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Sports massage or Physio?

Jan 11th, 2014

Andrew asked The Guru for the following Physiotherapy Advice:

Andrew asked The Guru for the following Physiotherapy Advice:

Hello,

I play squash twice a week and am right handed. I have lately been experiencing a lot of stiffness and pain in my left shoulder. I don’t know if it’s related to sport or lifting. In my job i carry a heavy bag full of files and am often running up and down stairs with it, perhaps it’s caused by this?

What would be the best course of action, please? Should I try a deep tissue/sports massage or go for physio?

Thank you,

Andrew.

The Guru Responded:

Hi Andrew

I guess it all depends on what you want to get out of it….

Sports Massage will help you feel better, as it’ll get rid of the soft tissue restrictions. What it won’t do is give you the ability to move better so it won’t return.

Physio [ with trained sports physios] will get you better, as it’ll treat the cause and not just the symptoms. It may take a little longer for you to feel the benefits, but the results will long term.

Here’s why….carrying the files and playing squash will lead to you fixing and stiffening up your thoracic spine. As you’re a smart bloke you’ll want to look forward to see where you’re going. Because you thoracic spine is stiff, this looking forwards will cause you to poke your chin out.

It’s the chin poking bit that stretches the front bit of your discs in your neck, which gives this really characteristic referred pain into your shoulder….left or right.

So, you need your thoracic spine and the front bit of your neck treated, not just soft tissue release around the painful bits.

Hope this helps.

Vincent Mac Responded

I would have to say I totally disagree with this advice from the guru. Without making a physical assessment of Andrew’s injury I don’t think it’s fair to say massage can’t really help him. Firstly, we don’t know what the range of motion in the shoulder is like. If the stiffness in the shoulder is caused by a restricted Subscap muscle or another one of the rotator cuff muscles, then massage can treat the cause and the symptoms. We also don’t know what the range of motion in the neck is, particularly with rotation to the left. Is the Levator Scapula muscle restricted, bound or otherwise compromising movement in the neck? Are the Rhomboids involved because of an imbalance with the Pec Major/Minor on is left side? All these soft tissue restrictions can be treated and resolved with specific massage techniques in order to bring full range of motion and a decrease in pain back to the shoulder.

Carrying the files will also depress the scapula and the acromioclavicular joint on his left side which in turn stretches the levator muscle & upper trapezius on the same side, maybe these muscles are causing the stiffness?

The front motion of the chin as is described by the guru is usually fired by muscles in the front of the neck such as the anterior scalenes and the sternocleidomastoids. The attachments of these muscles would not however move any part of the disks in your neck! If that was the case you would surely have far greater pain in your neck area and very little range of motion at all. In my experience as medical massage therapist I’ve never heard of a case where the disks in the neck get “stretched” because of forward head motion, especially as I’ve said, the attachments for the muscles I’ve described are on the facet joints and the spinous processes of the neck vertebrae! I don’t see how its possible for that movement of the chin to have any effect on the disks unless there’s another more serious underlying injury in the neck.

My advice would be to have the shoulder and neck tested for range of motion to see if muscles in the area are causing your problem. Ultimately, there’s no way an assessment can be made of your injury without a qualified therapist getting their hands on you and doing the appropriate tests. Good luck!

The Guru Responded:

Hi Vincent

Thanks for the comments. I’m not sure I said that massage can’t help, on the contrary I said it will make you feel better as it will get rid of the soft tissue restriction.

I’m not sure it will provide long term relief as the cause needs to be identified, and you’re correct in saying that it can’t be on an online basis. However, this is chicken and egg. Does posture produce tight muscles or doe tight muscle produce poor posture. As long as you roast the chicken and scramble the egg, you still get fed.

Just relieving soft tissue is only half of the solution.Β If you didn’t/don’t know that the front portion (only) of cervical discs give a very definite referral pattern in to UT/LS/Rhomboids when irritated (a la work of Cloward) then this will all seem like double dutch.

If you don’t have the ability to move better, and regain better control of the surrounding soft tissues and muscles then you’ll feel better, but can’t get better – long term

Vincent Responded:

Thanks for the reply and for the info on the cervical discs. I will look into this further as its always nice to learn about new areas of the body that can refer pain!

The chicken & egg analogy is very true also! Apologies for the tone of my original post. I’m just very passionate about the work I do and about massage in general πŸ™‚

Be well!Β V

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