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Subscapularis- The hidden source of pain

05 Jul 2018 by Maddi Boyer

“I’d like to look/assess/treat your Subscapularis muscle…” For the newer clients this statement is closely followed by blank facial expressions. For the current clients this statement is closely followed by a groan or cheeky eye roll.   

‘Unknown’ and forgotten even amongst health practitioners (trust me I know!!). The subscapularis is a large triangular shaped muscle that lies between your ribcage and shoulder blade. Why an entire blog post about just one muscle? I hear you ask.. From our experience the subscapularis muscle is a common source of pain for many of our clients, both local (shoulder region) and remote pain. Subscapularis also happens to be the muscle that relieved remote pain in my own body and hence is another reason I have chosen to write my first blog post on this incredibly annoying but fundamental muscle.

Subscapularis - What? Where? Why?


The image above to the left shows the subscapularis muscle insertion, the lesser tubercle of the humerus or upper arm bone. The second image on the right shows the muscles origin on the flat surface of the shoulder blade (subscapula fossa).

Ever heard of the rotator cuff? Subscapularis is one of four muscles that makes up the rotator cuff, which creates stability of the shoulder joint. The rotator cuff works similarly to that of the four guide ropes on a tent, should one become too tight or loose the other three are impacted creating an imbalance. As we know any malalignment within our bodies has the potential to produce pain.

The muscle is innervated by nerves travelling out of the neck. 

In our experiences, when subscapularis muscle becomes dysfunctional often it has the potential to lead to a number of other conditions, and very rarely produces local pain at the site of the muscle. Common referral patterns of a tight and unhappy subscapularis muscle include neck, back and shoulder pain, arm and wrist pain and you may also find reduced strength in these areas (Perry, 2018). 

How does Subscap become problematic?

Prone to becoming tight and shortened, this muscle is most commonly accessed by clinicians via the armpit. There are many different reasons why this muscle can become dysfunctional and aggravated. The most common we find is posture… There’s a reason why you were constantly reminded as a child to sit and stand tall!!

In certain positions and postures the subscapularis muscle can be shortened such as at the desk with use of a mouse, especially with the arm held away from the body. Other repetitive action also have the ability to produce dysfunction such as activities that involve a reaching action behind the back, common in swimming and racket sports.

A fall onto an outstretched hand in most cases will lead to prolonged periods of immobilisation such as a cast on the wrist or a sling for a shoulder injury, but did you know it can also  cause dysfunction to the subscapularis muscle. Once the immobilisation and rehabilitation period are complete, you may still find yourself feeling that things are ‘just not the same since that fall/break/accident’. This could potentially be due to unresolved dysfunction of the subscap. 

Even sleep position, one where you are side lying onto the shoulder, arm outstretched can lead to an accumulation of strain within the subscapularis muscle and resultant issues…. JUST FROM SLEEPING!

… I hear the cogs ticking over now….

How do you know if your Subscapularis needs attending to? 

STEP 1.

  • Assess your posture using a mirror.
  • Where are your shoulders sitting in relation to the rest of your body?
  • Do you have a gorilla's posture? (arms and shoulder position rolling inwards) 

STEP 2.

  • Assess your Range of Motion
  • Can you comfortably reach over head or do your shoulders feel restricted and tight?
  • Can you complete a Subscap Stretch against wall as pictured below?

  • Identify Weakness using the Lift-off Test
  • Leaning on an angle, shoulders resting against and feet slightly forward.
  • Place hand behind back palm contacting the wall.
  • Press the palm into wall as your body subsequently travels forward. 

If you noticed your posture is looking gorilla-like and/or had difficulty completing steps 2 and 3 it is likely your subscapularis muscle has been suffering in silence... or you have been soldiering on in pain!!

Addressing the subscapularis is relatively easy (unfortunately I cannot promise it will be completely pain free) but following on from treatment you will be sure to notice a difference! The catch, we can not do all of the work for you, if order to achieve long-term and effective results you will need to commit to simple postural correction, strengthening exercise and gain an understanding of how to assess and manage this area in future. If you are interested to learn more or found yourself to have some positive tests, please call our clinic to book your appointment. We are ready to help you!

References:

Kenhub (2018). [video] Available at: https://www.youtube.com/watch?v=_NvVjLUL3F4 [Accessed 13 Jun. 2018].
Perry, D. (2018). Subscapularis Trigger Points: The Icicles of Shoulder Pain | TriggerPointTherapist.com. [online] Triggerpointtherapist.com. Available at: http://www.triggerpointtherapist.com/blog/subscapularis-trigger-points/subscapularis-trigger-points-shoulder-pain-icicles/ [Accessed 30 May 2018].

Vizniak, N. (2012). Muscle manual. Professional Health Systems.

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