TRIGGER POINT OF THE WEEK – SUBSCAPULARIS & INFRASPINATUS THE DYNAMIC DUO
The Subscapularis muscle trigger points are involved in almost all shoulder joint pathologies. This is due to a neurological ‘shut down’ or ‘holding pattern’ where the arm automatically assumes a sling like position. As you know, the Subscapularis muscle internally rotates the shoulder into this position. The Infraspinatus does the exact opposite – it is an antagonist muscle. After several months of ‘holding’ in this way the Subscapularis is replete with large trigger points. You also know that Subscapularis is hard to reach, lying between the thorax and the scapula.
I invented the Niel-Asher Technique (NAT) in 1997 to treat a very specific condition called adhesive capsulitis (better known as frozen shoulder syndrome). NAT is an algorithm blending trigger point techniques in a sequence to stimulate various spinal reflexes. The NAT algorithm for the shoulder utilizes trigger points in the Infraspinatus to release the Subscapularis muscle!
So how does treating Infraspinatus trigger points release Subscapularis?
There are two ‘laws’ which give us a clue to how treating one muscle to release its antagonist.
Law of reciprocal innervation states thatwhen a muscle contracts, its direct antagonist relaxes to an equal extent allowing smooth movement.
Peripheral Spinal Reflex – R/I
This important reflex and has a major role in the control of voluntary movement. It is an automatic process when muscles on one side of a joint relax to accommodate contraction on the other side of that joint.
With the patient on their back and the flexed arm in the mid position find the most painful trigger point in infraspinatus in the upper middle (medial) border of the scapula and hold it; It should be exquisitely painful. Ask the patient to breathe and relax and let the shoulder drop into the pain. Hold these points for about two minutes. As the shoulder relaxes and releases you should be able to externally rotate the flexed arm (gently). Repeat until as much external rotation is released as possible then stop.
How do you treat trigger these trigger points? We’d be delighted if you want to share your own best practice.