How massage can help rehabilitate shoulder injuries

Shoulder pain has many different causes. The pain may occur in the joint itself or the muscles, tendons and ligaments of the shoulder. Shoulder pain can be associated with restricted joint range of motion and loss of muscle strength (3). Massage therapy has become a widely accepted treatment for shoulder pain (1). Massage therapy is usually viewed as an adjunctive therapy to prepare for mobilisation (1).

Types of shoulder injuries:

• Tear
• Impingement
• Tendonitis
• Subluxation
• Fracture

Possible signs and symptoms of a shoulder injury:

• Pain at the end of the collar bone
• Pain may radiate from shoulder to the back
• Pain on movement
• Pain can be described as pins and needles
• Numbness can also occur
• Pain on lifting with the injured shoulder or arm
• Swelling in the region
• Step-deformity may occur (lump) depending of the severity of the injury
• Stiffness as in the case of a frozen shoulder

Common shoulder Conditions:

• AC joint separation
• Shoulder dislocation
• Impingement syndrome
• Frozen shoulder
• Rotator cuff injury

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Massage therapy delivered to soft tissues and connective tissues may induce local biochemical changes that modulate local blood circulation, improve muscle flexibility, intensify the movement of lymph, and loosen adherent connective tissue. This may improve reuptake of local nociceptive inflammatory mediators and reduce pain (1).

Massage might also reduce pain by stimulating joint mechanoreceptor activity, which, in turn, is thought to block pain signals and reduce the awareness of pain. It has also been hypothesized that massage mechanically stretches shortened collagenous tissue and improves interstitial fluid content resulting in restoration of movement (2).

Massage may help to rehabilitate shoulder injuries and conditions by loosening the muscles. This may reduce the pain associated with the injury and alleviate any impingements that may be present (1). It also may help to heal any tears by promoting increased blood flow to the area. Massage may help to minimise scar tissue by promoting the muscle fibres to heal in the original direction.

As a result of over using a person’s ‘good’ shoulder, they may report pain on the opposite side of the body to the injury. Receiving massage to the non-affected side may help to alleviate pain. Massage may also help to increase the range of motion of the affected shoulder and reduce inflammation by speeding up the lymphatic system (1).

Research has found that combining massage with a home exercise program (including stretches) may help speed up rehabilitation, reduce pain and improve joint movement and strength (2). Including dry needling and traditional massage techniques alongside physical therapy programs may assist for faster recovery times, improving the outcomes in patients with post-operative shoulder pain (4).

No matter what the cause of shoulder pain, or whether it’s chronic or acute, massage (traditional form or dry needling) is a proven form of therapy. There is growing evidence to suggest that incorporating massage into rehabilitation programs may improve outcomes and pain may be reduced. This means that those effected can return to usual function sooner (1,2,3,4).

1. Massage therapy for neck and shoulder pain: a systematic review and meta-analysis, L.J. Kong, H.S. Khan, Y.W. Cheng, W.A. Yuan, B. Chen and M. Fang, Evidence- Based Complementary and Alternative Medicine, 14th January 2013.
2. Comparison of supervised exercise with and without manual physical therapy for patients with shoulder impingement syndrome, M. Bang and G. Deyle, Journal of Orthopaedic & Sports Physical Therapy 2000;30(3):126-137.
3. Effect of scapular function training on chronic pain in the neck/shoulder region: A randomized controlled trial, C.H. Andersen, L.L. Andersen, M.K. Zebis and G. Sjogaard, J Occup Rehabil (2014) 24:316-324.
4. Inclusion of trigger point dry needling in multimodal physical therapy program for postoperative shoulder pain: a randomised clinical trial, J.L. Aprias-Buria, R. Valero-Alcaide, J.A. Cleland, M.A. Atin-Arratibel and C. Fernandez-de-las-Pemas, Journal of Manipulative and Physiological Therapeutics, March/April 2015

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by Ben Hewitt