Shoulder Pain and Boundaries

I commonly hear the concern about a tight knot or muscle tension in the area between the scapula and the spine. While this pain on the medial side of the scapula could be a referral pattern from the levator scapula as discussed in my Nagging Neck Knots blog, it could also be due to trigger points in the infraspinatus muscle. 

What are Trigger Points?

Trigger points are formed in muscles when a small number of fibers contract locally. This knot can pull on tendons and ligaments and cause both pain at the trigger point site itself or refer pain elsewhere. You can usually feel a trigger point as a nodule in the taut bands of muscle fibers. 

The Infraspinatus Muscle and Shoulder Pain

The infraspinatus is one of the rotator cuff muscles, meaning it helps with shoulder movement. It lies right on top of the scapula and helps with externally rotating the arm and stabilizing the head of the humerus during upward movement of the arm. 

While trigger points and partial tears in the infraspinatus can refer pain to the medial border of the scapula, it is often one of the most common causes of shoulder pain. If you have an issue with this muscle, you may feel pain radiating deep into the front of the shoulder joint and extend down the front (anterior) and outside (lateral side) of the arm, even into the forearm and the thumb-side of the hand. Pain could travel upwards to the suboccipital region (base of the skull) and to the back of the neck. You may feel pain when sleeping on either side. It may be difficult to reach behind your back, especially with putting on a jacket or clasping a bra strap.

Often the injury is caused by overloading stresses, like repetitive movements involving the shoulder. This is common in people who are swimmers, tennis players, painters, tattoo artists, estheticians, hair stylists, and carpenters. Pain in this area also becomes more likely as we age. A full thickness tear in this muscle is uncommon, but can happen from acute trauma like a fall.

Western Medicine Treatment

If your doctor believes you have a partial tear and there is no imaging performed, then often physical therapy is prescribed. I think physical therapy is one of the best ways to address shoulder pain. Seeing a sports physical therapy is even better so that your exercises are geared toward continuing an active lifestyle.

Some doctors will recommend steroid injections with the goal of reducing inflammation to lead to less pain. For some people these steroid injections work, and for others the relief is temporary or not at all. In my opinion these injections act as more of a band-aid rather than a solution to treat the root problem. 

Acupuncture Treats Shoulder Pain…and Explores Your Boundaries.

The main acupuncture point on the infraspinatus is Small Intestine 11 (SI 11), or Tianzong, which means Heavenly Gathering. This is a powerful point and is tender on many people when palpated. The point is used to treat the scapular region to alleviate pain due to sprain or injury, painful blockages like trigger points, overuse, or poor posture. It works to remove blockages from the entire Small Intestine channel, but also supports opening the chest and side of the ribs. Since this point lies behind the breasts, it is also used for a wide variety of breast disorders including pain, lumps, and insufficient lactation.

Using acupuncture on this point, particularly electroacupuncture which is acupuncture hooked up to a gentle electrical current, is incredibly effective at treating the infraspinatus muscle. The current helps to resolve trigger points, reduce inflammation, clear up debris, break up scar tissue, and remind the body to bring resources to the area to heal. In this way it helps torn tissue heal faster. Often the improvement is immediate, with shoulder pain reduced and an increase in pain-free range of motion right after treatment.

I think of the shoulderblade and much of the Small Intestine pathway as the protective shield for the heart. It is on the yang side of the body and is like a physical barricade for our vulnerable front side. The Heart lies on the yin side of our body, an area to be nurtured and kept safe. It also is a place where we let in loving and fulfilling relationships. We can think deeper about the back side of the body and get curious about how we are protecting and taking care of our hearts. If there is pain in the infraspinatus/Small Intestine 11 area, I wonder about the protective layers and how the heart is doing. From an emotional angle, this protection could be represented by our boundaries. Do we need stronger boundaries? Or do we have incredibly thick walls that never crack open? Is there a door that can be opened when we choose? Does it feel safe to open that door and what or who are we letting in?

Image: Fellows, M. (2019, June 17). Sort it out….It’s the Small Intestine! Glastonbury Acupuncture. https://glastonburyacupuncture.co.uk/sort-it-out-its-the-small-intestine/

Easy Ways to Support Your Infraspinatus at Home 

It’s likely that you have trigger points or even small tears in your infraspinatus, especially if you’re over 30. There are simple stretch and strengthening exercises you can do to support this muscle and maintain range of motion in your shoulder.

Stretch exercises:

1. Starting with the affected arm at 90 degrees out to the side like a T, extend the arm back, internally rotate the shoulder by bringing the thumb to face down. At full extension bend the elbow and touch the bottom angle of the opposite scapula behind your back. 

2. Pull the affected arm across the chest, using the other arm above the elbow to guide the stretch.

Strengthening exercises:

1. Lie on your back with the arm close to the torso and elbow bent with fingers pointing up towards the sky. Keep your elbow and arm glued to your body and then slowly rotate the forearm as if to place the back of the hand on the floor. Return to the starting position. Repeat 8-10x. As strength develops, you can use very light hand weights to increase the work effort placed on the muscle. You’ll likely feel it even without weights!

2. Complete the same exercise as in #1 but lie on your side with your legs bent and your opposite hand supporting your head, or with your head resting on your opposite arm’s bicep. Keep your elbow pinned to your hip as you externally rotate the shoulder. You can use very light hand weights to increase the intensity.

Emotional Work: How are your Boundaries?

From an emotional point of view, I think digging deep into your sense of boundaries is important work. This can be explored through journaling, meditating, talking with a therapist/somatic therapy, breath work, and acupuncture treatments. I often think about the upper neck/back area like a turtle shell of protection. When it is so knotted and tight, I question if it is there protecting deep-seated emotions that haven’t been explored or noticed. In Chinese Medicine, emotions are a source of disease and so truly seeing and giving love and understanding to deep emotional feelings plays a critical role in bringing ourselves back into harmony and relieving pain. 

Acupuncture can help you move through these emotions, particularly if they feel stuck and heavy. Perhaps by doing the deep work to look inward, our turtle shell of tension in our upper neck/back can soften.

Book a free 15 minute consultation to see how acupuncture could support you.

Sources:

Deadman, P., Al-Khafaji, M., & Baker, K. (2016). A Manual of Acupuncture. Journal Of Chinese Medicine Publications; Vista, California.

Finando, D., & Finando, S. J. (2005). Trigger Point Therapy for Myofascial Pain: The Practice of Informed Touch. Healing Arts Press.

Whitfield Reaves, & Bong, C. (2009). The Acupuncture Handbook of Sports Injuries & Pain: A Four Step Approach to Treatment. Hidden Needle Press.

Gabi Curbelo is a licensed acupuncturist in Albany, CA specializing in therapeutic and intuitive treatments for wellbeing, musculoskeletal pain management, and facial concerns.