Infraspinatus Muscle Pain And Trigger Points

 

The Infraspinatus muscle is a common pain troubleshooter in athletes, musicians and desk criminals.

 

It is one of the four muscles of the rotator cuff. If you are working a lot in a bend over position, do lots of desk work or with your arm extended over your head, you are prone to develop a troubling infraspinatus.


People that often suffer are painters, rock climbers and desk workers. Also musicians that have to play their instrument with their arms or shoulders elevated, often develop trigger points in this muscle.

Content

Pain Zone

Attachment Points

Function

Overuse

Impaired Movements

Palpation

Self-Massage


Pain Zone


When trigger points are present in your infraspinatus muscle, they can give you pain right at their location and send pain to other, seemingly unrelated areas of your body.


The upper three trigger points - X1 – X3, shown under “Attachment Points” - mainly send pain to your upper neck and your shoulder. Moreover pain may radiate down the area of your biceps and into your inner elbow. Additionally the back of your forearm and hand may be painful too.
But pain can also be sent to your inner forearm and palm  - not shown in the pictures -.


The forth trigger point - X4 - sends pain to the outer and inner side of your shoulder blade and often is experienced as a burning pain.


This muscle can be involved in...


The intensity of the colour indicates how common pain in the respective areas is experienced. The darker the colour, the more common it is that you might feel pain there if trigger points are present in your infraspinatus muscle.



Attachment Points

The infraspinatus muscle attaches at the surface below the spine of the scapula and at the tuberculum majus.



The spine of the scapula is the prominent line that runs horizontally on the scapula. If you take your hand and lay it down with the palm on your opposite shoulder, you should be able to feel this spine with your fingers.



The tuberculum majus is the outer and upper part of our upper arm bone. This bone is also called the humerus.


Function


Some anatomy books say the infraspinatus muscle only does an outward rotation of the shoulder. An example for an outward rotation is when you rotate your hanging/loose arm so that your palm starts to turn away from your body - see pictures below -. The left arm would rotate counterclockwise; your right arm would turn clockwise.



Beside the just mentioned function, together with the other muscles of the rotator cuff – subscapularis, supraspinatus, teres minor – the infraspinatus muscle also stabilizes your shoulder while you move it.


Thus it helps the top of our humerus to stays nicely in place and connected in the shoulder joint. The more you abduct your arm, the more it gets activated. Bending your arm in this position will lead to activation peaks of this muscle - right picture -.


Infraspinatus Overuse And Trigger Point Development


During activities like rock climbing the infraspinatus muscle gets stressed a lot. Often you have to reach out and pull on holds far away from your body. If you are not used to it, strong enough or rest too little, you are prone to develop a troubling infraspinatus.


Furthermore games where you have to serve or throw a ball are quite stressing for this muscle. This is because you have to raise your arm and bring it behind your body to prepare for the serve or throw – outward rotation –. Repeating those movements thousands and thousands of times, which is just common if you train your serve or throw, is likely to overstress this muscle.


Here is a short but surely not exhausting list with sports where you can overstress this muscle.


  • Handball
  • Volleyball
  • Baseball
  • Badminton
  • Rock Climbing
  • ...


Beside these “active” activities, sitting a desk for longer periods of time often stresses your infraspinatus. This is because one tends to end up in a round shouldered position at the desk. In this position your shoulders get rotated inwardly and thus your infraspinatus will be elongated permanently.



Muscles do not like to be in elongated positions over long times. If they are, they tend to tighten up and eventually start to trouble you.


Impaired Or Painful Movements


Movements that can be impaired and painful include but are not limited to all movements where you lift your arm or have to rotate your shoulder.


Fastening your seatbelt: The following accounts for the situation where the seatbelt is to your left. Fastening the seatbelt may be painful because you either shorten or stretch the stressed infraspinatus. If you grab the seatbelt with your left arm you have to rotate your shoulder and move your arm behind you, which stresses the muscle – outward rotation –. 


Reaching with you other arm – the right one – over to your left to grab the belt, you do an inward rotation with your right shoulder and thus elongating the infraspinatus – because that is the opposite movement of an outward rotation –. For a tender muscle this can be already too much. Thus it may give you pain to stop you from doing this movement.


Other actions that activate the muscle in a very similar way and thus may be impaired are...


  • Reaching behind your body in order to pick something up
  • Scratching your back
  • Putting on a jacket
  • Combing your hair


Infraspinatus Palpation

Before you can massage the infraspinatus you have to find it. By now you know where it is located. But feeling and placing massage equipment on it is still is a different story. But do not worry, you will work it out. It just takes a little practice.


The easiest way to locate the muscle is by feeling it contracting. To do so, just let your arms hang loose. If you want to feel your right infraspinatus you have to use your left hand and vice versa.


Take your hand and place it like you already did on your opposite shoulder. Search with your fingers for your spine of scapula. Now reach with your fingers below this little spine and then rotate your hanging arm outwards by turning your palm away from your body. While doing the movement you should feel a muscle bulking up. That is your infraspinatus muscle.


Self-Massage Of The Infraspinatus Muscle


Massage of the infraspinatus muscle is possible with a tennis ball or a cane. Both are great tools for working it. A cane can be placed more accurately and you can apply more pressure. The Tennis Ball on the other hand is so small, it just goes anywhere. It always fits in the bag, not matter how stuffed it already is. That is great!


Massage With Tennis Ball

If you want to massage your left infraspinatus, take the tennis ball in your right hand. For massaging the right side, use your left arm. Your back is facing the wall. Place the ball on your infraspinatus and then press it against the wall. To really get into your infraspinatus you may want to turn/twist your body a little sideways. An angle of 30 – 45° works fine for me.



Some of you may have trouble placing the ball directly on the shoulder blade. If so, take the ball again with your right hand if you want to massage your left infraspinatus. Put the ball against the wall. Then press with your shoulder against it to prevent the ball from falling down. Now roll your back over the ball till you find the place you want to massage.



In both cases, experiment a little and try to be patient with yourself. Finding the infraspinatus muscle is not always easy. Especially because you do not use your hands for massage and cannot see the muscle.


For deeper penetration of the muscle, just press harder against the wall – without tighten up yourself too much – or lie down on the ground on the tennis ball. Lying down on the ball will enable you to exert more pressure, but personally I find it very difficult to properly access and thus massage the muscle in this position.


Massage With A Cane


In terms of access to the muscle, the massage with a cane is a little easier. Just sit down on a chair or your bed. Take the cane and place it on the infraspinatus. Now you can massage the muscle through pushing and slightly moving it.


References


Calais-German, Blandine. Anatomy of Movement. Seattle: Eastland Press, 1993. Print

Davies, Clair, and Davies, Amber. The Trigger Point Workbook: Your Self-Treatment Guide For Pain Relief. Oakland: New Harbinger Publications, Inc., 2004. Print

Simons, David G., Lois S. Simons, and Janet G. Travell. Travell & Simons' Myofascial Pain and Dysfunction: The Trigger Point Manual. Baltimore, MD: Williams & Wilkins, 1999. Print.

Schünke, Michael., Schulte, Erik, and Schumacher, Udo. Prometheus: Lernatlas der Anatomie. Stuttgart/New York: Georg Thieme Verlag, 2007. Print

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