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Shoulder and Upper Back Pain

The most common request I receive, as a massage therapist, is to work on a client’s upper back and shoulders.


September 27, 2012
By Shari Auth LMT LACU

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The most common request I receive, as a massage therapist, is to work on a client’s upper back and shoulders. The upper shoulder rub is a cliché of the massage profession. Most massage therapists can relate to being at a party, introducing themselves as a massage therapist, and having the other person, in jest, offer them their shoulders to rub.

Many people store tension in their upper back and shoulders, a.k.a. “the weight of the world on your shoulders” syndrome. In truth, many of my clients who chronically complain of tightness in the back of their shoulders are unaware of how much tension they are storing in the front of their shoulders, that is, in their chest. Accumulating tension in the shoulders can start a step deeper – in the tightening of the chest muscles.

Many clients who have upper back and shoulder tightness have shoulders that round forward. This rounding can be caused by a tight chest and diaphragm pulling the shoulders forward over the heart. In this case, the backs of the shoulders work doubly hard to hold themselves up, since there is no longer support from an open and functioning front body.

I’ve had many clients who just wanted me to pound away on their tight shoulders and upper back. This approach, though I’m sure it would feel good for the client, is only treating the symptom and not the cause.

When the front and back aspects of the body are balanced, the shoulders can slide down the back. If the front body is collapsing, the back of the shoulders becomes responsible for compensating for this.

In short, tight shoulders are a symptom and a tight chest may be the root cause. There is a popular adage in Chinese medicine about the importance of treating the root and not the branch. If you treat the branch your client will in time develop the same complaint again and again; if you treat the root they will come to you the next time they have an ailment, knowing you have solutions that work.

Auth Method
The Auth Method is a system of massage that takes the practitioner’s body into consideration. It was developed in the belief that, with the right tools, technique and body mechanics, performing massage can be effortless for the therapist while still offering benefits to the patient. One of those tools is using the forearms instead of the hands as your primary massage tool.

When using your forearms, it is advised to use the upper third of your forearm, because you’ll have more leverage than when using the middle or lower forearm. The forearms are perfect for chest massage because they are less pokey than the fingers or elbows and allow the practitioner to work a larger portion of the chest at once.

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Image 1: Use your lower arm to apply deep pressure to the anterior chest area and shoulder. 
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Image 2: Use light pressure to continue this stroke all the way to the elbow. 
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Image 3: Repeat the stroke, moving the hand forward toward the table – while the stroke is in progress, move the hand back to resting position. 
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Image 4: To get in deeper, move the client’s hand forward toward the table and then begin to straighten their arm, causing the pectoralis to stretch more.


 

Working the Chest
Position your client comfortably in supine position. Undrape their arm and upper chest by folding over one corner of the sheet or towel. Begin with basic effleurage to spread oil over upper chest, arm, and hand. Standing alongside the client, abduct the client’s arm out to 90 degrees with their elbow bent to 90 degrees as well. Holding the client’s right hand with your left hand and vice versa. Give a gentle rocking of their arm to ensure their arm is relaxed. Gently rest their upper arm on the table, still holding their hand with their elbow bent. Gently place the upper part of your forearm on the client’s chest just above the drape and just medial of the sternum. If your client has large breasts, move the breast tissue out of the way by bringing your forearm into contact with the chest in a slightly downward direction. Your hand should be just below their elbow or upper arm.

Your whole lower arm will be in contact with your client (Image 1). Begin your stroke by following the fibres of the pectoralis major muscle, moving along the medial border of the sternum up toward the clavicle, move laterally along the posterior clavicular border, passing just under the shoulder joint and onto the attachment of the pectoralis on the intertubercular groove of the humerus. The stroke can be continued all the way down to the elbow, although this latter half of the stroke is performed with light pressure (Image 2). If needed, the beginning part of the stroke over the pectoralis muscle can be performed with deep pressure. Simply hover your upper body over the stroke, dropping your body weight onto their chest. I find it doesn’t take much body weight to deliver the pressure needed to work deeply in this area. When you reach the end of the stroke, lift your arm up off their body and start from the beginning. Repeat this stroke a couple of times, varying the location of your forearm stroke to ensure that the whole area has received adequate work.

Passive movement
Passive movement is a great way to intensify this stroke. By moving a joint that articulates with of an area of tension, the tissue loosens from the inside out. This can be necessary for areas of built-up tension, but it’s also an easy way to work deeper on your client without putting additional stress on your own body. Try this stroke again, but this time instead of holding their arm stationary, move their hand forward toward the table (Image 3). This will open the shoulder joint and put the pectoralis muscle on a mild stretch. While continuing your stroke, take the arm back to its original position, releasing the stretch. When moving the client’s arm back and forth the pectoralis muscle oscillates between a relaxed and a stretched state, assisting in the release of tension in this area. Positioning a muscle “off the stretch” softens the muscle and allows the practitioner to work deeper. Positioning a muscle “on the stretch” makes the muscle more taut and intensifies bodywork on the stretched area. Play with this movement a couple of times to get the hang of this tool. Be sensitive with your pressure when stretching. To get in even deeper, move your client’s hand forward toward the table and then begin to straighten their arm, bringing the pectoralis into an even deeper stretch (Image 4).

In addition to massaging the pectoralis major, massaging the anterior deltoids, diaphragm and pectoralis minor will assist in bringing the shoulders back and opening the chest. Encourage your clients to take a deep breath into their chest after this work; they are likely to comment how much easier it is to breathe deeply. With their chest more open it will be easier for them to bring their shoulders back, releasing tension in the back of the shoulders.

When practising the Auth Method, it is not necessary to use muscular force; simply drop your body weight onto the tissue, you’ll naturally sink to the most superficial layer of tight tissue. As that tissue releases, you will sink into the next layer. This patient process of working layer by layer creates a massage experience that is deep without being painful for the client or strenuous for the practitioner.


Shari Auth is a licensed massage therapist and acupuncturist, and is certified in the Rolf method of structural integration and Chinese herbology. She is the founder of the Auth Method and has a DVD, book and home-study course on forearm massage, as well as a new DVD titled Forearm Massage: A Guide To Side-Lying Position.She teaches CE workshops and is an NCBTMB-approved provider. For more information, visit www.authmethod.com .


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