Issue link: https://www.massageandbodyworkdigital.com/i/1191154
Before we discuss palpation and strategies to make subscap work more palatable for the client, let's review the anatomy. The subscapularis is a thick muscle with a broad tendon that covers the anterior scapula and reinforces the shoulder joint (Image 1, page 65). This muscle functions to stabilize, internally rotate, depress, and adduct the humeral head in the glenoid fossa. Attachments are the medial border of the anterior surface of the scapula and the lesser tubercle of the humerus. This sturdy muscle provides 50 percent of the strength of the rotator cuff. The subscap plays a vital role in joint centration, depressing the humeral head (along with the other rotator cuff muscles) during abduction of the shoulder joint, and counteracting the powerful force of the deltoid. Weakness of the subscap—or as I like to think of it, disruption of its ability to function at full capacity—can lead to anterior glide syndrome as the larger internal rotators drive the humeral head anterior, which often leads to impingement syndrome. Another important function of the subscap is its eccentric activity, protecting the shoulder joint during external rotation. The scapula rests on the serratus anterior and subscap, which move across one another as the scapula moves. Working on these muscles assists the scapula to glide on the thorax. 66 m a s s a g e & b o d y w o r k j a n u a r y / f e b r u a r y 2 0 2 0 The shoulder joint follows the scapula, and increasing scapula stability and mobility leads to increased glenohumeral joint function. Skilled comprehensive work on the subscap is essential for recovery from rotator injuries. Trigger points refer across the shoulder blade, down the arm, and around the wrist (Image 2). PALPATION: FIND THE RIGHT SPOT I've discovered that approximately 80 percent of therapists in my workshops think they're on the subscap when they're on the latissimus dorsi/teres major. It's an easy mistake to make and easily correctable. The reason for this common error is because therapists attempt to enter the subscap too far inferiorly, which causes the ribs to block the therapist, and they mistake the fat lat for the subscap. The best place to enter subscap territory is the central portion of the muscle. Bear with me while I use this analogy. I live in beautiful Austin, which is in central Texas. Dallas is north and San Antonio is south. If I try to enter subscap in the San Antonio area (south), I'll most likely mistake the latissimus dorsi for the subscap (Image 4). If I enter in the Dallas area (north), I'll probably hit the tendon, which is fine if that's where I want to start (Image 3). I prefer to enter through Austin (central), Trigger points. Image courtesy of Peggy Lamb/Massage Publications. 2