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Pain Between Shoulders

Although there are any number of reasons that people call for remedial massage, probably one of the more common is for pain between the shoulder blades. This can be an isolated pain or it can be in conjunction with neck pain and stiffness or headaches. The pain can be persistent and chronic or it can appear acutely after a particular activity or movement.

Many people will believe that the root cause of the problem lies in the muscles between the shoulders blades, namely the rhomboids. If they book in for a massage then they will expect that the therapist pays particular attention to these muscles and the muscles around the area to reduce the tightness and tension.

MHowever, often the problem is not associated with tightness in the area but weakness. Tightness in other muscles is causing the muscles such as the rhomboids to become irritated because they are over-stretched not because they are overly tight. A massage therapist that tries to eliminate the tightness by stretching and adding length to the muscles may even be adding to the problem.

Often postural professionals will refer this condition with terms such as forward head posture or upper cross syndrome. The pain between the shoulders actually results from the complex interaction of the muscles around the shoulder girdle. It comes about from an increase in tightness in the muscles at the front of the neck and upper chest and weakness with the upper back and back of the neck (technically muscles such as the levator scapula, pectoralis major, suboccipitals, SCM and upper trapezius tend to be tight whereas the lower trapezius and rhomboid muscles tend to be weak).

Typically when you have your posture checked, a therapist would notice that the shoulder blades (the scapulae) are depressed lower than they should be and they are spread apart towards the sides of the body. When the shoulder blades are in this position, the traps and the rhomboids are stretched to their maximum and they struggle to hold the weight of the arms. The force of gravity leads to a constant pulling on the muscles and nerves in the area. The results is pain in and around the neck, between the shoulder blades and even down the arms.

Postural awareness is the first starting point for reducing the impact of upper crossed syndrome or forward head posture. Left untreated it can lead to degenerative changes in the upper back and result in constant neck pain, back pain and contributes to the formation of the Dowager’s Hump and be implicated in TMJ dysfunction.

  
Being mindful of when you are performing repeated tasks with you arms extended in front of you (such as typing on computers or driving) is a good starting point. However, restoring the balance between the muscles of the shoulder girdle is of prime importance and this can often be quite a challenge as normal movement patterns may have been compromised by persistant pain.

Massage can help to address some of the issues associated with these problems, in particular by releasing those muscles that are pulling the shoulders blades forward and down. Your therapist can also suggest stretching exercises for the upper chest and strengthening exercises for the upper back.

TMJ Pain?
Try Massaging your Pterygoids

You may be surprised if you were told that the hardest working joint in the body is the jaw or the temporomandibular joint (TMJ). It is virtually constantly working when talking, chewing, grinding and clenching and there are estimates that it moves more than a couple of thousand times every day. It is no surprise then that some of the muscles used to move the joint can become a little overworked and sore.
Often the result can be what is referred to as TMJ dysfunction which can manifest itself in a number of different ways. These include
Massage for TMJ dysfunction

  • headaches
  • dizziness
  • soreness and irritation of the eyes
  • difficulties with chewing
  • clicking/grinding jaw
  • problems with the ears including Tinnitus

The outcome is often that the TMJ dysfunction sufferer has poor quality sleep, is constantly in pain or discomfort and a general degradation of their quality of life.
It is not uncommon that these problems can be related to trigger points in the muscles that move the jaw and, although there are a number that can be affected including the masseter and the temporalis, one of the main culprits is often the pterygoid muscles. The good news is though that it is relatively easy to massage these muscles yourself so long as you know where to work.

The origin of the term pterygoid is Greek and the root of the word, pter-, refers to wing like (as in pterodactal) which is considered to reflect the shape of the muscles.

The group consists of the medial and lateral pterygoids each of which have their own recognised trigger point referral pattern.

Trigger Points and Self-Massage for Medial Pterygoid
If there are trigger points present in the medial pterygoids then the person will often have pain in the TMJ and also around the ear. It can also be difficult to swallow with pain referred to the back of the mouth. If you have restrictions in how far you can open your mouth then there is likelihood that you will have trigger points in this muscle, normally present on both sides of the head.

In order to self-massage the trigger points then you simply press up on the inside of the lower edge of the jaw using your thumb. As with any massage, then it is advisable to go gently at first as often the jaw can be extremely sensitive at these points.
The most effective way to reach the upper fibres of the medial pterygoid is through the mouth. With clean hands, reach into the very back of the mouth beyond the final molar. Work on the muscle just beyond the bony edge of the jaw (open and close the mouth to locate the muscle if required).

pterygoid sketch

Trigger Points and Self-Massage for Lateral Pterygoid
This muscle is considered by many to be the leading culprit for pain and TMJ dysfunction. For example, if you have clicking and discomfort on opening and closing the mouth then you may have trigger points in the lateral pterygoid. Constant tension in these muscles can lead to the jaw being disarticulated.
To locate this muscle, then commence just in front of the ear on the cheekbone. Press on the underside of the cheekbone whilst opening and closing your mouth. A couple of centimetres from the ear you will often hit pay dirt with a tight tender band going up under the cheek bone. This is the lateral pterygoid and gently massage this muscle until the pain and tension has reduced.

  
Any time you massage trigger points in muscle groups it is a good idea to stretch them out afterwards to enhance the relaxation of the muscle. One recommended stretch for these muscles is to open your mouth against resistance by placing your hand under your chin while you slowly open the mouth against the resistance.

Often you will need to repeat this self-massaging a couple of times a day for a number of days to completely eliminate the trigger points in the group. If you are a TMJ dysfunction sufferer though, the time taken to do this will be well worth the effort as the pain relief can be significant.

More info on pterygoid trigger point massage is available on the video below.


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