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Self Myofascial Release for the Teres Major

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A couple of months ago I wrote an article about the importance of the teres major muscle and how I often find it an area of tightness in my clients.  I recommended focusing on that area during manual therapy and some of your self myofascial release techniques.

I’ve had a lot of readers ask for more information so I wanted to share a video of how I perform some of the self-myofascial techniques.  My preferred technique is to use a trigger point ball or lacrosse ball against a wall (read my recommendations for which self myofascial release tools to use).

I see the teres major limiting horizontal adduction, arm elevation, and disassociation of the shoulder and scapula.  Again, if you haven’t read my previous article on the teres major go back and read more about this.  For the self-myofascial release techniques, we’ll work on these three areas.

I always start by rolling out the area and pausing on any tight/sore spots.  Most people stop there, but I think it is important to incorporate some movement with the self-myofascial release techniques.  In this video, I show you how I work the teres major during both horizontal adduction and arm elevation.  It is pretty hard to stretch the teres major, but I usually recommend following the self myofascial release for the teres major up with the cross body genie stretch.  This could also work well for the latissimus and even posterior rotator cuff.

Self Myofascial Release for the Teres Major

Teres Major: An Important Muscle that is Often Overlooked in Throwers

There is no doubt that baseball pitchers and other overhead athletes get tight from throwing.  We originally showed this in my study published in AJSM, pitchers had an immediate loss of shoulder internal rotation after 45 pitches on the mound.

I often say that this loss of motion can easily become cumulative if not addressed, and unfortunately, the majority of baseball pitchers I see tend to need work on their soft tissue mobility.  I believe this is directly related to the cumulative trauma to the muscles that has been left unaddressed for some time.

I am a firm believer that regular soft tissue maintenance work is important for baseball pitchers, but I also understand that having access someone like me isn’t very realistic for many athletes.

We have come a long way with tools to work on your own soft tissue, like foam rolling, massage sticks, and trigger point balls.  For throwers, we have been recommending the use of these tools for some time and you often see people focused on a few key areas like the posterior rotator cuff, lats, and pecs.  This is for good reason!

But there is another spot that I bet you are missing that I think is pretty important and will help you feel better quickly.

Teres Major

The teres major just doesn’t get enough respect.  It’s not lucky enough to be included as one of the “rotator cuff” muscles.  It’s not a big guy that you can read how to strengthen in Men’s Health, like the pecs or lats.  Sometimes I think it is forgotten!

The teres major is a pretty important muscle to focus on.

The teres major acts as an internal rotator and adductor of the arm.  Guess what the arm does as you accelerate through your mechanics to generate velocity on the ball?  That is right, you internally rotate and adduct the arm!

But unlike the pec and the lat, who also contribute to the same motion, the teres major has a more intimate relationship with the scapula and humerus.  When you look at baseball pitchers, you tend to see a large, overdeveloped, hypertrophied teres major.  This again tells me it is an important muscle for throwing.  (photo from wikipedia)

As the teres major gets tight and shortened from overuse and throwing.  you can start to see changes in scapulohumeral motion.  When assessing someone, you may see that the scapula looks like it wants to upwardly rotate more on the throwing side, which I often attribute to the teres major shortening not allowing proper separation of scapula and humeral arm movement.  Essentially the tight teres major drags the scapula up with the arm because the two can’t separate

It looks like the person is achieving good arm elevation but realistically they are just compensating with more scapular upward rotation.  If you look closely, you’ll even notice that they are elevating the arm less and upwardly rotating their scapula more.  This is probably going to cause some impingement and irritation to the shoulder.  Here is a great example:

Self-Myofascial Release and Soft Tissue Work for the Teres Major

So as much as I want to help you and work with you, I also want you to be able to manage this yourself a little bit.  Remember, we said earlier that you will lose motion after throwing, it’s all about managing this as best as you can.

A simple way to work on the teres major is to perform self-myofascial release to the muscle with a trigger point or lacrosse ball.  We often recommend you roll the back of the shoulder or posterior rotator cuff, but in my experience, we do not emphasize the teres major enough.  To do this you simply need to understand the anatomy of the muscle and adjust the placement of the ball.

I should note that I do not think foam rolling your lats will get your teres major very well.  The muscle is too short and situated up towards your armpit that it just doesn’t work well.  You need to get in there more focal with a smaller trigger point ball.

You can also read my article and video demonstration on self myofascial release for the teres major.

What Trigger Point Ball to Buy?

I typically use a couple of different trigger point balls, depending on how firm I want the ball to be.  I would recommend the softer balls for beginners and firmer for advanced users.  Here is what I recommend:

• For Beginners: Trigger Point Therapy Massage Ball.  These are a little more expensive than lacrosse balls at about $15, but they are softer and have a little nub than you can wedge into different areas, which I like.  This is a good starting point, but the newer Trigger Point Therapy X-Factor Ball is a little larger and more firm.  I use these a lot.
• For Advanced Users: SKLZ Reaction Ball.  You know those little yellow reaction balls that you drop and bounce all over the place?  A friend just recently turned me on to these as trigger point tools!  They work great!  They are firm and have great little nubs to really get in to the tissue.  Plus you can usually find them for under $10.
• You can always just go with a simple lacrosse ball as well.  I think lacrosse balls are great, but they are pretty firm and don’t have a small nub to use, making them less than ideal for some areas.  That being said they are under $2!

Try working on the teres major or recommending this to your athletes, I bet you see improvement pretty quickly.  Working on the teres major soft tissue with some self-myofascial release techniques is an important, yet often overlooked, area to emphasize in baseball pitchers and other overhead athletes.

Sharp Upper Back Pain Between Shoulder Blades: Causes and Treatments

What could be causing the sharp upper back pain between shoulder blades?

Pain Between the Shoulder Blades: Should I Worry?

Many who experience upper back pain (between the shoulder blades) think that they’re suffering from a common, harmless problem. They might think that they just slept in the wrong position or they’ve just been working out too much, that the problem is merely muscular and will heal itself. Even though it is possible that this pain stems from bad posture and/or excessive movement, there’s also a chance that it's a sign of a life-threatening disease so, instead of dismissing the pain, it’s much wiser to spend a little time doing research.

The pain in your upper back might be just a strained muscle, but it might be something more. Below, you'll find many other common causes for back pain between the shoulder blades.

Many separate muscles come together at the shoulder blades, making that area prone to strain or injury. 

Upper Back Pain: A Spinal Dilemma

Pain in the upper back could be related to spinal issues.

Swollen facet joints can produce aches in the upper back. The spine’s flexibility is provided by these joints: in other words, they’re necessary to carry out many kinds of movement (turns and bends are just a few examples). As with any other part of the body, facet joints aren’t invincible. If used far too hard or too often, they end up damaged and swollen and of course, swelling leads to soreness.

A herniated disc is another problem that can prove to be extremely painful. Spinal discs are rubbery pads between the vertebrae in the spinal column that work like shock absorbers. In childhood, the discs are gel-filled, but they begin to solidify as we get older. By middle age, the disks become as inflexible as hard rubber and more prone to injury. With injury or stress, a disc's inner material may swell outward, pushing through the outer shell, pressing against surrounding nerves, and rendering that area more prone to injury.

Swollen joints and herniated disks cause pain. However, the pain caused by the latter tends to spread discomfort along the arms as well and may be accompanied by numbness.

Disc problems that may cause back pain.

Sharp Pain in Back: A Bile Problem?

Biliary colic is another medical issue that might cause back pain and shouldn’t be taken lightly. This is a type of pain that occurs when a gallstone blocks a bile duct and causes a sharp upper back or rib pain that radiates to the right shoulder. It may manifest after ingesting a fatty meal in an episode of sharp, intense soreness that starts near the abdomen and branches out to the upper-back region and may be accompanied by nausea and vomiting.

Back Pain: What to Do 

Upon becoming aware of facet joint issues, spinal disc troubles, and bile-related problems, you may be wondering whether there’s a guide to how to distinguish these three from one another. You may also want to know if there’s a simple what-to-do guide to follow when you feel pain.

There’s no need to worry about finding those things since they’re all here. Use this list to help you determine your source of pain and course of action:

Is it a brief, mild ache? If so, this could indicate mere muscle strain, but it might also be either swollen facet joints or herniated discs. Experiencing this kind of soreness is a nuisance at best. Doing all sorts of chores and completing all kinds of office work should still be possible, but even the mildest pains could turn into more serious issues if proper actions aren’t taken. That’s why these steps are important to remember:

• Rest for a while and see whether the pain subsides.
• If the aching stops, consider these suggestions:

• Do some stretches before engaging in any more physical activity.
• Consider exercising (routines that benefits the upper back).
• Don’t move suddenly and quickly to avoid additional strain.
• Exert effort to correct common posture problems.

Would you describe the pain as long and moderate? If so, this could indicate the presence of either one of the two issues previously mentioned, swollen facet joints or herniated discs. In this case though, medical attention might be necessary. Moderate pain that stays for half an hour (or more) sometimes means that the ache-causing concern has worsened. If the pain gets worse, doctors will have to use certain imaging technologies (such as X-Ray for facet joints and MRI for herniated discs) to determine the extent of the damage.

Is the pain intense and accompanied by numbness? If the episodes of soreness are almost unbearable and there are instances in which certain parts of your bodyfeel numb (or in some cases, tingling), then it’s definitely time to pay a visit to your physician. Together, such symptoms are considered a telltale sign of serious spinal disc dilemmas. If left unchecked, a severely herniated disc could even cause paralysis or permanent nerve damage.

Is your noticeable pain accompanied by nausea? Periods of upper back pain between the shoulder blades that are accompanied by nausea are indicative of biliary colic. In fact, some medical experts suggest that it’s best to immediately call for an ambulance if this combination of symptoms manifest. Also, those who’ve been suffering from aches after they’ve eaten (another warning sign) should really be wary of these simultaneous symptoms.

Solutions and Treatments for Pain Between the Shoulders

So clearly, upper back pain (between the shoulder blades) may be just muscle strain, but it may also be linked to several health problems, medical issues which aren’t equally dangerous–some causing only temporary discomfort while others that might prove to be fatal if left untreated. Well, each of these issues is also solved (or at the very least, managed) in different ways, as well.

• Swollen Facet Joints. As discussed above, the mildest joint troubles could be prevented from becoming worse through fairly simple techniques, such as maintaining proper posture and avoiding sudden movement. If more severe, the condition might require the aid of a physical therapist to help with strength and flexibility. Individuals suffering from more serious cases of facet joint concerns are given these options:
  • To undergo a procedure called "nerve blocking" so that the soreness would immediately subside. People wondering what’s done during the procedure would most likely end up shocked after realizing that steroid injections are involved.
  • To take painkillers and muscle relaxants on a regular basis. While minor cases of the spinal problem can be effectively handled using over-the-counter medication, the condition’s more alarming variants require powerful prescription drugs.

• Herniated Discs. Treatments for this medical issue are similar to the ones developed for swollen facet joints. Doing spine-enhancing exercises and being mindful of the body’s position are more than enough to solve the concerns faced by people with minor disk hernia. Sometimes, anti-inflammatory injections and pain medications are added into the mix. Surgery is only reserved for very severe cases. After all, it’s the solution that comes with the most risks.
• Biliary Colic. People who develop this disease undergo a treatment process that takes advantage of four different types of medication. In particular, they’re asked to take NSAIDs, antibiotics, spasm fighters, and anti-nausea pills. Aside from that, they’re also told to pick among the many ways of cleansing the gallbladder and the bile duct. Well, only one of those methods isn’t surgical in nature – oral dissolution therapy (unlike surgery-type solutions, it doesn’t work fast).

Do the Right Thing

Soreness in the upper-back region (particularly between the shoulders) shouldn't always be dismissed as a minor problem. In some instances, the aching sensation is a sign of spinal degradation. In others, it indicates the emergence of a dangerous digestive system disease.

People who’ve been experiencing chronic upper back pain (between shoulder blades) shouldn't wait until their health worsens before consulting their doctor.

Cure Sore Shoulders With 5 Easy Stretches

Introduction

The rhomboid major and minormuscles in the shoulder are the muscles that enable the shoulder blade to move. It is thanks to these muscles that shoulder blades are attached to the thoracic wall. The purpose of these muscles is to stabilize the shoulder blades, pulling them downward and together. These small muscles also help maintain proper posture and keep the shoulders from dropping forwards. As a result of being in constant use, these muscles can easily become sore and tense, especially if you sit in a hunched or slouched position all day behind a desk.

In addition to postural causes, sore shoulders and painful shoulder blades can also be caused by a variety of conditions. In the majority of cases the pain is caused simply by posture or overexertion, however some more serious conditions are also factors behind this type of pain. If you are experiencing more severe pains in this area then it can also be indicative of a heart attack, or of gallstones. Consequently you must ensure you see a doctor or other health professional to get checked out properly. It is highly likely that there is nothing serious, but it's better to be safe than sorry!

Returning to the purpose of this hub, if your rhomboid muscles have become sore and tensed because of a lot of exertion or bad posture, you should try the following shoulder blade stretches to help alleviate your aches and pains.

The 'Wall' Stretch

The name for this stretch is a bit of a give away. It's a very easy stretch to complete, but is quite effective and will help loosen your muscles. You can do this first stretch with one arm or with both your arms at the same time. Face a flat wall in a standing position, while making sure that you are so far from the wall only the tips of your fingers come into contact with the wall. Now let your fingers climb up the wall while walking towards it slowly. Ultimately, this will raise your hands and will stretch your fingers as far up as possible while you will be standing closest to the wall.

Door Handle Stretch

Again this is a really easy shoulder blade stretch that you may do with a chair, door handle or towel rail. Grab hold of your chosen object with both hands while standing in front of it. Now lean toward the object but do not move your arms, and step backwards slowly while maintaining a firm grip on the object. This will ultimately bend your torso at a 90 degree angle and will extend your arms completely. If you chose to use a door handle (and the door is closed) then this can be useful as you can apply a bit more stretch to your shoulders than you could with a moveable object.

Door Frame Stretch

This particular stretch concentrates on each side of the shoulder one at a time. This means you will have to complete this stretch on one side first, and then repeat it on the other side. This way you will be able to equally stretch both sides. Stand in an open doorway and raise your arm in a 90 degree angle out to your side. Point your forearm toward the ceiling and extend your upper arm horizontally. The vertical part of your arm should be placed against the door-frame. Lean forward and take really gently half steps. This stretch will prove to be beneficial not only for curing pain between your shoulder blades, but also for stretching out your chest and upper back.

The 'Arms Behind Back' stretch is an easy stretch that adapts with your progress.

Source: Rowan University

Arms Behind Back Stretch

Keep your back straight and extend both your hands behind your body while keeping them clasped together. Gently lift your hands toward the ceiling and maintain this position for at least 20 seconds as you stretch your shoulder blades to the max. Return to the initial position gently and repeat until you feel relief in your shoulder blades.

Overhead Arm Stretch

This is probably one of my favorite shoulder stretches as it is one of the best 'quick fixes' to relieve tension in your shoulders and get rid of some of that stiffness. Basically you take each arm one at a time and raise it above your head. Then bend the arm at the elbow so that your hand and forearm go behind your head and touches your opposite shoulder. The more you can push your elbow in and slide your hand down your upper back the more you will feel this stretch.

The main benefits of this exercise is to stretch the posterior deltoid muscle, together with the triceps. Once you have done this for one side, make sure you also stretch the other side to ensure they are stretched evenly.

Conclusion

If you ever feel like your shoulder blades and muscles feel sore or tensed you can perform any of the above shoulder blade stretches to provide quick relief. For longer term relief you will want to look at what the causal factors are of your aches and pains, whether it be bad posture or over-use. In the case of bad posture, you can look at getting a more ergonomic chair, keyboard and desk (see these tips). Taking a break regularly is also important, and so is undertaking a regime of strengthening exercises in addition to just stretching. These will help you to build up muscular strength and stability that will minimise the soreness that develops in your shoulders.

Of course if you have a high level of pain then this may indicate something more serious, so don't ignore your body, if you are in pain then please see a medical practitioner.

Thanks for reading this hub and I hope it has given you a few useful ideas to help alleviate your shoulder pain.

6 Exercises To Fix Your Hunched Back

What Is Postural Kyphosis?

Postural kyphosis is another term that means hunched back. It means there is an excess curvature in the upper back. Kyphosis is curvature of the spine that causes the top of the back to appear more rounded than normal.

Sometimes kyphosis does not cause any symptoms other than the back appearing abnormally curved or hunched. However, in some cases the condition causes back pain and stiffness, tenderness of the spine and tiredness.

If you have severe tension in one part of your body then that tightness will probably effect the rest of your body because the body is a kinetic chain, everything is interrelated, nothing works alone meaning that you will find muscle imbalances in other areas to compensate.

So in the case of an upper back kyphosis the chest for example is tense and tight and the upper back is tense and lenghened. They are both weak because they lack flexibility.

Flexibility is the capacity for a muscle to change shape so a muscle that is chronically short or chronically long is a weak muscle, it's not working optimally.

Strengthening

I have found that strenghening is not effective at all, I have been working with a kinesiologist specialized in posture who has told me that the previous way to correct posture by stretching and strenghening has been a total failure.

I have corrected my upper back kyphosis and anterior pelvic tilt successfully with her help only with stretching and mobilization exercises.

The problem is that with bad posture comes a difference in muscle activation. The nervous system is excessively sensitive to certain muscles and excessively insensitive to others. Short and tight muscles are overly recruited and you are very conscious of these muscles.

Squeezing your pectorals is much easier then squeezing your back muscles, the mind body connection is weaker there. Notice the attention we give to our pectorals and abdominals compared to our back muscles.

Some will say that is because we want to look good and we care more about what's in the front of the body but I think it has also to do with the fact that it is way easier to work the front muscles and thus is more rewarding at the gym. People don't like to struggle.

My kinesiologist explained to me that you could think that the back needs strenghening to pull your shoulders and thoracic spine backwards but actually the weakness of the back is understood because of a lack of mind body conection. The central nervous system has in a sense forgotten about these back muscles that's why it's so hard to squeeze them by sheer willpower. The central nervous system cannot be effective in a body with chronic tensions, so the objective here is to stretch everything.

The best way to strenghen a muscle is by stretching its opposite. If you stretch the pectorals you will have better activation of your back muscles for example.

Trigger Points

Trigger points are really sensitive points, spots of chronic tension in the muscle. You know you've found a trigger point when the pain is really sharp and travels to another place in the body.

For example if you press on the neck and the pain travels all the way to the shoulder. That is a sign that you are dealing with chronic tension and you should give it special attention. So what you have to do is massage it for a minimum of 2 minutes with a tennis ball or lacrosse ball for better results. Do this before every stretch!

The exercises I have used to fix this problem are the following: pectoral stretch, shoulder stretch, upper back stretch, back and front neck stretch, whole upper body stretch, lats stretch, levator and upper traps stretch.

Interesting Discussion On Posture And The Nervous System

Pectoral Stretch

A tight chest pulls your shoulders forward thus making you have a rounded upper back. You end up with narrow pectorals, rounded shoulders and probably forward head posture. Follow these steps:

• Starting Position

• Push with hand and make sure your opposite shoulder touches the ground

Upper Back Stretch

With a kyphosis the back muscles are in chronic tension. The muscles in the upper back are weakened and lenghened. The back muscles don't have the strength to pull the thoracic spine backwards.

• Starting position

• Put yourself as far back as possible without falling backwards

• Slump backwards and pull face towards knees

• Pull your back away to stretch it even further

Shoulder Stretch

There is a massive amount of tightness in the shoulders. It's maybe one of the hardest parts to stretch along with the neck in my own experience. The rounding of the shoulders makes the rear deltoids long, weak and tight. The front deltoids become short, weak and tight. We have to stretch all of that.

• Starting Position

• Turn your hand

• Pull Forward

• Exercise 2: Start Position

• Pull forward with other arm

Lat Stretch

This is the most effective lat stretch I have found. The most simple as well. Lat tightness will contribute to rounded shoulders and thus kyphosis. When your shoulders are continually forward this puts the lats in a shortened state which exacerbates the rounding of the shoulders since it will pull them down and forward even further.

• Use a rubber band to extend your arm and use your hips to twist your body

Full Video

Levator and upper traps stretch

In a kyphosis position in order for the head to maintain upright the upper traps and levator muscles have to become overactive and compensate for the lenghened and inhibited muscles of the rest of the back like the rhomboids and lower trapezius. Both an overactive and inhibited muscle or you could say a chronically tight and a chronically lenghened muscle are weak and are tense.

Whole upper body stretch

This will stretch the whole upper body. If anything is tight you will know by doing this stretch. It's also a mobilization exercise of the thoracic spine. I found it great especially for shoulder tension and in the chest.

• Starting Position

• Lower your butt and rib cage to the ground

Important Points

If a stretch doesn't work for you or if you can't get into position comfortably then change exercise because it could mean that you are just not ready for it and you need to stretch another part of your body first.

You have to be smart and not injure yourself. If a specific muscle won't losen up then there is a reason. The body knows better than you what is possible at the moment.

Change exercise and then you can come back to the previous one. The order that I put forth here is the order that worked for me. Try it but change it if it doesn't work for you.

Always massage before stretching for optimal results and find those trigger points