Can massage help with shoulder pain?
The misery of shoulder pain!
Shoulder pain can be very debilitating and have a very negative impact on our daily activities. There are many reasons why you may be suffering from shoulder pain.
In this article, I will go through some of the problems I often see in my massage practice and explain how massage and exercises can help.
What causes shoulder pain?
There are many possible causes of shoulder pain. You may have heard terms like shoulder impingement, frozen shoulder, bursitis, rotator-cuff injury or tear, all of which can cause painful symptoms, and limit your ability to move your arm properly.
Sometimes you can put your shoulder pain down to an injury but often it can creep up on you gradually over time, and before long you are in pain and finding it difficult to move your arm in a normal and pain-free way.
If you haven’t had an obvious injury like a fall, then it is very probable that it all began with the muscles becoming tense, tight and tired from overuse and repetitive movements.
How can massage help my shoulder pain?
In an ideal world, we should consider having deep tissue massage or myofascial release treatment as a form of maintenance to prevent this muscular tension and tightness, but most of us leave it until we are experiencing painful symptoms. The earlier you address any symptoms, the less treatment you will need to get better, it really is often that simple.
We use our arms all the time, reaching for things, lifting things, typing on the computer and daily activities like brushing your teeth or hair, driving, cycling the list goes on. So it’s not surprising that our shoulders can run into problems sometimes.
As muscles become tight and tense they start to restrict our movement. The shoulder is a very mobile joint, over time as the muscles become tighter the shoulder joint can become compressed and restricted in its movement and this can start to aggravate underlying structures like a bursa, or tendon, as well as impinge sensitive structures, causing pain when we move our arm.
What is bursitis?
A bursa is a small fluid-filled sac which allows two surfaces to move over each other easily and smoothly such as a tendon moving over a bone. Sometimes the constant repetitive movement combined with tight muscles can start to irritate the bursa and cause inflammation and pain. In the medical world this is called bursitis.
Bursitis can take a long time to get better and often needs rest to improve. Resting the shoulder and arm is not easy as we need to use them so much in our daily lives.
Although massage can not directly contact the bursa it can relax and soften the tight muscles around the shoulder joint and reduce any compression and restriction, therefore, reducing the pressure and irritation on the bursa and potentially speeding up the recovery time. Icing is also often helpful in reducing pain and inflammation.
What is tendinopathy of the shoulder?
Tendinopathy is a term used to describe any type of damage to a tendon and includes tendinitis, tendinosis and tenosynovitis.
Tendinopathy of the shoulder happens when a tendon becomes irritated, inflamed, weak and damaged and, although it can be caused by an injury, it is often the result of overuse and repetitive movements.
Tightness of the muscles causes restriction and compression around the shoulder joint and can compress and restrict the tendons, leading to irritation and weakness of the tendons or tendon, which then leads to inflammation, damage and pain.
As with bursitis, rest and icing is usually helpful as well as specific stretches but massage can also to help relax and release tightness in the muscles around the shoulder joint, improving the movement and releasing the tightness and compression on the tendons.
A very specific massage technique called transverse fibre friction developed by Dr James Cyriax has been shown to stimulate fibroblast and collagen production as well as breaking down scar tissue and aligning fibres.
What is a shoulder impingement?
As the muscles around the shoulder become tight and tense the shoulder joint can become restricted and compressed. Movement then becomes impaired, leaving underlying sensitive structures like tendons vulnerable to getting pinched or compressed, especially when we lift our arm up in front of us or out to the side. This is known as shoulder impingement.
Shoulder impingement syndrome is often a precursor to bursitis, tendinopathy and rotator cuff injury.
As in the previous examples, relaxing and reducing the tension in the muscles with deep tissue massage techniques can reduce this compression and allow more space for the shoulder joint to move freely and not impinge. Stretching exercises are also prescribed to help relax and release tight muscles.
What is a rotator cuff injury?
Four muscles around the shoulder collectively make up what is called the rotator cuff. They are the supraspinatus, infraspinatus, teres minor and subscapularis. Together their tendons form a cuff like layer that surrounds the top of the upper arm bone called the humerus.
The head of the humerus attaches to the socket on the shoulder blade known as the glenoid fossa, where these two structures meet is your shoulder joint. Anatomically this is known as the glenohumeral joint.
For a more detailed look at the glenohumeral joint click here.
A healthy shoulder joint is a very mobile joint, and sacrifices stability for mobility. This leaves it vulnerable to injury and dislocation. Wear and tear, overuse and muscle imbalance can leave the rotator cuff vulnerable to weakness and tears.
A small rotator cuff tear might not be too painful or limit your movement and even a larger tear might not, but often they will cause pain and restrict your ability to move your arm in the normal way.
Rotator cuff tears are graded depending on their severity and may need surgery, although this study shows that surgery for rotator cuff tears was often no better at reducing pain and improving movement and function of the shoulder than receiving more conservative treatment approaches like physiotherapy, so it could be worth trying this first before deciding to have surgery.
Although massage is not going to repair a rotator cuff tear, it may help to encourage the injured tendon to heal more quickly. Often the surrounding muscles become painful, tight and irritated due to compensating for the reduced shoulder function and massage can certainly help to reduce this problem and improve your pain-free range of motion, making everyday activities less painful.
I will often prescribe exercises to help with rotator cuff injuries, focusing on strengthening the rotator cuff muscles and other shoulder muscles to help support and stabilise the shoulder joint, stretches are also prescribed to reduce tight muscles that can be restricting movement.
What is frozen shoulder?
Frozen shoulder is a term I hear my clients use a lot when describing their shoulder problem. People often think they have a frozen shoulder when it may be one of the above conditions already discussed in this article.
Often the conditions already described above can be a precursor to getting a frozen shoulder, this is because they limit your ability to move the shoulder joint normally and over time the joint capsule starts to stiffen up.
A true frozen shoulder occurs when the thick fibrous capsule that incases the shoulder joint becomes inflamed. Over time the tissue tightens and shrinks and adhesions start to occur, causing pain and severely limiting the movement of your shoulder joint.
Its is often sore and tender and everyday activities become very challenging, a simple action like trying to put your coat on can be very difficult and painful.
Medically a frozen shoulder is known as adhesive capsulitis. There are usually three phases that a frozen shoulder goes through.
The first phase is know as the freezing stage and is when the shoulder becomes painful and starts to stiffen up, this typically occurs over a a period of weeks.
The second phase is known as the frozen phase and although the pain might decrease movement is often still very restricted. This second phase usually occurs over a few months
The third phase is the thawing stage and is recognised by your ability to start moving the shoulder more freely and with less pain, you will also start to get your arm and shoulder strength back. It can often take months and sometimes up to 2 years or more to fully gain a normal range of movement.
In the initial stages of a frozen shoulder, it is best to rest the shoulder and only use it within the pain-free range. Using over the counter anti-inflammatory drugs can help reduce the pain and I find that applying an ice pack regularly can be helpful too. Once the initial pain has reduced and you start to regain some movement, then specific exercises can help to speed up your recovery. The video below gives you some useful exercises that can help with a frozen shoulder.
Due to pain and limited movement, the shoulder, neck and upper arm muscles can get tight and painful and massage can certainly help to keep this secondary problem to a minimum which will also help you to maintain as much pain-free movement as possible.
So can massage help with shoulder pain?
In my experience, I would have to say it can, although it will depend on the severity of the problem. When things become more chronic it can take more treatment and the results might be limited.
The best thing is to get treatment sooner rather than later as when things get left they can become more problematic. I always find that the earlier a shoulder pain is treated the more chance it will get better and in less time. When left, it will often get worse and take more treatments.
If left to become too chronic then massage can still be helpful but often is more supportive in relaxing surrounding muscles that are getting aggravated and helps to prevent the problem from becoming worse, in addition to supporting the bodies recovery process.
Even if massage cannot directly resolve the problem it can often help to calm down the secondary issues like aggravation in the surrounding muscles.
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