It happens weekly if not daily, a client walks into my room and says that their neck and upper shoulders (traps) are tight. Usually causing tension neck aches and or headaches. Sometimes even nerve related symptoms like hands falling asleep can accompany this
client.
What is next? How would I proceed at Hands Made for Healing Well, let’s find out?
In a basic massage, the order of events would be simple. The client would go face up on the table and the massage would begin as you can imagine with work commencing on the neck. There is nothing wrong with this approach. Here is the thing, massage does not work the “knots” out. In fact, saying there are “knots” in muscles is anatomically impossible. A muscle cannot tie itself in knot period. Sounds good right, but then what do you feel when a therapist runs over a tender point? There are many different explanations such as adhesions, trigger points, strains, sprains, or bruises to name a few. Now, massage can in various ways help all of those issues stated, but if you envision massage as taking a tough steak and rolling over it until it cuts with a plastic fork then you may be mistaken. This begs the question; how does massage relax my muscles so much then? The answer is by up regulating our parasympathetic nervous system (PNS)and down regulating our sympathetic nervous system(SNS). Our PNS is in our rest, relax, and recover system. This is how our body heals. The other our SNS is what commonly referred to as our fight or flight system. Both serve a purpose and are needed. The problem is our SNS likes to take over too much and never really calm down. It can be activated by both physical, emotional, and mental stress. To sum that all up our nervous system controls way more structurally, like muscle tension, than is possible to overcome with human strength. Now we come full circle back to massage and its effect on the neuromuscular level. That is the reason for the sense of feel good after a typical massage. Again, still highly effective in a lot of cases, but the biggest issue is we never really figure out the why of the problem. Which in this case is why are the upper shoulders so tight anyway?
Now let us say you schedule an integrated manual therapy session with me instead. The idea here is simple. We want to find the root cause of your tight traps and or back and address that. I usually will still do some neuromuscular work just to calm them down, but most of the time the problem exists elsewhere. The first thing I like to watch is how the scapulas are moving when the client does a forward-facing wall slide. In a good healthy shoulder, they should downward rotate from the contraction of your serratus anterior muscle. Often, the scapulas are adhered to the rib cage and cannot move or the serratus anterior is simply too weak to rotate it down. In either case the trapezius likes to take over and work overtime to compensate for this problem. Once I see this, I like to have the client do front facing wall slides for high reps and really get those serratus muscles fired up. Second thing I look for the Thoracic spine mobility (tspine). Our Tspine should have some degree of mobility after all there are joints at each vertebra, so flexion/extension and some rotation should be achievable. I test this with a few easy mobility test and just feeling there rib spring or lack of. I will also look to see if a client exhibits an extreme curve or hump in the tspine area. In a simple way good mobility here helps mobility in the scapulas. I may add some active cupping therapy to during movements if I see the need arise. Sometimes there are immediate effects but other times sending the client home with home care retraining work is needed along with a follow visit. I have had great success in treating not only trapezius pain but shoulder pain in general when approaching it this way.
(Video Credit goes to Eric Cressy of Eric Cressy Performance)
What is the lesson here? Pretty simple, just because it hurts does not mean it is the problem. Sure, go try a regular massage and if it helps then great problem solved, but if it doesn’t do not write off massage as rubbish. The solution may require you to dig a little deeper or seek out a different perspective.