The shoulder

Your shoulder is a complicated area because it does several things, which is why when something goes wrong, it can take a while to fix. This is an overall look at how the shoulder works, rather than an anatomy lesson.


Bones and connections

It is important to know a few of the connections that your shoulder muscles make with the bones, so you can get an idea of how complex the shoulder is. There are connections between the shoulder blade (scapula) and collar bone (clavicle); between the shoulder blade, collar bone and top of the arm bone (humerus); between the base of the skull, shoulder blade, collar bone and the trunk of the body.

The shoulder joint isn’t a snug fit like the hip joint. Your hip fits into the hip socket and rarely moves out of the socket, unless there is an injury or your tendons are too loose (hypermobile). The shoulder joint is different because the arm bone is allowed more range of movement and doesn’t fit into the joint as tightly. It also means your shoulder is more prone to injury.

What are the main muscles of the shoulder?

The rotator cuff muscles surround the shoulder, giving it support and allowing it to move. The rotator cuff muscles are the subscapularis, supraspinatus, infraspinatus and teres minor. They connect the shoulder blade to the humerus and keep the head of the humerus in the socket.

When most people think of the shoulder, they think of the back of the shoulder, but the pectoralis major muscle at the front is very important. It helps with support and movement. It attaches to the clavicle, the sternum (breastbone) and to the humerus. Because it attaches to the arm bone, it helps with movement of the arm as well as the shoulder.

The deltoid muscle on the arm is the strongest shoulder muscle. It has three sections. It attaches to the clavicle in the front and at the back, it attaches to the scapula.

The levator scapulae muscle attaches to the neck and goes down to the top of the scapula.

The trapezius (“the traps”) is a large muscle that attaches at the back of the skull, the spine, the clavicle and part of the scapula. Because it covers a large area of the upper back, it is involved in a lot of the movements of the shoulder.

The rhomboid major and minor muscles attach from the spine to the inner border of the scapula, just below the levator scapulae muscles.

The teres major muscle attaches to the lower outside part of the shoulder blade and to the humerus.

The latissimus dorsi muscle (“the lats”) is another large muscle. It runs from the humerus across the back, attaches to the spine and runs down your body to the top of the hips.

What are the most common injuries?

Rotator cuff injury: is when one of the muscles or tendons of the rotator cuff is torn. This can happen from overuse or from an injury.

Impingement: can be painful if there is an injury or inflammation in the rotator cuff muscles. This is because the edge of the scapula (the acromion) presses on the rotator cuff when you lift your arm.

Tendonitis: inflammation of the tendons.

Frozen shoulder: inflammation of the shoulder that limits mobility.

How does your posture affect your shoulders?

Our lifestyles influence how our muscles and joints are held in place. For example, if you do a lot of things in your daily life that involve your shoulders to be angled forward, your muscles will be continually holding your body in that one posture and this leads to you overworking them. Overused muscles tend to get tighter and less flexible, resulting in discomfort and limited range of motion.

What can massage do for tight shoulders?

Massage helps to ease tight muscles by stretching and warming them and encouraging the muscle fibres to relax. The newly relaxed muscles allow the shoulders to be held in a more natural, less tight position. Massage can also help ease pain and discomfort and allow you to move the arms and shoulders more freely.

How often should you have a massage?

You’re an individual and your posture and lifestyle are unique to you. The length of time between massages should be unique as well. Regular massage helps most people whose bodies are affected by less than perfect posture. What does regular mean? That’s up to you. For some people, it’s a monthly massage and for others it’s less often or even more frequent and there are times when you only need one.

What can you do if you can’t afford a massage?

You can usually release the tension in your muscles through a combination of rest, massage, intelligent stretching (e.g. yoga or pilates) or soaking in a warm bath.

You can find free apps online to help you stretch. If you have a tennis ball at home, you can use that to give yourself a massage. Stand against a wall and roll it around the shoulder or lie on the floor and roll it under your body.

If you have an injury or are in pain, see your doctor before you try anything at home. You need a diagnosis and to rule out anything serious.

I hope this has been helpful. As usual, if I’ve made any errors, please contact me.


Massage Myths

I was going to make the title Lies Massage Therapists Tell You, but this wouldn’t be fair because, although there is a lot of nonsense that massage therapists tell their clients, a lot of them truly believe what they’re saying because they were taught it. Even in the course I completed under an examining body that is highly rated, there was information about what massage can do for you that is just not possible. I’ll go through the main myths and help to explain these in terms of the body’s physiology and how they can’t possibly be true. The next time your massage therapist tells you something that doesn’t make sense, question them about why they believe that. There is very little regulation in complementary therapy in the UK and the quality of courses varies.

Massage removes toxins from your body and is great for detoxing

This is nonsense. Your liver detoxes your body at its own rate (see my post on the liver for more information). Nothing you can do will speed that up. If you have been exercising and your muscles are tight, a massage can help to ease the tightness in the soft tissues by improving circulation locally, which may help local toxin removal. This is not the same as the idea of a detox for the whole body.

You feel spaced out after a massage because toxins have been released

This myth was told to me by one of my clients who had heard it from another massage therapist, but it didn’t make sense to me. If massage released that many toxins that you felt light headed afterwards, it surely wouldn’t be good for you. In my own experience, I sometimes feel light headed after a massage and sometimes I feel fine. I have also had clients who normally have low blood pressure and occasionally get dizzy and they usually say they have the same light headed feeling after a massage.

This is what I have concluded and to me, this sounds like a more science-based reason: When you lie down, your blood pressure may drop. Your blood pressure also drops if you relax during a massage or if you were already tired. When you get up from the massage table afterwards, you may feel light headed because of this lowering of blood pressure. I can’t see any other reason, but I’m open to other theories, if they sound reasonable.

You need to drink lots of water after a massage

A number of my clients have been told this by other massage therapists who have told them that you lose water during a massage. If you’re having a sports massage and you’re sweating a lot, that’s fair enough as you’ll be losing fluid through sweat, but other that this, there’s no valid scientific reason why you need to drink more water. Drink when you are thirsty. Your body tells you when you need water. Even if you’ve had a sports massage, you don’t need to drink loads of water, just when you are thirsty.

Massage can speed up your metabolism

There is absolutely no evidence that this can happen during a massage and it makes no sense. Your metabolism is regulated by your endocrine system (which includes the thyroid gland). A massage can’t possibly influence this system and therefore your metabolism will be the same before and after a massage, even if you have regular massages.

Massage increases your blood circulation

This does happen on a local level, wherever you have been massaged. It won’t make a permanent difference if you feel you have poor circulation. It may increase during the massage and straight after and that’s it.

Massage can help you to lose weight and treat cellulite

I’m sorry to be the bearer of bad news. There’s no quick fix for weight loss or cellulite removal.

For cellulite, massage may help temporarily hydrate the cells in the surface of the skin (which is what cellulite creams do). The hydrated cells are fuller and give the skin a firmer appearance, so it may seem that cellulite has been removed, but once the skin returns to its normal state, you’ll notice less of a change. I would assume you’d be offered a course of massages to remove cellulite, rather than just one. You may also be told to eat healthily and exercise more, which may help the appearance of your skin if you weren’t already following a healthy lifestyle. You can do all this on your own without paying for massages. There is no proven research on massage for cellulite removal.

For weight loss, it makes no sense that massage would be of help. If you were changing to a healthier lifestyle, having a massage may help you feel more in touch with your body and more encouraged to lose weight by exercise and eating healthily. On its own, massage cannot make a difference.

Where it may possibly help is if you were retaining water, there are certain types of massage that may help to release excess fluid. However, if this is the case, you’d need to know why you were retaining water in the first place and you should see your GP first. If you retain water because of a medical condition and a massage helps to remove this, it will only be temporary because the underlying condition will still be present.

Massage can balance your energy

This is a concept from Chinese medicine and there is no scientific proof that any “energy” exists that needs to be balanced. There are therapists who take what sounds like a mysterious or romantic idea from another culture and mix it with accepted Western therapies, often having very little understanding of the culture they appropriated it from.

So what can massage do then?

Massage can help to relieve pain by easing tension in the soft tissue of the body. Tension can restrict movement, making it painful and uncomfortable. Massage can help to relieve this discomfort.

Massage can help you relax. Allowing someone else to take care of you for an hour or so can be psychologically therapeutic.

You may feel more in touch with your body after a massage. We learn to disconnect from our bodies as we get older. My clients are often surprised when an area of their bodies is tight because they were only aware of one other area that was causing a problem. People often get used to having tight shoulders that they hold high up, rather than relaxing and allowing them to drop naturally. After a massage, my clients often report that their shoulders feel like they’ve dropped back down. I ask them to focus on that feeling, so they know in future where their shoulders are meant to be.

Massage can help you recover after an injury. I’ve worked with clients after accidents and injuries. Mentally, it is helpful to have someone who wants to help you. Physically, when you’re healing from an injury or are on crutches, you end up using your other muscles to help out, which means they’re working harder than usual and there may be a build up of tension. Scar tissue may be reduced by regular sports massage.

Sports massage is helpful during training for a sports event or if you are very active. I have worked with professional dancers as well as people who are training for marathons and other sports events. Regular sports massage helps ease muscle tension, which helps muscle and joint flexibility. This in turn helps prevent injuries and improves performance.

Massage during pregnancy can help deal with aches and pains in the shoulders, lower back and hips. It can’t trigger labour though. I have been seeing pregnant women in my practice for twelve years and not one of them has gone into labour. Some of my clients have been at their due dates or even a little past and nothing I have done has made any difference to when the baby has arrived. It can make you more relaxed, it can help ease tension, it may even help you sleep better if tight muscle was preventing this, but that’s about it.

Massage during labour may help ease tension in the muscles of the hips and thighs. I teach a course to couples, so that fathers-to-be can learn a simple massage routine to help during labour. It focuses on the muscles that are being used during labour and so far, feedback has been positive.

In conclusion

There is, unfortunately, a lot of nonsense in the massage world. If you get told something that sounds wrong or silly by someone giving you a massage, why not ask them why or what the science behind it is? Perhaps they’ve never thought it through but were taught it at some point and you may be able to prevent that myth spreading further.