Ever feel a sharp pain in your shoulder when lifting a heavy object or reaching for something on the top shelf? That could well be a strain in the supraspinatus tendon, which connects to the small and generally weak supraspinatus muscle that lies beneath the upper trapezius muscle on the back of the shoulder blade. It is sometimes called the ‘suitcase muscle’ because it is used in movements requiring raising an arm to the side, such as when carrying a suitcase held away from the body.
Supraspinatus tendonitis can also be caused by moving heavy furniture, overhead sports like tennis or baseball, painting a ceiling, or simply working long hours at a computer with insufficient elbow support. However, the onset of pain is often hard to connect to any specific cause or activity, being just as likely to result from strenuous athletic activity as sudden jerky movements, and can persist for years without accurate assessment and treatment. Massage therapists themselves may experience this tendonitis after certain outward circular strokes or lifting their massage tables.
As the supraspinatus is only one of the rotator cuff tendons that can cause shoulder pain, precise injury verification is important for administering the appropriate treatment.
As with many tendon strains, supraspinatus pain is generally felt several hours following the activity. Strong shoulder pain when lifting the arm to the side or a popping sound in the shoulder joint are common symptoms of this tendonitis, but pain may also be felt in various parts of the arm during assessment tests as a result of a micro tear at the tendon’s attachment to the bone.
Massage therapists often refer patients with this type of shoulder pain to see a physician for an X-ray, particularly if caused by a fall or other trauma. X-rays may reveal a fracture, or calcium deposits in the tendon, which can be treated by surgery.
The primary test to determine whether the injury is supraspinatus tendonitis is resisted abduction while placing the shoulder in certain positions. Special testing to differentiate between the various rotator cuff muscles is a part of the massage therapist diploma training. The patient fires the muscle while the RMT observes or offers resistance, gently at first, then harder. Discomfort pain or an inability to perform the movement will lead a massage therapy student to identify a minor supraspinatus injury, compared to a different musculoskeletal problem, a joint capsule concern or boney issue. This allows the student therapist to identify if they can proceed with a treatment safely, or if they should refer the patient out for further testing with their doctor, physiotherapist or chiropractor.
Massage therapists will determine the location of the supraspinatus injury by testing the patient’s range of motion by identifying pain as they lift their arm slowly from their side (the painful arc), or as the therapist takes the limb through its range passively. While minor strains will generally heal with several weeks of rest, range of motion may remain limited. Friction therapy is the most effective method of breaking down adhesive scar tissue and increasing blood circulation to encourage the healing process and improve free range of motion.
Friction is applied by the thumb in a horizontal direction, starting with very light pressure and slowly increasing, communicating with the patient to ensure that the technique isn’t too painful.
Friction therapy generally takes weeks or even months to be effective, depending on the extent of an injury, and cannot begin until the injury has reached an advanced stage of healing. Massage Therapy students are trained to use effective interview questions to identify the stage of healing their patient is in so that treatment is both safe and effective. When acquiring hands-on practice in the therapeutic massage college clinic, students combine this friction therapy, along with other massage therapy techniques, to the upper back and neck to enhance circulation. Both stretching and self-exercise in the patient’s own time complement supraspinatus treatment.
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