The infraspinatus muscle is a common problem in the shoulder and the most likely to generate pain when the client sleeps on their side. Its position in the shoulder is critical for stabilizing the head of the humerus from shifting forward.
Assessment of the Patterns
The infraspinatus is one of the most commonly occurring pain patterns in the body and the most common pattern in the shoulder. An anterior humeral head stresses the joint and activates the infraspinatus trigger point. This joint problem occurs in many ways but is most commonly caused by sleeping on the painful shoulder. After the humeral head is displaced, the infraspinatus stretches by being draped forward when sleeping on the opposite side. Consequently, the stretch activates the trigger point pattern.
Evaluate other indicators of this pattern. Nocturnal shoulder pain is usually infraspinatus but could be several muscles. Check the sleeping position. Sometimes, pain occurs because the arm position overstretches tendons.
- Coracobrachialis is the closest pattern to infraspinatus and the most difficult to separate as the motion of reaching behind the back creates activates both referrals. When the pattern is just in the shoulder, range-of-motion and palpation are needed to separate these patterns. When the full pattern is present these two patterns can be differentiated by the pattern in the forearm. Coracobrachialis is distinctive when it refers to the shoulder, posterior forearm, and hand but skips the wrist.
- The weakened grip can also be created by the extensors of the forearm, especially after a frozen shoulder.
- When the full pattern is present and radiates into the radial hand, it can be mistaken for the referral of scalenes. The infraspinatus is more focused on the shoulder and disturbs sleep where scalenes are usually focused on the hand and upper back with stiff and swollen hands in the morning.
- Latissimus dorsi also produces when reaching overhead but not when reaching behind the back or when reaching around the back of the head. Triceps pain is usually more vague and superficial on the posterior arm and shoulder.
There are many patterns that run along the inside of the shoulder blade. This area is one of the most common complaints. However, this pattern is not one of the most common referrals to that area.
- The most common patterns, in our age of Forward-Head Posture, is from scalenes. The other symptoms like stiff hands and Forward-Head Posture help to point in that direction.
- The middle trapezius creates a feeling of burning or itching instead of pain.
- The pattern of rhomboids is easy to confuse because we often reach while slumping. I fit isn’t clear, try illiciting the pattern with static pressure.
- The multifidi tend to produce patterns that are sharp, small, and in the lamina.
Open the Nerve Roots
This routine for the cervical lamina groove is a great way to open the nerve roots of the lower cervical vertebrae. Often, I go a step further and work in the upper cervical area. Releasing the atlantooccipital area helps in several ways:
- The head is better balanced over the neck
- The lower neck and shoulders are more stable after treatment
- The anterior neck tends to release where it is difficult to treat
Mobilize the Humeral Head.
It is hard to get lasting results when the humeral head is anterior. This occurs when working the tendon of the subscapularis. This mobilization through tendon work is why so many therapists focus on subscapularis work. This tendon routine treats the humeral head from several different angles. I often get relief by merely mobilizing the humeral head with static pressure. In this case, gentle sustained static pressure for a few minutes can be amazingly effective. Additionally, shift your contact to find and release tight fibers between the greater tubercle and the coracoid process.
Treat the proprioceptors in the tendons
Review this routine on the treatment of the Rotator Cuff tendons from The workbook of Classical Neuromuscular Therapy. Surprisingly effective for releasing the rotator cuff muscles.
Direct treatment of the trigger points
Review this routine on the treatment of the Posterior Scapula from The workbook of Classical Neuromuscular Therapy. This directly addresses infraspinatus.
Review this post about self-care of the infraspinatus. This information should be a part of your closure and self-care for patients. Especially, be familiar with how to assist your client in using a ball to compress and release trigger points in the posterior shoulder.
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Tony Preston has a practice in Atlanta, Georgia where he sees clients. He has written and taught about anatomy, trigger points, and cranial therapies since the mid-90s.
*This site is undergoing major changes. We are reformatting and expanding the posts to make them easier to read. The result will also be more accessible and will include more patterns with better self-care. In the meanwhile, there may be inconsistency in formatting, content presentation, and readability. Until we get older posts updated, please excuse our mess.