Massage Therapy Journal Summer 2024

Summer 2024 • 25

Hips, Shoulders and the Symptom Cascade

shoulder problem. Remember that the arms are like wings. The shoulder muscle attaches to the skull, C1 through T12, and because the latissimus dorsi’s tendon is the tough, diamond-shaped thoracolumbar fascia, you could even say that each arm starts at the opposite iliac crest. As a massage therapist, you are already working on all of this, of course, but awareness, intention and sequencing are important and change how the client takes in your work. The fundamental issue is posture-based joint stress. Restrictions in shoulder movement generally start with limitations in gliding, a small but crucial movement. Joint limitation cannot be fixed by pushing the arm at end range. If you can restore glide—then release fascial restriction and tension in overworked muscles—your client’s healthy range of motion, and your success rate, will increase dramatically. Fascial techniques are immensely helpful. In truth, though, fascia and muscle are often intertwined. Fascia surrounds each muscle and also surrounds all the individual structures of muscles, even into the muscle cells themselves, which have a cytoskeleton, or fibers that separate and connect the parts of the cell.

In a way, humans are like dogs standing on their hind legs. When our simian ancestors stood up on two legs, the hips and the shoulders evolved in very different ways. We have traded stability for mobility in both sets of joints, but most of all in the shoulder. The shoulder adapted to maximize range of motion and dexterity, and the hip for stability with motion. Both joints switched orientation by 90 degrees. The benefits of being able to stand on two legs and to move our arms around are obvious. But most hip and shoulder problems also stem from our evolution. Gravity tends to take the hips forward in space, which may include an overarched low back. In less flexible people, that tends to be accompanied by hamstring shortness. In people with more flexibility, psoas spasm. An overarched lower back position pushes the femoral head forward against the front of the acetabulum, labrum and front capsule and ligaments, which can lead to groin pain, limited range of motion and psoas spasm. Ultimately there could be a labral tear, arthritis and complications to the low back and sacroiliac joint regions. What about the shoulder? These postural asymmetries put stresses on the shoulders by destabilizing and displacing them. Think about it this way: Forward shifted and/ or forward-tilting hips lead to a backward tilting ribcage. The chest ends up collapsed and the neck compressed with the head forward. Gravity then draws the humeral heads forward. The symptom cascade for shoulders is quite similar to the hips: labral and biceps tendon damage, limited motion, rotator cuff strain, and pain and/or arthritis. The Benefits of Massage for Shoulder Problems You don’t need me to tell you that massaging By the time many people reach middle age, they’ve been in this type of position for a long time.

Fascia surrounds each muscle and also surrounds all the individual structures of muscles, even into the muscle cells themselves, which have a cytoskeleton, or fibers that separate and connect the parts of the cell.

Muscle Fiber

Myofibril

Muscle

Actin

Fascia

Blood Vessels

the shoulder muscles—from the biceps to the spine—helps immensely with any

Sarcomere

Myosins

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