Massage Therapy for Shoulder Pain
Massage therapy as a therapeutic intervention is being embraced by the medical community. This is in part because it is a non-pharmacological therapeutic intervention that is simple to carry out, economical, and has very few side effects. One area that is being explored is the use of massage therapy for patients who suffer from shoulder pain.
Structures to be aware of when treating shoulder pain
There are many ways to approach the treatment of shoulder pain, I often treat this area while passively moving the arm through a wide range of motion. Gently stretching the muscles, neurovascular structures and investing fascia of:
• teres major
• teres minor
• triceps brachii
• pectoral muscle group
• latissimus dorsi
Medial axillary space/ Triangular Space
The Axillary space is bounded by teres major muscle, teres minor muscle and humerus. The long head of triceps brachii splits this area into medial and lateral group. Scapular circumflex artery and scapular circumflex vein pass through it.
Lateral axillary space/ Quadrangular Space
The axillary nerve and posterior circumflex humeral artery can be irritated by soft tissue structures. Symptoms include axillary nerve related weakness of the deltoid muscle, resulting in a reduction in shoulder abduction. The pain from axillary neuropathy is usually dull and aching rather than sharp, and increases with increasing range of motion. Many people notice only mild pain but considerable weakness when they try to use the affected shoulder.
The radial nerve and profunda brachii artery pass through the triangular interval, on route to the posterior compartment of the arm. The triceps brachii has potential to irritate the radial nerve in the triangular interval.
Massage Therapy for Shoulder Range of Motion
If the goal is improving shoulder range of motion, a number of papers have demonstrated the effects of soft tissue mobilization or stretch training on tissue stiffness, shoulder internal rotation and horizontal adduction.
- 4 weeks of soft tissue mobilization had an affect on tissue stiffness, shoulder internal rotation and horizontal adduction in baseball players with posterior shoulder tightness (Yamauchi et al. 2016).
- Modified cross body stretch and modified sleeper stretch leads to decreased the stiffness of the teres minor and infraspinatus (Umehara et al. 2017)
- Instrumented manual therapy with self-stretching significantly reduces ROM risk factors in baseball players with motion deficits (Bailey et al. 2017)
- A 4-week treatment program of manual therapy or dry needling demonstrated a significant improvement in pain pressure threshold, muscle elasticity, and stiffness of neck and shoulder muscles (De Meulemeester et al. 2017).
- A 8-week posterior shoulder stretching program significantly increased internal rotation and horizontal adduction ROM in university-level overhead athletes (Chepeha et al. 2017).
Why Does Massage Therapy Work?
A biopsychosocial framework helps put into context the interconnected and multidirectional interaction between: physiology, thoughts, emotions, behaviors, culture, and beliefs. In terms of clinical responses to massage therapy there are a couple of proposed mechanisms of action, including but not limited to:
• Neurodynamics - “A clinical concept that uses movement (1) to assess increased mechanosensitivity of the nervous system; and (2) to restore the altered homeostasis in and around the nervous system.” (Grieve's Modern Musculoskeletal Physiotherapy).
• Neuroplasticity - Touch can help sharpen the image of the self in our body maps.
• Contextually Aided Recovery - The way we present ourselves and present our techniques is tied to clinical outcomes, the magnitude of a response may be influenced by mood, expectation, and conditioning.
• Neuromodulation - Massage has an effect on peripheral and central processes - input from large sensory neurons may prevent the spinal cord from amplifying nociceptive signaling.
• Social Grooming - Nervous system regulated by touch (social grooming) helps modulate the activity of neural circuits important for maintaining resting state. This reduced physiological and behavioural reactivity to stressors results in improved mood/affect.
• Mechanotherapy - "Any intervention that introduces mechanical forces with the goal of altering molecular pathways and inducing a cellular response that enhances tissue growth, modeling, remodeling, or repair.” (Thompson et al. 2016).
More to Explore
Babatunde, O.O., Jordan, J.L., Van der Windt, D.A., Hill, J.C., Foster, N.E., Protheroe, J. (2017). Effective treatment options for musculoskeletal pain in primary care: A systematic overview of current evidence. PLoS One.
Bailey, L.B., Thigpen, C.A., Hawkins, R.J., Beattie, P.F., Shanley, E. (2017). Effectiveness of Manual Therapy and Stretching for Baseball Players With Shoulder Range of Motion Deficits. Sports Health.
Bailey, L.B., Shanley, E., Hawkins, R., Beattie, P.F., Fritz, S., Kwartowitz, D., Thigpen, C.A. (2015). Mechanisms of Shoulder Range of Motion Deficits in Asymptomatic Baseball Players. Am J Sports Med.
Bervoets, D.C., Luijsterburg, P.A., Alessie, J.J., Buijs, M.J., Verhagen, A.P. (2015). Massage therapy has short-term benefits for people with common musculoskeletal disorders compared to no treatment: a systematic review. J Physiother.
Cheatham, S.W., Lee, M., Cain, M., Baker, R. (2016). The efficacy of instrument assisted soft tissue mobilization: a systematic review. J Can Chiropr Assoc.
https://www.ncbi.nlm.nih.gov/pubmed/27713575 (OPEN ACCESS)
Chepeha, J.C., Magee, D.J., Bouliane, M., Sheps, D., Beaupre, L. (2017). Effectiveness of a Posterior Shoulder Stretching Program on University-Level Overhead Athletes: Randomized Controlled Trial. Clin J Sport Med.
De Meulemeester, K.E., Castelein, B., Coppieters, I., Barbe, T., Cools, A., Cagnie, B. (2017). Comparing Trigger Point Dry Needling and Manual Pressure Technique for the Management of Myofascial Neck/Shoulder Pain: A Randomized Clinical Trial. J Manipulative Physiol Ther. https://www.ncbi.nlm.nih.gov/pubmed/28017188
Gerber, L.H., Sikdar, S., Aredo, J.V., Armstrong, K., Rosenberger, W.F., Shao, H., Shah, J.P. (2017). Beneficial Effects of Dry Needling for Treatment of Chronic Myofascial Pain Persist for 6 Weeks After Treatment Completion. PM R.
Gigliotti, D., Xu, M.C., Davidson, M.J., Macdonald, P.B., Leiter, J.R., Anderson, J.E. (2017). Fibrosis, low vascularity, and fewer slow fibers after rotator-cuff injury. Muscle Nerve.
Hawk, C., Minkalis, A.L., ... Bhalerao, S. (2017). Systematic Review of Nondrug, Nonsurgical Treatment of Shoulder Conditions. J Manipulative Physiol Ther.
MacPherson, H., Vickers, A., Bland, M., Torgerson, D., Corbett, M., Spackman, E., ..., Watt, I. (2017). Acupuncture for chronic pain and depression in primary care: a programme of research. Southampton (UK): NIHR Journals Library.
Steuri, R., Sattelmayer, M., Elsig, S., Kolly, C., Tal, A., Taeymans, J., Hilfiker, R. (2017). Effectiveness of conservative interventions including exercise, manual therapy and medical management in adults with shoulder impingement: a systematic review and meta-analysis of RCTs. Br J Sports Med.
Umehara, J., Hasegawa, S., Nakamura, M., Nishishita, S., Umegaki, H., Tanaka, H., . . . Ichihashi, N. (2017). Effect of scapular stabilization during cross-body stretch on the hardness of infraspinatus, teres minor, and deltoid muscles: An ultrasonic shear wave elastography study. Manual Therapy.
Umehara, J., Nakamura, M., Fujita, K., Kusano, K., Nishishita, S., Araki, K., Tanaka, H., Yanase, K., Ichihashi, N. (2017). Shoulder horizontal abduction stretching effectively increases shear elastic modulus of pectoralis minor muscle. J Shoulder Elbow Surg.
Vickers, A. J., Cronin, A. M., Maschino, A. C., Lewith, G., Macpherson, H., Foster, N. E., . . . Collaboration, F. T. (2012). Acupuncture for Chronic Pain. Archives of Internal Medicine.
Wilk, K.E., Arrigo, C.A., Hooks, T.R., Andrews, J.R. (2016). Rehabilitation of the Overhead Throwing Athlete: There Is More to It Than Just External Rotation/Internal Rotation Strengthening. PM R.
Yamauchi, T., Hasegawa, S., Nakamura, M., Nishishita, S., Yanase, K., Fujita, K., . . . Ichihashi, N. (2016). Effects of two stretching methods on shoulder range of motion and muscle stiffness in baseball players with posterior shoulder tightness: A randomized controlled trial. Journal of Shoulder and Elbow Surgery.
Zaremski, J.L., Wasser, J.G., Vincent, H.K. (2017). Mechanisms and Treatments for Shoulder Injuries in Overhead Throwing Athletes. Curr Sports Med Rep.