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Subscapularis Massage

I recently posed an online question to other therapists about what muscles they believe do not receive sufficient attention from bodyworkers. My suggestions was the SCM (sternocleidomastoid) muscle at the front of the neck. Other suggestions included the gluteal muscles, the pecs and abs which didn’t surprise me too much. However, a few therapists included the subscapularis muscle in their lists which I have to admit, is not a muscle I would normally spend a great deal of time on.

Their comments inspired me to have a look at subscapularis, what it does and why it may be important for some shoulder conditions.

Now the subscapularis muscle is part of the rotator cuff group, along with the teres minor, infraspinatus and supraspinatus muscles. These muscles work together to stabilise the humerus in the glenoid fossa of the shoulder. From a massage therapists terminology it attaches to the anterior surface of the scapula at the subscapular fossa and the lesser tubercle of the humerus. It’s action is to internally rotating and adducting the humerus (along with it’s stabilisation role).

Pain and dysfunction in the subscapularis muscle often manifests as an inability to lift the arm above the shoulder (although it should be mentioned that not being able to lift the arm above the shoulder does not necessarily indicate that there is an injury to the muscle as there are other conditions which have the same impact on lack of shoulder mobility). It is often the case that someone who spends a lot of time in front of a computer may very well have some dysfunction of the subscapularis, such as trigger points (this applies to anyone who works with their arms out in front of them including massage therapists!).

Pain that is due to dysfunction of the subscapularis can manifest in a number of different ways, it can be sharp and located in the shoulder, deeper or at the top of the shoulder. It can refer down the arm. There can be impingement of the brachial nerve which can lead to numblike sensations or tingling down the arm. The pain can gradually appear over time or, in the case of an acute incident, it can happen at an instant (throwing or pitching a ball is commonly cited as a major contributer to subscapularis injuries). Subscapularis therapy is often indicated when a client is recovering from frozen shoulder.

Massage for the Subscapularis
Access to the subscapularis is limited particularly when a client is lying prone and most therapists prefer to do their subscapularis bodywork with the client either supine or in a side-lying position. Examples of supine and sidelying subscapularis massages are shown in the videos below.

Supine Massage

Sidelying Massage

Dr Ben Benjamin advocates using friction treatments to address subscapularis tendon injuries and claims that it can be a remarkably effective treatment for most muscle, tendon and ligament injuries. Friction massage for the subscapularis can be mildly unpleasant and should be performed from 5 to 15 minutes and is demonstrated on the video below.

  

Can I Massage your Obturator Internus?

I recently attended a deep tissue massage course in Sydney where I was introduced to the obturator internus muscle. I probably should have known where it is in the body and what it does but, I have to admit, I didn’t. The reason being is that it is in a pretty personal part of the body that I tend to stay away from during professional massage.

Now the formal description of the location of this muscle is that it “originates on the medial surface of the obturator membrane, the ischium near the membrane, and the rim of the pubis”. In language a little easier to understand it runs from the pelvic floor muscle, under and around sit bone (the ischial tuberosity) and attaches near the femoral head in the hip. It is one of a group of muscles that laterally rotates the hip (and it also assists in the abduction of the thigh).

Although I can understand that as a hip rotator that it may be important to release the obturator internus if someone is having hip problems, but given that I was not aware of it before the course, I think it is probably less important than other hip rotators such as piriformis.

On the course we spent over an hour talking about the obturator internus, receiving demonstrations on how to massage it and then practising working on it. All well and good in terms of improving the knowledge and education of the therapists, learning in a safe and supervised session. There seemed to be a real buzz and energy in the class about this one muscle that unnerved me though.

Although we are only talking about soft tissue bodywork, working in and around this part of the body is fraught with danger. If I went into see a therapist for the first time and they started massaging my obturator internus, I would be concerned that I was in the wrong type of massage establishment.

It is a highly personal area of the body that, in my view, the vast majority of massage therapists should never consider working. Yes knowledge of the anatomy and physiology is good but this type of bodywork should only be performed by therapists who are recognised as being experts and specialists in working with hip and pelvic floor issues (releasing and relaxing the obturator internus may be indicated with people who have a dysfunctional pelvic floor).

  
I would probably include massage to the coccyx in the same category – yes there are times when it may be indicated, yes most therapists could probably do effective body work in and around the coccyx. But in my view, probably best that coccyx massage is left to those who consider themselves to be specialists.

Maybe I picked up the vibe of the class wrong but just seemed that there was going to be a whole group of therapists targeting this previously unheralded muscle on an unsuspecting public.

Suffice to say though that you can rest assured that I would never be asking you the title question of this post.


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