Client is an 81-year old man who woke up in the middle of the night with chest pains. After the doctors determined that he was not having a cardiac episode, they prescribed a bunch of pain meds and muscle relaxants. The meds gave him bad constipation and he lost his appetite and 20 pounds, which on him was far too much weight to lose, so he was keen on finding a non-medical solution to his pain.
He experienced pain and/or limited range of motion in shoulder flexion, abduction, lateral rotation, protraction and retraction. Was unable to upwardly rotate shoulder. Extension, adduction, medial rotation, retraction were within normal limits. After assessing his range of motion, we began the session.
Working on the elderly requires a very deft and gentle touch. Their skin is very fragile and easily torn, and it is important to work to create a comfortable group of positions for them to recline, as their joints are often painful and makes difficult prone or supine positions for very long.
This particular man required trigger point work in his subscapularis and serratus anterior muscles, which have insertions on the anterior surface of his scapula, which means going in through his axilla to access the muscles. Also, his infraspinatus, supraspinatus, levator scapula were all very tight and required work as well. Using very slow, gentle pressure, I was able to get the subscapularus trigger points released, as well as relaxing the posterior rotator cuff muscles and levator scapula.
Recommended a weekly appointment for the next four weeks to continue making progress.
Last night, I had a breakthrough with one of my clients. She had been coming to me for around six months with this problem in your shoulder: she presented nerve pain from her brachial plexus distally to her wrist, and she couldn’t medially rotate her arm into “handcuff position” without considerable pain. I’d been trying various ways of opening her shoulder up without much success, and I could tell she was becoming frustrated with the slow pace of progress.
Part of the problem was that I wasn’t digging down deep enough to discover the exact pattern of referred pain, and I had conflated the two pains. The nerve pain and the deep scapular pain were really from two separate groups of trigger points, and that was causing me a bit of vexation. But last night, she described the nerve pain differently than we had discussed in the past, and a light bulb went on. That lead me to her scalene muscles, and some palpation on them triggered the pain sensations she had been experiencing. Digging into them with vaulted fingers and thumbwork deactivated her trigger points there, and there was immediate relief.
With that solved, I went back to basics on her medial rotation problem. The main muscle of medial rotation is the subscapularis, which is where she was feeling her pain, so I decided to check it’s primary antagonist, the infraspinatus. Started out with some softening, friction circles, and then when she was softened - bingo! - I felt it; a tiny trigger point about the size of a glass-headed pin. Soon as I put pressure on it, she said, “That’s it!” and we went in to some deep direct pressure, trying to crush the TrP against the scapula to get it to release. Over the course of about 10 minutes, that darned trigger point slowly, so slowly, released and let go. I wanted to test it out that I had gotten all of it, so I took her arm and slowly put it into medial rotation, with no pain. Gradually, I was able to move her arm painlessly through its full range of motion in that aspect.
You should have heard us whooping and hollering!
This is exactly why I love this work so much. Every day I get to help people, and then we have this particularly exhilirating moments like this. I am humbled and ecstatic to be able to be of such service to others.
