Stubborn knots that wont release...Argh!!

[Bawney]

I have been seeing a male client for massage once a week for the past four weeks at the therapy centre where I work, he has problems with his right shoulder, and the range of his arm movement has been quite restricted due to shortening of the muscles and tightness. However, the shoulder has improved alot since having massage, but I cant seem to rid the horrible stubborn knots just above the scapula in the trapezius. Even though I have applied lots deep thumb, elbow & knuckle pressure on them, they just wont go/release Its really frustrating meCan anyone offer me some advice on what other techniques I can use please? He has been in a bad way with muscle tension & tightness due to years of bad posture as well, so maybe this is just going to be a bit of a long haul...Rome wasnt built in a day as they say! He is such a lovely man too, very jovial, and a pleasure to treat.

I'd be grateful for any tips please, thanks x

 

[Zarrar Awan]

presumably you've tried all the obvious options. Have you considered dry needling/acupuncture? or could it be 1st rib, rather than a knot?

 

[alvin]

No, they are definately knots not bone. They feel rather grisley and mobile under the skin, and adhered to the trapezius muscle - site area over the Rotator Cuff - Supraspinatus.

They are little buggers to deal with, as every time I apply deep pressure they move out the way!!!

No, not thought of dry needling/acupuncture, but will suggest it to him, thanks.

 

[JBallaa]

Working from the elbow up to the shoulders can release a lot of stubborn tension in the traps. If it is contributing it is usually quite uncomfortable, so they do feel like you are doing something, rather than just massaging an arm. It's trigger point theory, but just working all the muscles without worrying about specific trigger points seems to have a huge effect anyway.
I find a lot of men in particular seem to fight back on the area the harder you go, and complain you're not working deep enough if they're not fighting back. Making their arms hurt seems to confuse their brain and it all loosens up.

Another idea is something like hot stones - using temperature and pressure confuses the brain and they (him or the muscles) can't fight back as much. Stones are an easy way of getting hot or cold temps with pressure, though there are metal things that warm up/chill easily or you might be able to find one of those home massage things that can be warmed/chilled (obviously a wooden one would be no good, wouldn't hold any temp). Ice massage always confuses the brain very quickly, and at least summer is the right time of year to be trying it

 

[retarded]

Thanks cola,

He's actually already having hot stones therapy with my colleague who owns the therapy centre once a week plus he sees me a couple of days later for the specific problem massage. Funnily enough though, I did mention to him yesterday that I will have a go with the stones too and alternate them with the cold ones as well. I was thinking of using them as a tool to apply deeper pressure after I've warmed up the problem site. We may be both better off in the end as at least it will save my poor thumbs and knuckles, they are really aching after yesterdays attempt....ouch!!

I'm not too up on trigger points/theory im afraid.......yet, I am keen to learn though and I think this may be included in the itec sports massage course that im taking in September. I'll be very glad to have this qualification, I cant wait, as then I'll know more about treating these types of conditions.

Can anyone else offer any suggestions for helping my client....Please?

cheers all!

 

[aQueecourb]

Hi Jill
Sounds like one of those annoying swines we all get sometimes.
I have a couple of questions:
First, what dose he do for a living, and secondly, dose he work out?
You mentioned that his posture was bad, in what way?

If the pain intensifies when he lifts the shoulder past 90 degrees then it is probably supraspinatus.
Check the insertions of pectoralis major and minor and coracobrachialis at the front of the shoulder.

Try this, first lie him on his front and massage the upper back muscles espacialy trap' for a few mins. Then lie him on his back and pinch trapezius, then feel for the top of the scapula and palpate along it with your thumb pushing trapezius out of the way until you find the knot(around lev scap' probably), then gently apply pressure until it is as much as he can comfortably stand then hold it for 20 sec's then slowly release and massage, repeat this process at all tender points from the top of the arm to the base of the neck.
It is more likely one of the muscles under trapezius that is the problem, and not trap' itself.

If (as in most people) his chest muscles are stronger than his upper back muscles then there is a 'tug of war' that the upper back muscles lose, causing them to become tight and painful, its only a few fibers, but they never get to rest.
But definitely check the muscles at the front of the shoulder.
Also levator scap' is worth checking and serratus anterior.
Don't forget that there are a lot of muscles that affect the shoulder, and they all affect eachother, even the ones at the front. pain is often felt in the weakest link in the chain, but that doesn't mean that the problem originated there, it may be that hes had it for years but only now is feeling it at the weakest point. Can you move his shoulder through the full ROM while he relaxes without him feeling any pain?

At the end of the day, probably the best thing the man can do is strengthen his upper back muscles.
If he has had it for a long time then it will take you a while to fix it, but it will only be temporary, you need to identify the root cause (imbalance most likely between the opposing muscles) and advise him how to fix it permanently.

Don't doubt yourself, people should take better care of themselves.

Well I hope Ive been of some help at least.
Kind regards
Shaun