Active Release Treatments for Shoulder Injuries and Pain Relief
Updated: Jul 12, 2019
Have you or someone you know experienced shoulder pain, been to physical therapy for a rotator cuff strain or had a cortisone injection to treat a torn labrum in the hopes of avoiding surgery? Know of any athletes whose careers were affected by a shoulder problem?
The answer to all of those questions is probably a resounding yes.
That's because shoulder injuries are very common amongst the general population and especially among exercise enthusiasts and athletes. Whether it's from lifting a heavy box overhead, throwing a 100 mph fastball, bench pressing heavy weight, lifting up your kid, walking your dog, doing construction work or even sitting at a desk for countless hours, the chances are that at some point in your life your shoulder will hurt, potentially a lot!
With this in mind, treatments and shoulder injury prevention strategies abound and each unique shoulder injury may require a slightly or vastly different injury recovery protocol. For example, treatments for repeated shoulder dislocations and instability will differ significantly from treatment interventions for frozen shoulder (adhesive capsulitis). A severely torn labrum may require surgery before any rehabilitation therapies can be helpful at all whereas a painful shoulder impingement can often times be remedied with a combination of treatments including a wide range of rehabilitation treatments such as physical therapy, acupuncture, graston technique and a range of clinical massage therapies.
One such manual therapy treatment for shoulder injury rehabilitation and recovery as well as for on-going shoulder injury prevention is Active Release Techniques, also commonly known as Active Release, Active Release Therapy and ART.
What is Active Release Techniques?
Active Release is a movement-oriented system of manual therapy that helps resolve a wide range of muscle, nerve and joint injuries. It is a patented system developed by Dr. Leahy in the late 90s that addresses various injuries by breaking up scar tissue, releasing adhesions in and between muscles and un-trapping nerves that get stuck in muscles or impinged by bones. This allows muscles to slide, contract and lengthen properly which contributes to better muscle and joint function. Enhanced function helps drastically with the injury recovery process and reduces the chances of re-injury.
The following videos demonstrate clinical Active Release and Myofascial Release treatments for specific shoulder muscles. Which ones I use depends on many factors including the type, severity and duration of the shoulder injury as well as client goals.
PLEASE NOTE that these videos are NOT instructional videos for health providers to use for learning, certification and teaching. These videos are strictly for client education and any use of these videos or the Active Release name, trademark or logo without up-to-date certification is strictly prohibited and may result in legal action by Active Release Techniques, Inc. and On Your Mark NYC, LLC.
ACTIVE RELEASE TECHNIQUES FOR THE SHOULDER
Let's start with the ROTATOR CUFF, which is the group of 4 muscles that help stabilize the shoulder by keeping the ball and socket together. These 4 muscles are relatively small and lie deep to some of the bigger shoulder muscles such as the Pec Major, Deltoids, Upper Traps and Latissimus Dorsi ("Lats"). They are easily injured in part because very often they essentially have to fight against some of the larger shoulder muscles to keep the shoulder functioning properly.
Infraspinatus / Teres Minor
These two muscles essentially work together to externally rotate the shoulder joint (AC joint). They are commonly injured during forceful deceleration movements such as throwing a baseball or football or while playing tennis. Treatment for these muscles can feel very relieving and therapeutic, as well as painful. But the results can be significant and fast!
This muscle is central in keeping the head of the humerus (ball) in the shoulder socket when initially raising your arms overhead. At a certain point the upper traps and deltoids take over as the arm gets higher. When this muscle is under-active, stuck or injured, it may lead to shoulder impingement which can be very painful and even result in full tears of the muscle and/or bone spurs. Active Release treatments for this muscle are easy and can result in discomfort but also immediate and lasting pain relief. It can be treated alone or by separating it from the upper traps.
This muscle internally rotates the shoulder and can develop nasty little trigger points that are very uncomfortable to have treated but can create significant pain relief. It is underneath the large Pec Major muscle and thus it takes advanced clinical skills to effectively treat it without pressing on an important nerve. The "Subsac" often gets a bad rap because it internally rotates the shoulder which is thought to contribute to poor posture and sub-optimal biomechanics and thus gets lumped together with the Pecs and Lats for this reason. While this can be true, it also plays a central role in shoulder joint stability and thus often needs to be treated and strengthened.
Biceps tendonitis is one of the most common shoulder injuries because of its location and function. It in essence goes right through the 'grand central station' of the anterior shoulder; it is surrounded by the pec and lat tendons and blends directly into the shoulder joint capsule, leaving it vulnerable to acute trauma and chronic wear and tear. The biceps tendon can get stuck to the deltoids as well as the pec tendon and so Active Release treatments such as the one below can help reverse that and lead to injury recovery.
Shoulder Joint Capsule
This shoulder treatment helps the ball of the shoulder to slide and glide better within the joint socket. It also pulls muscles off of each other and breaks up adhesions in them. This treatment in many ways is a combination of Active Release and Myofasical Release. Many of my treatment protocols blend Myofasical with ART, deep tissue massage and trigger point therapy to relieve shoulder pain and many other sports injuries.
The "Pec" or Pectoralis Major is a large and strong muscle that can excessively internally rotate the shoulder and pull it forward in a chronic way that breeds trouble for the shoulder complex. This happens in part because of poor posture but also from exercise and sports. Pretty much every shoulder injury that I encounter requires some attention to this muscle for shoulder pain relief and lasting injury recovery.
I refer to this muscle as Pec Major's nasty little cousin because all it ever seems to do is cause trouble. I've never heard anyone say anything good about this muscle. You can't see it, it doesn't help you look or feel better and it is often times involved when there is a nagging shoulder injury. It also, however, can be integral in correcting poor posture and resolving shoulder pain because of its tendency to pull the shoulder blade forward. Advanced clinical massage therapy skill is needed to effectively treat this muscle without causing pain by compressing ribs or further irritating the muscle itself.
Rhomboid / Middle Trap
This muscle is central in maintaining good posture and smooth shoulder mechanics. It often feels tight because it is under a lot of tension from being stretched and chronically weak. But it is not a muscle that needs to be stretched in most cases even though it feels like it needs to be. Instead, it needs to be activated and strengthened as well as treated with manual therapy to release trigger points that form in the muscle. This Active Release Technique treatment feels very therapeutic and often results in notable pain relief and enhanced range of motion.
Upper Trap / Levator Scap
These two muscles are where people often feel a lot of tension even if they don't have a specific shoulder or neck injury. These muscles can contribute to headaches, neck pain and shoulder injuries by affecting how well the joints and muscles move. I don't think I have ever treated or effectively resolved a shoulder injury without working on these muscles. They are central in the body's stress response, when holding a heavy bag in your hands or over your shoulder, when lifting things overhead and in controlling posture and maintaining neck, head and shoulder stability.
The "lats" is one of the largest and strongest muscles in the body. It is the dominant muscle during pull-ups, rowing, swimming and most pulling motions in general. The downside with this muscle in terms of shoulder injury risk and recovery is that it contributes to internal rotation of the shoulder joint. Excessive internal rotation can put stress on the anterior shoulder, increasing the risk of shoulder impingement, biceps tendonitis and rotator cuff strains as well as poor posture. It is often the forgotten muscle in shoulder pain as well as low back pain but can be crucial to injury recovery. In over 75% of shoulder injuries and in 50% of cases of low back pain, I incorporate Active Release treatments and myofascial release on the lats.
In summary, Active Release Techniques is one very effective method of treatment for many shoulder injuries. On its own and in combination with other rehabilitation therapies it can be a valuable asset in helping you recover from small and serious injuries as well as prevent future ones from happening. Active Release is primarily done by massage therapists, chiropractors and physical therapists. The knowledge base and training required to take and pass Active Release courses are vast and so finding a certified ART provider can be an important step in the injury recovery process.