subscap, "the sour patch kid"

"I haven't been able to reach above head in years." "I can't put my seatbelt on or take off my bra without pain". "Both of my shoulders are so messed up, I can't even brush my hair without it hurting." 

I hear complaints like this all too often. I also hate to say this but I also hear, "I tried bodywork and massage, but it didn't help." If the therapist does not have the specific skill set, odds are pretty good that massage therapy won't help much. 

The subscapularis, or subscap, is a very difficult muscle to find and palpate, let's face it- I have never had a client that is just overwhelm with joy when we do subscap work, although they do love the benefits. As one client said to me "It is kind of like a sour patch kid. Sour then sweet but also feels like you shouldn't be in there." But the pain-free range of motion was appreciated after the session. 

Real quick, lets break down the anatomy. The subscap is a thick muscle with a broad tendon that covers the anterior portion of the scapula and reinforces the shoulder joint. The muscle functions to stabilize, internally rotate, depress, and adduct the humerus. It's a pretty badass muscle and does a lot for the strength of our shoulder (making up about 50% of the rotator cuff strength) and joint centration. It also counteracts the powerful force of the deltoid. I could go on and on about this guy. Important trigger points to remember are across the shoulder blade, down the arm, and around the wrist (this one is often overlooked). 

A lot of therapist think they are on the subscap when they are in fact palpating the fat lat or the teres major. It is an easy mistake and easy to correct, I had to learn for myself. Why is this so common? Many therapist attempt to enter the subscap far too inferiorly, which causes a roadblock by the ribcage and the lat is mistaken for the subscap. Here is my tip:
Pinpoint your location by sliding your fingers laterally to feel the lateral border of the scapula. If you are lateral to the lateral border of the scapula, you are on the lat or teres major, not subscap. This is still fantastic work, but the client could be missing out on a lot of benefits. I always think: "to palpate the subscap, my fingers must be medial to the lateral border of the scapula."

Hope this helps,

Sara

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