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Perfect Spot No. 14, The Most Predictable Unsuspected Cause of Shoulder Pain
updated
by Paul Ingraham, Vancouver, Canada
by Paul Ingraham, Vancouver, Canada
Trigger points (TrPs), or muscle knots, are a common cause of stubborn and strange aches and pains, and yet they are under-diagnosed. The 13 Perfect Spots (jump to list below) are trigger points that are common and yet fairly easy to massage yourself — the most satisfying and useful places to apply pressure to muscle. For tough cases, see the advanced trigger points treatment guide.
I avoided adding Spot 14 to this series for many years, because it’s a little tricky to find. But precision is not required: although there is one specific spot that’s especially good, nearly anywhere just under the ridge of bone on the shoulder blade is worthwhile, and often a surprising key to pain and stiffness everywhere else in the shoulder… but especially all the way around on the other side, facing forward.
Spot 14 is the site of my greatest single treatment success in a decade of professional massage. It’s a good story, and I tell the whole thing in another article.1 The short version: my wife’s uncle, tough as an old boot, was laid low by a toothache-like misery in the front of his shoulder — and after a couple minutes of rubbing Spot 14 on the back of his shoulder, he was completely fixed… in less time than it takes me to make coffee. He was completely fixed… in less time than it takes me to make coffee.He spent that weekend swinging his arm around, chuckling, and saying, “Well, damn, ain’t that something!”
For most people, Spot 14 is a just pleasant surprise: a “secret” way to ease shoulder tension that almost no one has a clue about until they feel it, but after that it seems obvious. Learning about Spot 14 is a great way to get a reputation for magic hands.
How do you find Perfect Spot No. 14?
To qualify for “perfection,” a satisfying spot for massage should be both easy to get to and worthwhile. It is easy to get to the neighbourhood where Spot 14 lives. It’s just hard to find the exact address, which is the most worthwhile.
The neighbourhood is the triangular shoulder blade. Finding the infraspinatus muscle is basically as easy as touching the shoulder blade. That bone is mostly covered by the infraspinatus muscle, which is under (infra) the ridge (spine) of bone. The shoulder blade’s ridge of bone is roughly horizontal and spans the full width — it’s an easy bony feature to find. (There is a supra-spinatus muscle above it, but it’s much smaller and hidden under a thick layer of trapezius.) The infraspinatus is large, flat and mostly just below the skin (or a paper thin part of the trapezius).
This schematic shows how the fibres of the infraspinatus fill the space below the spine of the scapula, and converge on a point on the upper arm. When they contract, they spin the arm in its socket (arrow).
The entire muscle really is worth massaging, better than many other muscles — “good” for massage. An inch-wide strip along the top edge is “better” to massage. And “best”? Perfect even? Spot 14 tends to be quite a small, specific patch of muscle at one end of that strip, closest to the middle of the back: the upper, inner “corner” of the shoulder blade, just under the ridge. There really is one spot here that is particularly, profoundly sensitive in many people, but you can be right next it and no one is the wiser — it usually takes some fairly detailed fingertip and thumbtip exploration to “nail it.” On the bright side, I think it’s a noteworthy spot in easily 90% of the population, so the search probably won’t be in vain.
And if you miss it? Luckily, the rest of the muscle rarely disappoints. See below for “closely related spots.”
What does Perfect Spot No. 14 feel like?
More than any other perfect spot, I think, Spot 14 is obscure until you feel it. Spot 14 itself rarely aches or feels stiff, in my experience. Instead, people feel pain and tightness well lateral to Spot 14. Spot 14 lurks so far towards the inner edge of the shoulder blade that it almost doesn’t seem like a shoulder spot, but that’s it’s secret: rub it firmly, and almost anyone will feel the sensation spread laterally and penetrate through and around the rest of the shoulder.
Like most trigger points, Spot 14 will feel raw and burning if you are too hard on it, but it generally produces a sickly ache. Penetrating referral to the front of the shoulder can be surprisingly specific and isolated, almost as if the shoulder is being touched in two different places at one.
How do you treat Perfect Spot No. 14?
There’s another reason I hesitated to promote this spot to Perfection: not only is it a bit tricky to find, but it’s hard to reach. If you’re doing self-massage, this significantly increases the difficulty level. It virtually requires a couple tips and tricks. Specifically, you really need just the right kind of ball — fairly firm and small for accuracy, and a bit grippy so that you can easily trap it between your shoulder blade and a wall without it slipping. Most toy stores have small bouncy rubber balls. These are just about ideal, although they can be a little bit too hard for some people. A squash ball is a perfect way to start off more gently, but it’s also a little too soft to finish the job. So you really want both: a squash ball to start, a harder rubber ball once the tissue is warmed up.
Squash balls are good and grippy, and soft enough to be a gentle way to start massaging a thin, sensitive muscle like the infraspinatus.
And then you need some practice. It’s not rocket science, but it won’t go smoothly the first time you do it either. It’s almost impossible for the average person, who has never thought about anatomy before, to go accurately muscle exploring this way. I’ve watched people try. They drop the ball. It ends up on the other side of their back. Even if they get in into the right area, it quickly moves — control comes only with more practice.
But with that practice, it’s no big deal. It just takes a few tries to start to get the hang of it.
The infraspinatus is not a thick muscle. You’re pinching a thin layer of muscle between skin and bone. Gentleness is strongly advised, especially at first.
Closely related spots
The approximate location of Spot 14 & friends in the infraspinatus triangle. The pale blue band across the top indicates the most worthwhile area.
Teres minor: I explained above that it’s worthwhile to massage anywhere under the ridge of bone on the shoulder blade. In fact, you can keep right on going towards the outside edge until you fall off it… and then you’re massaging the teres minor muscle, a close cousin of infraspinatus in the “crotch” where the arm meets the back. In terms of sensation, these two muscles are nearly indistinguishable — both often produce deeply, sickly aches throughout the shoulder. This is true of all four of the deep shoulder muscles, the infamous “rotator cuff,” but the infraspinatus and and the teres minor are the two that are reasonably easy to get to.2
Lateral edge of infraspinatus: another noteworthy spot to massage is the lateral edge of the infraspinatus muscle. The muscle fibres are parallel to the edge of the bone, and are fairly thick and easy to feel. Push on them perpendicularly, like you’re trying to push them across the shoulder blade, towards the middle of the back. The sensation comes not just from the point of contact, but from the stretch.
Tip of the shoulder blade: the very bottom of the scapula is an easy spot to find. The shape of the bone there is prominent. As mentioned above, you can make it pop out clearly by putting the hand behind the back. The infraspinatus muscle covers the entire shoulder blade, right down to this tip. The fibres are thin where they anchor to the bone, and they don’t seem like much, but don’t let that fool you: even gentle pressure can feel quite potent here.
The role of Spot 14 in “frozen” shoulder
A true case of frozen shoulder (adhesive capsulitis) involves a mysterious pathological process, and cannot be reliably treated by any means, massage or otherwise, and many attempts to treat it will simply make things worse.3 That said, some of its symptomsmay be effectively treatable. Much of the pain and stiffness patients experience can be temporarily, partially relieved by shoulder massage in general and Spot 14 in particular. Although that falls short of a miracle cure, many frozen shoulder victims are grateful for any relief. It probably beats pain killers (but I’m guessing — no one has studied it).
Many people have claimed therapeutic victory over frozen shoulder with massage and manual manipulation alone. I just don’t believe it. What I do believe is that some cases of severe shoulder pain are simply mistaken for frozen shoulder — somewhat like “migraine” is incorrectly used as a synonym for any bad headache. This leads to some great cures for surprisingly yielding cases of supposedly “frozen” shoulder. The anecdote I gave at the top of the article is a good example of a case that could easily have been misdiagnosed as adhesive capsulitis.
About Paul Ingraham
I am a science writer, former massage therapist, and assistant editor of ScienceBasedMedicine.org. I have had my share of injuries and pain challenges as a runner and ultimate player. My wife and I live in downtown Vancouver, Canada. See my full bio and qualifications, or my blog, Writerly. You might run into me on Facebook and Google, but mostly Twitter.
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