Upon inspection, we noted that his shoulders were rolled forward (protracted) and that he had a forward head posture. His musculature was well developed and symmetric. However, his muscle lengths were out of balance. He had a shortening and tightening of his chest muscles (pectorals), back muscles (latisimus), upper shoulder muscles (upper trapezius), and occipital muscles bilaterally. We also located a trigger point in the muscle under his right scapula, which was very tender to palpation. Shoulder and spine ranges of motion were somewhat limited due to spinal restrictions and the associated tight musculature. Shoulder x-rays were unremarkable, but neck x-rays revealed a complete loss of the normal curve of his neck.
When discussing treatment options with him, we learned that he was interested in correcting the condition and preventing its return. In order to accomplish that, we needed to address each of the contributing factors. Ultrasound and transverse friction massage was performed directly to the inflamed tendon. The patient was given instructions to perform ice massage to the area at home, stretches to address the imbalance of the associated tight muscle groups, and strengthening exercises for his rotator cuff. Manual trigger point therapy was performed directly to the right sub-scapular muscle. Chiropractic adjustments were also performed to the restricted spinal joints.
After 4 weeks, Kevin noted a significant improvement in pain and function. He rated his improvement at 50%. After 8 weeks, his symptoms were gone and he returned to his normal activities.