deep tissue massage bruising Massage Case Study: Shoulder pain after surgery

Pain and range of motion restrictions following shoulder surgery are common. How should we approach these areas as massage therapists? What techniques should be use, and which should we avoid?

0:25 Interviewing a massage client
1:40 Dealing with surgical implants during a massage
2:20 Mirroring the client's self-reported pain
3:03 Client demonstration: Warming up the shoulders
6:14 Unilateral shoulder massage
7:18 How to turn the head: https://www.youtube.com/watch?v=SQAHh...
8:18 General myofascial release for the painful shoulder
9:16 Using joint compression to mobilize the shoulder
10:27 Working with the pain more directly
10:45 Do I need to break up scar tissue or adhesions?
11:58 Working with referred pain
14:05 Cradling the arm to mobilize the shoulder
17:25 Working with the shoulder while prone
19:07 Body mechanics for working with the lateral scapula
20:05 Working specifically with the rotator cuff muscles
22:59 Repositioning the arm

In this video, I demonstrate how I work with one particular case of shoulder pain. This won't apply to every client, but I think that the general strategy I lay out will apply to many people with lingering shoulder pain/dysfunction following surgery.

I start with the interview. This is where I determine the history of the shoulder: What prompted the surgery, the surgery performed and any hardware implanted, and what symptoms still exist. I ask about range of motion restrictions, and where the client feels the "pull" when they reach that restricted end-range. This can give me clues about where I should be working. The anterior shoulder pain in this particular case makes me suspect the infraspinatus, but I still work broadly rather than just focusing on that one muscle.

When working with dysfunctional shoulders, I like to introduce plenty of safe movement. A common phenomenon in tight or frozen shoulders is a reflexive tensing of muscles whenever the arm is brought into certain positions. By exploring the existing range of motion and applying pressure, I want to convince the nervous system that there is no danger that needs to be braced against. This is a process that can take a number of sessions.

I make sure to work with the synergists and antagonists of the muscles involved, including the deltoids, pecs, traps, and all rotator cuff muscles. No dysfunction occurs in isolation.

When I do specific work like trigger point therapy, I make sure to err on the side of doing too little, and I frequently reintegrate those small areas with the body at large. Too much focus on one area can reinforce the idea of the "bad shoulder," and that's not the message I want to send.

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deep tissue massage bruising Massage Case Study: Shoulder pain after surgery
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