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Cervical Compression and the Lower Back
When a patient presents with lower back pain, we expect to see some amount of antalgic lean. It is understood that this lean is both a conscious and reflexive protective mechanism of the body to reduce the pain and prevent more irritation in the back.
Peer Points: In The Business of Herbs
When it comes to herbs, acupuncturist Cathy Margolin wants her patients and customers to know she is the expert they need. In order to do this, Margolin has studied the marketplace and incorporated key business lessons to build an herbal company that sells and markets herbs to the masses who may be skeptics.
Acupuncture: The Key and Future of High Sports Performance
Acupuncture is commonly utilized in the intervention of pain and has also been gaining popularity in sports medicine. Athletes are treated with acupuncture for the relief of soft tissue injuries such as sprains, muscle strains, and tendonitis.
PCOM Symposium Celebrates 25 Years
Acupuncture and Oriental medicine practitioners and students, as well as providers representing various other health care disciplines, flocked to San Diego's Catamaran Resort Hotel to attend the PCOM Annual Symposium on Oct. 24-27.
B Vitamins May Reduce Risk of Age-Related Macular Degeneration
A study published in the July 2013 issue of the AJCN provides additional evidence suggesting higher nutritional status of certain B vitamins may be important in the prevention of age-related macular degeneration (AMD).
Treating CTS and Wrist Tendinitis of Myofasial Origin
Carpal tunnel syndrome (CTS) is the most common and most clinically significant of all nerve entrapment syndromes, present in 2.7 percent of the adult population.
Electric Qigong: An Ancient Therapy Evolves
Recently in a small, dimly lit treatment room in downtown Taipei, Wesley Chen instructed his patient to lie down. A frayed wire, which he wrapped around a small piece of metal, is now plugged in.
Managing a High Protein Diet
One of the most common clinical presentations in today's clinic is patients following a high protein diet. It seems that every year a new version of a high protein diet appears promising weight loss and physical transformation.
The Shoulder Girdle's Importance to the Cervical Spine
The shoulder girdle consists of three bones: the clavicle, scapula and humerus. It is suspended at its posterior margins from the cervical and thoracic spine by the trapezius muscles, levator scapula, rhomboid, serratus and latissimus dorsi.
News in Brief
WFC Documents the Global Advance of Chiropractic; National to Conduct Study of Orthotics for Back Pain.
German Auricular Acupuncture: Effective For Your Patients
Auricular medicine as developed by Western medical doctors in Europe is a complete modality of diagnosis and treatment. Unlike body acupuncture, auricular acupuncture is treating the central nervous system rather than meridians.
Acupuncture Today Continues To See Unprecedented Growth
For the past decade, the profession has seen steady growth in stature with legislators and the general public. The growing presence of the profession has been directly reflected in the growth of our publication.
Give the Gift of Change
As human beings, we are blessed with something remarkable that we generally take for granted: the gift of conversation.
Dedicated to Excellence
For 27 years, Horace C. Elliott, executive vice president of the National Board of Chiropractic Examiners, has set new standards of excellence for chiropractic licensure and testing.
Informed Consent and Your Practice (Pt. 1)
Earlier this year, The Back Letter gave extensive coverage to an article by Dagenais, et al., in The Journal of Manipulative and Physiological Therapeutics on informed consent in the chiropractic profession, calling it "perhaps the best article ever written on informed consent for low back pain."
Where to Adjust: Best / Worst Tests
Wondering which methods are best (and worst) suited for determining the appropriate manipulation site?
Acupuncture & Substance Abuse Rehabilitation
One of the most rapidly changing areas of healthcare is that of addiction medicine. Advances in brain imaging technology have allowed doctors and scientists to understand addiction, and recovery from addictive disorders, at the level of the individual neuron in the brain.
Acupuncture In Haiti: Aid that Works
I recently returned from Haiti. So many people ask whether Haiti has recovered since the earthquake of January, 2010. Once you've been to Haiti, you would never ask that question. It doesn't make any sense.
Breathing Techniques To Resolve Patient Issues
When a patient of mine who has practiced yoga for nearly 30 years, told me that she was experiencing panic attacks, I was surprised. "After so many years of training, can't you turn them off?" I asked. "I do turn them off, but only temporarily," she replied.
Partnerships Leverage Power for Our Profession
While there are many recognized benefits and advantages to developing partnerships between organizations, the main reason why partnerships are established is relatively simple: There is added value in working together for a common cause or purpose.
How to Enhance Exercise Rehab With Manipulation and Soft-Tissue Therapy
As chiropractors, we are in a unique position to use our manual therapy techniques to facilitate exercise rehabilitation.
Continuing Education Showdown: Online Learning vs. In-Person Seminars
Many state TCM and acupuncture regulatory bodies and associations are interfering with the success of their members by limiting the number of continuing education credit hours they can earn online.
Studies: Acupuncture Effective For Depression
Many people suffering from depression can find a natural and effective way to treat their symptoms with acupuncture, according to the latest study.
Facial Rejuvenation: The Key to Exceptional Results
Acupuncturists make the best detectives. I know this first hand because I'm an acupuncturist and a private investigator and in both professions, there is a need to dig deep to solve the mystery.
Thrive in 2014: Five Habits to Start Cultivating Now
The entire health care system is once again – or perhaps I should say still – in a state of flux, and our profession is not immune to the brouhaha.
November, 2008, Vol. 08, Issue 11
Subscapularis: Overlooked and Undertreated
By David Kent, LMT, NCTMB
The subscapularis is an often neglected and/or undertreated cause of posterior shoulder pain with restricted range of motion (ROM). According to Travell and Simons, "Differential diagnosis of subscapularis TrPs includes C7 radiculopathy, thoracic outlet syndrome, adhesive capsulitis and 'impingement syndrome.'" In this article, I will review how you can determine when the subscapularis muscle is responsible for causing shoulder pain and restricted ROM, as well as review its anatomy, function, trigger-point patterns and treatment options.
Intake and health history forms will help you identify some common factors that may contribute to the formation and perpetuation of trigger points, as well as the shortening of the subscapularis muscle. According to Travell and Simons, some of these factors include the following:
Taking a photo of your client in front of a postural-analysis grid chart is an effective method of evaluating, documenting, educating and ultimately showing a client their postural progress over a series of treatments. For example, a constant slumped, forward-head, adducted-scapulae posture will perpetuate trigger points and the shortening of muscles, such as the subscapularis, by continually keeping the humerus in a position of medial rotation.1 (Figure 1)
Trigger Points: When trigger points are present in the subscapularis muscle, they produce referred pain "in the posterior deltoid area ...down the posterior aspect of the arm, and then skip to a band around the wrist."1 (Figure 2) Remember that referred pain is a symptom; we want to address the cause. So intake forms, postural analysis evaluations, range-of-motion and orthopedic assessments, and being familiar with trigger-point patterns are all helpful to designing and implementing a customized therapy plan. But treating a trigger point is only part of the solution. We need to avoid a recurrence in the future. It is therefore necessary to demonstrate to your client which muscles need more lengthening and which ones need more strengthening so that all of the joints are properly aligned and moving through their full range of motion.
Anatomy: The subscapularis is one of four muscles that make up the rotator cuff, along with the supraspinatus, infraspinatous and the teres minor muscles. In my dissection seminars, I always highlight the subscapularis, which is the most anterior of the rotator cuff muscles. (Figure 2) It is a thick triangular muscle that attaches medially on the anterior or costal surface of the scapula on the subscapular fossa; it forms part of posterior wall of the axialla. Laterally, it attaches on the lesser tubercle of the humerus and the lower half of the shoulder joint capsule.
Actions: The subscapularis is primarily responsible for medially rotating and adducting the arm. It also helps to hold the humeral head in the glenoid cavity. To check for shortening in the subscapularis it is necessary to evaluate both abduction and external rotation.
Abduction: According to Travell and Simons, when evaluating a shoulder with restricted abduction, it is first necessary to determine if the restriction is being caused by the inability of the scapula to move on the rib cage, the humerus to properly articulate in the shoulder (glenohumeral) joint, or a combination of the two.1 The difference can be easily determined by placing your hands on the client's scapula to prevent its movement while asking the client to abduct their humerus. (Figure 3) When the subscapularis is involved, it restricts glenohumeral movements like abduction and lateral rotation, but it does not restrict scapular movements on the rib cage. If scapular movements are restricted, it is necessary to evaluate muscles that run from the torso to the scapulae, such as the pectoralis minor, serratus anterior, trapezius and the rhomboids.1
Lateral Rotation: When checking lateral rotation at the shoulder, adduct the arm by placing the elbow at the side. Then bend the elbow 90 degrees to show the amount of rotation at the shoulder joint. (Figure 4) The arm should be able to laterally rotate 90 degrees. In addition to the subscapularis, other synergistic muscles such as the teres major, latismus dossi and pectoralis major also adduct and medially rotate the arm. These muscles must also be evaluated and treated. Keep in mind that the antagonistic muscles are weak and over-lengthened, so they need strengthening. Muscle movement charts can aid in quickly identifying the muscles involved and show the normal range of motion for the muscles and joints being evaluated. (Figure 5)
Treating the Subscapularis: While there are many different approaches to treating the belly of the subscapularis muscle, I find one particularly effective. However, some clients may only be able to tolerate static pressure versus movements with this method, such as with-fiber or cross-fiber techniques.
Before the session ends, advise your client that they will receive the most benefit from your therapy session by actively engaging in self-care stretching techniques, such as the doorway stretch, which will further help improve muscle length, and create and maintain balance in the shoulder. (Figure 10)
You have now identified several factors associated with subscapularis pain and discomfort with the help of assessment aids and tools such as intake forms, charts and postural analysis photos. Continue to study and broaden your skills with hands-on seminars and DVD programs. You can share your tips and experiences in the treatment room by dropping me a line at .
Click here for more information about David Kent, LMT, NCTMB.
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