before starting rehabilitative exercises hinges upon how quickly one heals, as well as the type and the severity of the injury.  Working it too soon may cause further damage.

On the other hand, if the shoulder is not used enough, the shoulder muscles weaken, so strengthening exercises are an important part of rehabilitation. Stretching exercises increase the range of motion of the shoulder.

Stretching exercises may… may… help prevent Frozen Shoulder from occurring after an injury that causes one to restrict shoulder movement due to excruciating pain.
Stretching exercises are often started after a few days of rest, but it’s best not to overdo it.

Building up Strength:
Warming up with five minutes of ‘a mini version’ of the exercise you are about to do prepares the body by increasing heart and breathing rates, and increasing blood flow to the muscles, and raising body temperature. Warming muscles and tendons improve range of motion and reduces the risk of injury and warm muscles are more flexible than cold muscles.

Have Patience. Too much too soon can cause overuse injuries. Strengthening a group of muscles should only be done every second day to give the muscles a chance to heal. Strengthening exercises load the muscles slightly beyond their limits and cause micro tears. If given a proper chance to heal, muscles become stronger. If not given a chance to heal, chronic inflammation and problems may develop.

You should feel a bit fatigued by the end of a dozen reps. If you feel fatigued after just a few reps, reduce the difficulty of the exercise by lowering resistance (e.g. use lighter weights or no weights). If you do not feel fatigued after a set, increase the difficulty of the exercise by increasing resistance, but again… not too much.

Don’t “lock” the elbows. Your elbows should be slightly bent. This makes the muscles work harder to increase the effectiveness of the exercise. Locking a joint while exercising also increases the chances of injuring the joint.

Posture: The shoulders should be kept back and down during exercise.  The same goes for when you are standing or sitting.  Slouching reduces the space the Rotator Cuff tendon passes through and puts unnecessary strain on the shoulder joint.

Take it easy and don’t  jerk. Proceed slowly and steadily to use the muscles, not momentum, to complete the exercises. For exercises involving lifting or pulling, slowly lift or pull, hold for a second, and slowly lower or return.

Stretching:
Stretch Gently:  No bouncing. Stretch until you feel a tug but don’t go past. Always hold a stretch for about 30 seconds. Do not stretch to the point of pain. Over-stretching can tear muscles.

Breathe normally during stretching exercises.

Dumbbells or resistance bands are often used to provide resistance in strengthening exercises. Handheld weights come in a variety of weights, so you can gradually increase difficulty of exercises.
Resistance bands provide resistance when stretched. They come in a variety of thicknesses to provide different levels of resistance and are usually color-coded. When using resistance bands, increasing the distance you stand from whatever you have them attached to increases the resistance.

Part of your Shoulder Stabilising should incorporate Remedial Massage and its wise to see a qualified therapist.  If you’re experiencing shoulder problems, call me and book a massage today and see what a difference it can make.

The Rotator Cuff is a group of  four muscles along their tendons working together to give the Glenohumeral (shoulder) joint stability.  Each Rotator Cuff muscle moves the arm (from the shoulder joint) in a specific direction, and work together to stabilise the shoulder joint.

The Rotator Cuff muscle group include:

* Supraspinatus
* Infraspinatus
* Teres Minor
* Subscapularis

Causes of Rotator Cuff Injury:

A strain or tear in the Rotator Cuff may be the result of an injury such as a fall, or it can happen gradually from constant overuse.

Due to the function of these muscles, sports which involve a lot of shoulder rotation including involving repetitive overhead movement such as swimming, tennis, contact sports or continual high reaching.  These sorts of activities put the Rotator Cuff muscles under a lot of stress.

Minor injuries that are not given a chance to heal can cause severe inflammation and degenerative changes in the tissues, so early treatment is important.

Whether injury develops gradually from overuse or suddenly from a traumatic injury, it is often because the Rotator Cuff is not strong enough for the given task

Poor posture and slouching also places unnecessary stress on shoulder joint.

Tears of the muscles and or tendons  tends to happen as a result of a sudden, powerful movement. It can include falling over onto an outstretched hand at speed, making a sudden thrust with the paddle in kayaking, or following a powerful throw.  Test cricketers are high risk candidates for Rotator Cuff injuries.

Symptoms of Rotator Cuff Injury:

The main symptoms of Rotator Cuff injuries are shoulder pain and weakness, and appear to worsen when lifting the arm above shoulder level.

Symptoms may occur suddenly if the Rotator Cuff is injured by a traumatic injury – like an accident or fall -or a blow during contact sport.. Though majority of Rotator Cuff injuries occur gradually and symptoms appear gradually, the  massage therapist should not mistake the symptoms for that of a Frozen Shoulder.

Massage Therapy:

Deep tissue massage is often used in the treatment of soft tissue injuries of the Rotator Cuff. Massage therapy relieves pain and increases range of motion while it improves blood  circulation and speeds healing. Massage therapy also reduces stress.

If there is swelling of the joint, massage should be lightly applied.

If you’re experiencing pain in the shoulder and haven’t tried massage therapy make a call today.  Arrange an appointment and experience the many benefits that massage has to offer.

The shoulder girdle consists of  a whole bunch of bony joints and muscles that connect the upper limbs to the rest of the skeleton and provide an impressive range of movement.
The three bones which form the Shoulder Girdle are the Scapula, the Clavicle, and the Humerus, and the most important feature of the shoulder is the large range of movement that it allows, which is of prime importance to daily life.

Trapezius.

The Trapezius Muscle has many functions:

• Moving the shoulder blade in toward the spine.
• Moving the shoulder blade up and down.
• Bringing the head and neck in a backward direction.
• To rotate and side bend the neck.
• Assists in breathing.
• Rotates the shoulder blade so that the upper-most part of the upper arm faces up.

The Effects on the Neck:

Because the Trapezius Muscle works to move the neck in several directions, its degree of tightness or looseness affects neck flexibility.

For people who work at desks and computers, or who spend many hours driving, the Upper Trapezius is that muscle above your shoulder that becomes very sore and painful.

The Trapezius Muscle is in four parts:

The upper fibres of the cervical vertebrae is the weakest part of the muscle and only provides minor elevation of the clavicle.

• The area commonly known as’ Upper Traps’ is a strong elevator, rotator and retractor of the Scapula.
• The mid-portion of the Trapzius is mainly responsible for scapula retraction.
• The lower fibres of Trapezius assists in retraction and rotation.

Working together they have the effect of simultaneously lifting and retracting the Scapulae. The Trapezius is used most commonly to fix the Scapula to allow the Deltoid to move the Humerus.

Action:

• Laterally rotates, elevates and retracts Scapula. If Scapula is fixed, extends and laterally flexes neck.

Typical uses:

• Shrugging shoulders.
• Overhead movements.

Levator Scapulae.

Shrugging the shoulders (scapula elevation) involves the use of Levator Scapulae and Trapezius.

Fixation of the scapula by other muscles, allows the Levator Scapulae muscles to work together to aid cervical extension, or independently to laterally flex (side bend) the neck towards the side of the working muscle.

Action:

• Elevates the scapula and gives lateral flexion of the cervical spine (each side independently)
• Also responsible for the extension of the cervical spine (each side independently).

Typical use.

• Shrugging shoulders.
• Carrying a heavy shopping bag.

Rhomboids.

There are two rhomboid muscles – Rhomboid Major and Rhomboid Minor.

Rhomboid Major is larger and positioned below Rhomboid Minor.  Chins and dips are excellent activities for developing these muscles.

Action:

• Retracts Scapula (bringing the shoulder blades together). Rotates Scapula downwards to rest position.

Typical use.

• Pulling a draw open.

Pectoralis Minor.

The Pectoralis Minor muscle is the smallest of the two pectoral (chest) muscles.

It works together with the Serratus Anterior  which protracts and rotates the Scapulae upwards.

When the two work together, pure protraction (without rotation) is produced.

Actions:

• Elevates ribs if scapula fixed, protracts scapula (assists Serratus Anterior).
• Rotation of the scapula downwards.

Typical use.

• Pushing a door open.

Serratus Anterior.

The Serratus Anterior muscle is used in activities which draw the scapula forwards.

It is used strongly in push-ups and bench presses. Winged Scapulae are an indication of a weak Serratus Anterior.

Actions:

• Laterally rotates and protracts Scapula.

Typical use.

• Reaching up to open a high window.

Sternocleidomastoid.

Sternocleidomastoid can clearly be seen when you turn your head to one side, on the opposite side of the neck.

Actions:

• Flexes and laterally rotates cervical spine. Protracts head when acting together . Extends neck when neck already partially extended

• Contraction on one side only: Laterally flexes (side bends) to the same side and rotates to the other.

Typical use:

• Looking at the floor.
• Looking over your shoulder.
• Holding the phone between your ear and shoulder.
• Generally being a sticky beak.

The shoulder joint is one of the body’s most flexible and allows the arm to be positioned and moved in just about any direction.

The Shoulder Joint also allows the arm to be rotated inward (internal rotation) or outward (external rotation) to help put the bent forearm in a favorable position to perform a required task.

The head of the Humerus is almost spherical in shape and rotates freely in the glenoid fossa of the Scapula.
The shoulder joint’s flexible ligaments, the Rotator Cuff, and the other muscles that cross this joint all add to the shoulder’s stability and its incredibly amazing range of movement.

Deltoid.

The Deltoid muscle is used in all side lifting movements and any movement of the humerus on the Scapula. It is divided into three portions, anterior, middle and posterior, with the fibres having different roles due to their orientation.

Actions:
• Anterior portion – Shoulder flexion and internal rotation.
• Posterior portion – Shoulder extension and external rotation.
• All fibres – Shoulder abduction.

Typical Use:
• Lifting.

Supraspinatus.

The Supraspinatus muscle is one of the four muscles which make up the rotator cuff. Its main function is to stabilise the upper arm by holding the head of the humerus in position.
It is important in throwing motions to control any forward motion of the head of humerus.

Actions:
• Abduction .
• Stabilisation of the humerus and shoulder joint.

Typical use:
• Holding shopping bags away from the body

Infraspinatus.

The Infraspinatus muscle assists the lifting of the arm while turning the arm outward (external rotation). It is the main external rotator of the shoulder joint.

It is one of the four rotator cuff muscles crossing the shoulder joint and is commonly injured.

Actions:
• Shoulder abduction.
• External rotation.
• Stabilises the shoulder joint

Typical use:
• Brushing hair.

Teres Major.

The Teres Major is only functional when the Rhomboids fix the scapula. This muscle mainly helps the Latissimus Dorsi.

Action:

• Medially rotates and adducts arm.
• Stabilises the shoulder joint.

Typical use:
• Tucking your shirt into the back of your jeans.

Teres Minor.

The Teres Minor is one of the four rotator cuff muscles surrounding the shoulder. Its main action, along with the Infraspinatus  is to externally rotate the shoulder joint. It assists the lifting of the arm during outward turning (external rotation) of the arm.

There are two Teres muscles, the other being Teres Major.
The other muscles whose tendons form the rotator cuff are:
•    The infraspinatus muscle, which (like the teres minor) helps in the outward turning (external rotation) of the arm.
•    The supraspinatus muscle which is responsible for elevating the arm and moving it away from the body; and
•    The subscapularis muscle, which moves the arm by turning it inward (internal rotation).

Actions:
•    External rotation.
•    Shoulder abduction and stabilises shoulder joint.

Typical use:
•    Brushing hair.

Subscapularis.

The Subscapularis moves the arm by turning it inward (internal rotation).

The Subscapularis is one of the four rotator cuff muscles which cross the shoulder joint. The muscle also acts to hold the head of the humerus in position and prevents it moving forwards. It is shown here with a couple of ribs cut away at the front.

“Subscapularis” means under (sub) the scapula (the wingbone). The subscapularis muscle originates there, beneath the scapula.

Actions:
• Internal rotation.
• Adduction.
• Stabilises shoulder joint.

Typical use:
• Tucking your shirt into the back of your jeans.

Latissimus Dorsi.

The Latissimus Dorsi muscle is one of the largest in the body.

It is a powerful extensor muscle of the arm and is used extensively in chinning and climbing and its basic function is to pull the shoulders downward and towards the back.

It extends from the spine, hip and ribs to the upper arm.

They are commonly known at ‘the lats’.

Actions:
• Extends, adducts and medially rotates arm.
• Helps with deep inspiration and forced expiration

Typical use:
• Pushing down on the arms of a chair when standing up.

Pectoralis Major.

Pectoralis major is the largest and most superficial of the two chest muscles. Pec Major and the anterior fibres of Deltoid work closely together. Pec-fly and push-up exercises are good for the Pectoralis major.

Actions:
• Clavicular head:flexes and adducts arm.
• Sternal head: adducts and medially rotates arm .
• Accessory for inspiration.

Typical use:
• Applying a roll-on deoderant.

You’ll find a Wry Neck, also called Torticolis, will appear upon waking in the morning or from a sudden, quick movement involving the neck.  In the lead up to condition the patient has usually performed activities that involve slouching, poor posture, repetitive neck movements or over lifting.

This gradually stretches tissue in the neck over time, causing injury to the facet joint.  A Wry Neck may also occur due to sleeping in the breeze of an open window or under a fan.

Symptoms of a Wry Neck.

Patients with a Wry Neck feel sharp pain to one side of the neck. They will find it difficult to turn the head to the painful side and will adopt an unnatural stance due to pain.  This is due to the contraction of the Sternocleidomastoid muscle giving a lateral distortion of the head towards the side of the spasm.

The patient is usually finds this difficult to sit or stand normally this due to muscle spasm and pain.  Pain may be referred into the shoulder blade, upper back or the arm on the affected side.

Symptoms are usually compounded by turning the head to the affected side, bending forwards or leaning sideways, lifting, arching backwards or slouching for extended periods.

Sometimes there may be no identifiable reason as to why the symptoms have started.

Apart from sleeping in the breeze of an open window or under a fan, contributing factors can also be:

• Bad posture
• Neck joint stiffness
• Muscle weakness or tightness
• Incorrect lifting technique
• A lifestyle or occupation involving sitting at a computer or driving for long periods, bending, or lifting heavy objects.

Treatment for a Wry Neck

Most patients with a wry neck will respond to massage  and recover quickly and a competent therapist will work within your pain threshold.  If you display the above symptoms arrange an appointment and begin to feel the relief  massage has to offer.

The shoulder complex consists of three bones and three separate joints.

The Bones of the Shoulder:

Humerus:  the upper arm bone
Scapula: the shoulder blade
Clavicle: the collarbone

The scapula, known as the shoulder blade, is an unusual shaped bone and includes:

Glenoid Cavity:  A shallow socket on one end of the scapula.
Acromion:  A part of the scapula that projects over the top of the shoulder.
Coracoid Process:  A part of the scapula that projects in front of the shoulder.

The Joints of the Shoulder:

Glenohumeral Joint (Shoulder Joint):
You’ll often hear it referred to as simply the shoulder joint.  The glenohumeral joint connects the upper arm bone to the shoulder blade.  It is a ball and socket joint. The head of the upper arm is shaped like a ball which sits in a shallow socket at the lateral end of the shoulder blade.

The socket of the shoulder blade, the glenoid cavity, is very shallow but has a lip of fibrous tissue.  The glenoid labrum that it’s attached to makes it deeper and helps stabilise the shoulder joint. The glenohumeral joint is the most flexible joint in the body.  Movement at this joint allows the arm to be raised and rotated simultaneously.

The Acromioclavicular Joint:
The acromioclavicular joint connects the collarbone with the shoulder blade.

The Sternoclavicular joint:
The sternoclavicular joint connects the collarbone with the breastbone.

The Scapulothoracic Joint:
This is not really a joint. The shoulder blade sits on the back of the rib cage and moves up and down and rotates with shoulder movement.

All three joints work together to allow movement of the arm in all directions.  When moving the arm out to the side, motion occurs at the glenohumeral joint.  As the arm is raised above shoulder level, movement also takes place at the acromioclavicular joint and the shoulder blade moves up.  A little further, and movement happens at the sternoclavicular joint raising the collarbone tilts.

The Shoulder Joint Capsule:
A joint capsule is a pouch that encloses a freely movable joint. It is attached to the bones of the joint. It has a tough, fibrous outer membrane and an inner synovial membrane, which produces joint fluid… synovial fluid that lubricates and nourishes the joint.

The shoulder joint capsule encloses the glenohumeral joint, and is reinforced by ligaments. The shoulder joint capsule is loose enough to allow a wide range of motion and it allows the bones to separate by about 25 mm.

A joint capsule is also called an articular capsule. The ends of the bones of the heads of the humerus and the glenoid which form the glenohumeral joint are covered in smooth cartilage (aka articular) to reduce friction.

Ligaments are sturdy strips of connecting tissues that the keep bones of the joint together.  The shoulder joint uses several.  The ligaments of the shoulder joint (aka the glenohumeral joint) help limit the movement of the shoulder joints, but it is the tendons of the rotator cuff that keep the bones of the shoulder joint in position.

Tendons: A tendon is a band of tough, fibrous tissue that join muscles to bones and doesn’t stretch.

Muscles: Muscles contract to pull on tendons to move bones. Muscles have much more elasticity than tendons.  The shoulder is stabilised by several muscles.

The Rotator Cuff: The rotator cuff is a group of four small muscles and along with their tendons, envelope the glenohumeral joint. The rotator cuff stabilises the shoulder joint movement, and keeps the head of the humerus lined up with  the glenoid cavity. The muscles of the rotator cuff allow the upper arm to move in all directions.

The Rotator Cuff is composed of Four Muscles:

Supraspinatus:
Contraction of the supraspinatus muscle moves the arm up and away from the body at the shoulder joint. It is the main agonist muscle for this movement during the first 30 degrees of its arc.

Subscapularis:
The Subscapularis rotates the head of the humerus medially (internal rotation).  When the arm is raised, it draws the humerus forward and downward.  It is a powerful defence to the front of the shoulder joint, preventing displacement of the head of the humerus.

Infraspinatus:
It is an external rotator of the glenohumeral joint and adductor of the arm.
Teres Minor: The Infraspinatus and Teres minor laterally rotate the head of the humerus.  They also help hold the humeral head in the glenoid cavity of the scapula.

The Biceps Tendon:
The Biceps Tendon that attaches the biceps muscle to the shoulder runs over the top of the humerus and attaches to the top of the glenoid labrum.

Bursae:
This is a pouch containing a small quantity of lubricant known as synovial fluid.  It’s located between moving parts of a joint to reduce friction.

In the shoulder joint, the subacromial bursa is found between the acromion and joint capsule. It’s the acromion that forms the summit of the shoulder, and is a large, somewhat triangular or oblong process, flattened from behind forward, projecting at first outward, and then curving forward and upward, so as to overhang the glenoid cavity.  The subscapular bursa is located between the subscapularis rotator cuff tendon and the joint capsule.

The shoulder is a very complex part of our anatomy and often bears the brunt of some punishing treatment we are inclined to inflict on ourselves in the name of sport or fitness.

If you’re experiencing pain in the shoulder and haven’t tried massage therapy make a call today.  Arrange an appointment and experience the many benefits that massage has to offer.

Desk jobs, extended working hours, long distance driving and incorrect sitting position may all contribute to problems in the neck and shoulders.

Painkillers are all to often prescribed for shoulder pain, and risk making your shoulder problem worse by allowing you to go on with the same activities that caused the problem in the first place!

Prescription drugs are not a good therapy for shoulder pain. They only deaden your awareness of the problem and damage can be exacerbated. In other words, they only hide the symptoms and don’t fix the problem.

Neck and shoulder massage can relieve the tension and stress around the neck and shoulder area naturally. The importance of the neck and shoulder region lies in the fact that the neck is a flexible structure that connects the brain to the rest of the body. Tension in this important part of the body invariably causes overall discomfiture and slackness.

Furthermore, anxiety and monotonous posture severely reduces the usual mobility of the neck and shoulder. A neck and shoulder massage by a competent therapist can eliminate stress and bring relief to the neck and shoulder muscles.

Benefits include:

• Massage restores mobility in the neck and shoulder.
• Relieves stiff neck and/or shoulder muscles and increases flexibility.
• Improves blood circulation and overall feeling of well being.
• Neck and shoulder massage relieves pain and stress.
• Relaxes and soothes the mind and body.

If you haven’t tried deep tissue massage therapy make a call today.  Arrange an appointment and experience the many benefits that deep tissue massage has to offer.