By Laurie Melrose-Doering, Osteopath & Applied Kinesiologist
Subscapularis tendinopathy is a very painful condition usually caused by overuse or traumatic injury to the subscapularis tendon. The subscapularis muscle is one of the rotator cuff muscles and, as such, plays an important role in stabilizing the ball-in-socket joint of the shoulder.
Although less common than supraspinatus injuries, subscapularis tendinopathies are quite common.
As with all tendinopathies, subscapularis tendinopathy is a result of tendon overuse. As is the case with supraspinatus problems, it is repetitive overhead activities combined with internal rotation that places the most strain on the tendon.
Throwing and front crawl are therefore two activities that you may find difficult.
Because it is so flimsy, the subscapularis tendon is also easily injured during trauma. The trauma in question is usually a rapid excessive stretch into external rotation, such as a ballistic throwing motion without warming up.
Most people have a gradual onset of dull, achy shoulder pain behind the armpit. The shoulder pain can be sharp on certain movements and is often aggravated by activity.
You are likely to struggle with internal rotation combined with overhead activities, e.g. giving a high five.
There is also likely to be tenderness of the subscapularis tendon.
Often, rest or ice often alleviates the shoulder pain.
Osteopaths or other manual therapists rely on a thorough case history combined with palpation, and active and passive range of movement tests.
If the diagnosis is still unclear or the shoulder pain does not improve with treatment, ultrasound is advised.
Subscapularis tendinopathy responds very well to treatment, especially to osteopathy. It is important, however, that any underlying cause is removed.
With treatment, symptoms can resolve in 2–6 weeks. It can, however, take longer in older patients who or patients where the underlying cause has not been removed.
The following approaches can help the subscapularis:
If the injury is acute, you should protect and rest the shoulder, i.e. avoid aggravating movements.
The aim of exercise is to mobilize the shoulder within a non-painful range. I recommend a pendulum exercise that involves circumduction of the shoulder. This requires no effort because gravity does the work, and increases local blood supply, which promotes tissue healing.
Then, I recommend opening up the shoulder in order to provide more space for subscapularis. This can be done by stretching the pectoralis minor muscle or swimming backstroke.
A static stretch should be 3 x 30 seconds – less than this has little effect, more than this does not provide additional benefit.
To strengthen the muscle and the tendon, I recommend a thera-band. Isometric, concentric, and then eccentric exercises should be performed.
Finally, a small, light ball is fantastic for proprioceptive exercises. You can roll a ball up a wall for example.
Massage can reduce tension and resolve trigger points in associated muscles. It can also increase local blood supply that will promote healing. However, massage should not be too gung-ho.
An acupuncturist will focus on local shoulder points, and LI15, LI16, SJ14, SI10, LI4 and SJ5.
Some patients may get pain relief from TENS machines. And low-intensity ultrasound treatment can increase local blood flow and promote tendon healing.
Surgery should be reserved for debilitating cases that do not respond to conservative management.
I have found osteopathy, especially when coupled with specific diagnosis based on AK muscle testing, to be very effective in the treatment of supraspinatus tendinopathy.
Muscle testing allows me to tailor the treatment to the individual. For example, it allows me to ascertain reactive muscle patterns. This is where contraction of one muscle can inhibit another muscle. Inhibiting the hyper-facilitated muscle interrupts this abnormal reflex.
In addition to treating reactive muscle patterns, I treat all other functional muscle weaknesses, peripheral nerves and joint dysfunctions in the shoulder. I also address the spine, as this is where the nerve supply arises.
A dysfunction at the manubriosternal joint – at your chest bone – often brings with it functional weakness of the subscapularis. This then places more strain on the tendon.
I have found treatment of the manubriosternal joint to be very effective in helping subscapularis.
If you think you may have subscapularis tendinopathy, please get in touch.
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Aston Clinic London is a third-generation complementary health clinic located in New Malden, serving Kingston, Norbiton, Wimbledon, Raynes Park, Surbiton, Chessington, Worcester Park, Sutton, Richmond, and other areas of southwest London and Surrey.
By Laurie Melrose-Doering, Osteopath & Applied Kinesiologist
