In my last article I covered the ways to use the foam roller to release tightness in the lower extremity and mid back. However, I find the foam roller can be tricky to use for the upper extremity and neck because you need something a bit smaller and more focused to release trigger points in these areas. So, I find using a lacrosse ball to be excellent for exactly this purpose!
Primarily, I use the lacrosse ball for people suffering from shoulder pain. The most common cause of shoulder pain is sub-acromial impingement syndrome. You might have heard this called tendonitis or bursitis, but in reality both occur together, and so it’s more accurately called sub-acromial, or shoulder impingement. The tendon that is most often getting pinched is the supraspinatus tendon. This is one of your four rotator cuff muscles and below I have included a picture which shows how it travels through the sub-acromial area (area just underneath your collarbone).
So, if this supraspinatus tendon gets pinched then it can create pain not only in the shoulder but also down the arm. If you want a visual explanation of this then see the diagram below from a recent journal article that shows its referral pattern of pain.
(article available at: https://bmcmedicine.biomedcentral.com/articles/10.1186/1741-7015-9-8 )
How do we settle shoulder impingement?
The main reason people end up with shoulder impingement is due to tightness in the muscles that attach to the shoulder blade. If these muscles tighten up then they end up creating less space for the supraspinatus tendon to travel through the sub-acromial space shown above. So, which muscles are the big players and how do we release them? Look no further! Below I have listed which muscles typically need to be treated and I have shown where I place the lacrosse ball when I am trying to work these muscles out.
After placing the ball in these areas, I then lean up against a wall and roll the ball around until I find a particularly nasty little area of soreness. I then stay on this spot and hold pressure on the area until the tenderness starts to resolve. Not all of the tenderness may resolve, but a lot of it should settle within 10 seconds. If it doesn’t, then just move onto another area and then come back to it later. I find that it doesn’t take me any longer than 5 minutes total to get through these 5 areas (so about 1 min per area because each area may have several trigger points). If you massage too vigorously or too long or press too hard, then it may temporarily exacerbate your symptoms. So, start off gentle and get more aggressive as you feel comfortable with it.
When should this be done?
If you are recovering from an acute shoulder injury then 3-4 times a day of 5 minutes may be necessary. Otherwise, I try to do this before I do a workout whether I will be heavily using my shoulders or upper extremities.
Will this cure my shoulder impingement?
It certainly might help lessen some of the pain, but often there are a variety of things that need to be done to fully settle shoulder impingement. Sometimes the trigger points are so deep that you can only reach them by doing intramuscular stimulation (IMS) or dry needling. Sometimes, there is so much inflammation that laser treatment is necessary to settle some of this. There can also be bone spurs in the supraspinatus tendon that require shockwave therapy. Often, strengthening exercises are necessary to correct muscular imbalances that have led to the problem in the first place. If in doubt, feel free to see one of our great physiotherapists by calling our office or booking your appointment online.
Can I use the lacrosse ball for these areas even if I don’t have shoulder impingement?
The short answer – YES! Creating more mobility in the shoulder is generally a good thing, and can be safely performed by many individuals. However, if you have a history of shoulder dislocations or are generally a very hypermobile person, you should consult with a physiotherapist prior to starting this.