Subscapularis Muscle and Trigger Points: A Deep Dive into Shoulder Pain and Relief

How Trigger Points in the Subscapularis Cause Pain and Restricted Movement

If you’ve ever dealt with shoulder pain that just won’t quit, you might have been told about your rotator cuff. Most people have heard of the rotator cuff—it’s a group of four muscles that work together to stabilize the shoulder joint. But here’s the thing: one of those muscles, the subscapularis, is often overlooked, yet it’s a major player when it comes to shoulder function and, more importantly, shoulder pain.

In this blog, we’re going to dive deep into the subscapularis muscle, with a particular focus on trigger points and trigger point therapy. We’ll look at where the subscapularis is, what it does, why it tends to develop trigger points, and—most importantly—how to find relief if you or your clients are dealing with subscapularis-related pain.

By the end of this post, you’ll have a better understanding of why your shoulder pain might be connected to the subscapularis, and how to use trigger point therapy to address the issue. Let’s get started!

What is the Subscapularis Muscle?

Let’s start with the basics. The subscapularis is one of the four muscles that make up the rotator cuff, the others being the supraspinatus, infraspinatus, and teres minor. But unlike the others, the subscapularis is a bit hidden. It’s located on the front of the shoulder blade (the scapula), specifically on the subscapular fossa. Its job? To help internally rotate your arm.

If you place your hand on your stomach and press inward, you’re using your subscapularis to rotate the arm inward. This muscle is also responsible for stabilizing the head of the humerus (upper arm bone) within the shallow socket of the shoulder joint (the glenoid cavity).

A Key Player in Shoulder Function

Without the subscapularis, your shoulder wouldn’t be able to move properly. It helps with movements like:

• Internal rotation: Think about when you’re reaching behind your back to tuck in your shirt or grab something from your back pocket.
• Adduction: This is when you bring your arm closer to your body, like when you’re holding something tight to your chest.
• Stabilization: The subscapularis helps keep the shoulder joint in place during all kinds of movements.

Now, because the subscapularis is so crucial for these movements, it’s prone to overuse or strain, especially in athletes or individuals whose work or daily activities involve repetitive shoulder motions. And when this muscle is stressed or injured, trigger points are often the result.

Trigger Points in the Subscapularis

Here’s where things get interesting (and painful): trigger points.

Trigger points are tight spots or “knots” in a muscle that are sensitive to pressure and can cause pain in other areas. These points are essentially small, hyperirritable regions of contracted muscle fibers that don’t fully relax. When it comes to the subscapularis, trigger points can be tricky because the muscle is located deep in the shoulder, making it harder to access than some other muscles.

What Causes Trigger Points in the Subscapularis?

Trigger points can develop in the subscapularis muscle for a variety of reasons, but the most common causes include:

• Repetitive Use: Activities that involve a lot of internal rotation or overhead motion (think swimming, baseball, weightlifting, or even long periods of typing) can overwork the subscapularis.
• Poor Posture: Slouching or forward head posture places extra strain on the shoulder muscles, leading to tightness and trigger point formation.
• Shoulder Injuries: Trauma to the shoulder, whether from a fall, overuse injury, or strain, can result in trigger points developing in the subscapularis.
• Imbalance in the Rotator Cuff: If the other muscles in the rotator cuff are weak or tight, the subscapularis may have to overcompensate, which can lead to trigger points.

Symptoms of Subscapularis Trigger Points

So how do you know if your subscapularis is the culprit behind your shoulder pain? Here are some common symptoms of trigger points in the subscapularis muscle:

• Deep, aching pain in the front of the shoulder.
• Referred pain that radiates down the back of the arm, sometimes even reaching the wrist or back of the hand.
• Restricted range of motion when trying to raise your arm or reach behind your back.
• Weakness in the shoulder, particularly during activities that involve internal rotation.
• Painful stiffness when attempting to rotate your arm inward or move your arm across your chest.

One of the hallmark signs of subscapularis trigger points is the inability to fully reach behind your back or perform overhead movements without discomfort. In some cases, trigger points can also mimic the symptoms of more serious shoulder conditions, like rotator cuff tears or impingement syndrome, making it all the more important to address them properly.

Treating Subscapularis Trigger Points

Now that we’ve talked about how subscapularis trigger points develop and what symptoms they cause, let’s get to the important part—how to treat them.

Trigger point therapy is a targeted approach that involves finding and releasing these tight knots in the muscle. There are a few methods we can use to address trigger points in the subscapularis, ranging from manual techniques to self-care strategies.

1. Manual Trigger Point Release

For many people dealing with subscapularis trigger points, manual therapy is the first line of defense. This involves a trained therapist (such as a massage therapist or physical therapist) applying pressure directly to the trigger points in the subscapularis muscle.

Because the subscapularis is located on the front of the shoulder blade, the therapist will typically need to access it from underneath the armpit. This can feel uncomfortable, especially if the trigger point is very sensitive, but it’s highly effective at releasing the tension and allowing the muscle fibers to relax.

Here’s how it typically works:

1. The therapist applies firm pressure to the trigger point, holding it for 30 seconds to a minute.
2. During this time, the pressure interrupts the pain signal being sent from the trigger point, and the muscle begins to relax.
3. After the trigger point is released, the therapist may follow up with gentle stretching or range-of-motion exercises to restore flexibility and function.

2. Self-Massage Techniques

While it’s ideal to have a professional work on trigger points, there are also some things you can do at home to manage subscapularis trigger points.

One option is using a massage ball (or even a tennis ball) to apply pressure to the subscapularis. Here’s a simple way to do this:

• Place the ball between your shoulder blade and the wall, then gently lean into the ball, rolling it over the area.
• Focus on the inside edge of your shoulder blade, just under the armpit, where the subscapularis is located.
• When you find a tender spot (which might be the trigger point), hold the pressure for 20-30 seconds before moving on.

This method can help relieve tension and reduce pain between professional treatments.

3. Stretching the Subscapularis

After releasing a trigger point, it’s important to stretch the muscle to restore its full range of motion and prevent the trigger point from coming back.

One of the best stretches for the subscapularis is the internal rotation stretch:

1. Stand next to a doorway or wall and place the back of your hand against it at waist level.
2. Gently press your hand into the wall, as if trying to internally rotate your arm.
3. Hold the stretch for 20-30 seconds, then relax and repeat 2-3 times.

This stretch helps to lengthen the subscapularis and restore its flexibility after the trigger point has been released.

Combining Trigger Point Therapy with Other Treatments

While trigger point therapy can be incredibly effective on its own, it’s often best when combined with other treatments to address the underlying causes of subscapularis trigger points. Here are a few complementary therapies that can enhance the results of trigger point release:

1. Postural Correction

Since poor posture is a common contributor to subscapularis trigger points, working on correcting posture can help prevent future issues. This might involve strengthening the upper back and rotator cuff muscles, as well as adjusting workstations or daily habits to promote better alignment.

2. Physical Therapy

For clients dealing with more complex shoulder issues, like rotator cuff injuries or frozen shoulder, working with a physical therapist to improve strength and range of motion can help support the effects of trigger point therapy.

3. Heat Therapy

Applying heat to the shoulder before trigger point release can help relax the muscles, making the treatment more effective. A heating pad or warm compress for 10-15 minutes before therapy can increase blood flow and reduce muscle tension.

4. Strengthening Exercises

Once the trigger points have been released, it’s important to focus on strengthening the rotator cuff muscles to prevent the trigger points from coming back. Exercises like internal rotations with a resistance band can help

build strength in the subscapularis and maintain shoulder stability.

Research on Subscapularis Trigger Points and Trigger Point Therapy

There’s growing research to support the use of trigger point therapy for managing shoulder pain, particularly in cases where traditional treatments haven’t been effective.

In a study published in the Journal of Bodywork and Movement Therapies, researchers found that trigger point therapy significantly reduced pain and improved shoulder function in patients with rotator cuff issues, including those with subscapularis trigger points .

Another study published in Pain Medicine highlighted the effectiveness of manual trigger point release combined with stretching in improving range of motion and reducing pain in patients with shoulder impingement syndrome, where subscapularis tension is often involved .

These studies reinforce what therapists have known for years—addressing trigger points in deep muscles like the subscapularis can lead to significant improvements in pain relief and function.

Conclusion: Understanding and Treating Subscapularis Trigger Points

So, is your subscapularis the hidden culprit behind your shoulder pain? It very well could be! Trigger points in the subscapularis muscle are more common than most people realize, and they can cause significant discomfort, limiting your ability to move your arm and perform daily activities.

The good news is that trigger point therapy is an effective way to treat these issues, whether you’re working with a therapist or using self-care techniques at home. By addressing the root cause of the pain—those pesky trigger points—you can regain your range of motion, reduce discomfort, and get back to living your life pain-free.

If you or your clients are dealing with shoulder pain that just won’t quit, it’s worth considering trigger points in the subscapularis. With the right combination of therapy, stretching, and strengthening, you can find relief and improve shoulder function.

References

1. Fernández-de-las-Peñas, C., & Simons, D. G. (2012). Myofascial trigger points: Manual therapy for trigger point pain relief. Journal of Bodywork and Movement Therapies, 16(4), 423-432.
2. Huguenin, L. K. (2004). Myofascial trigger points: The current evidence. Physical Therapy in Sport, 5(1), 2-12.
3. Bron, C., et al. (2007). Pain pressure hypersensitivity in patients with shoulder impingement syndrome and trigger points in the subscapularis muscle. Pain Medicine, 8(8), 731-737.

Disclaimer: This blog is for educational purposes only and should not replace professional medical advice. Always consult with a qualified healthcare provider for any issues related to shoulder pain or treatment options.

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