นวดกดจุดบําบัดโรค

Nuad Kod Jud

THAI ACUPRESSURE
For Orthopedic Disorders
As instructed by the Wat Po School, Bangkok

10 11 12

3 3 2 1 1

4 7
5 8
15
6 5 8 14
9
2nd back line
3rd back line

1st back line

A Step-By-Step Guide by Noam Tyroler

Learn Thai Acupressure on Video

www.thaiacu.com
 CHAPTER 4 SHOULDER

Treatment routines in this chapter

The pain in these four conditions is independent of shoulder motions:
Routine - 11 “Pain at the midpoint of the inner edge of the shoulder blade”
Routine - 12 “Pain at the lower third of the inner edge of the shoulder blade”
Routine - 13 “Shoulder pain with additional pain while breathing”
Routine - 14 “Pain next to the lower medial part of the shoulder blade with additional pain
along the thoracic spine”
The pain in these two conditions is created by shoulder motions:
Routine - 15 “Stiff shoulder with pain when raising the arm”
Routine - 16 “Shoulder pain when bending the arm behind the back”
The treatment of upper back, shoulder blade, and shoulder pathologies
Shoulder pains are the third most common musculoskeletal pains, following lower back and neck pains. Shoulder pains
may be the result of traumas, but are more often due to occupational overuse, sport strains, poor postural habits,
postural deviations, or stress. The routines in this chapter are divided into two groups: Shoulder disorders with pain
that is created by shoulder motions, and upper back or shoulder blade disorders with pain that is independent of
shoulder motions. In the first group are disorders of the shoulder joint (glenohumeral, and acromioclavicular joints) that
are usually more serious conditions and take longer to heal, though the Thai routines show excellent results in most
cases in which surgery is not needed. A ”real” frozen shoulder that involves adhesions in the joint capsule (adhesive
capsulitis) is especially hard to treat. Often nothing will help but only time. It will often heal on its own within 1-3
years. In the second group are disorders of the thoracic back and the shoulder blade that are often more mild and
would usually show fast therapeutic results. The Thai routines do not treat shoulder separation or subluxation that
require the intervention of a specialist. You can treat chronic conditions following such injuries using the Thai routines,
but exclude the shoulder stretches of the Thai general massage altogether! Choose one routine out of the six
according to signs relevant to the Thai diagnosis (see diagnosis table), regardless of the western medical definition of
the condition. Whenever the symptoms of your client match the symptoms described by one of the Thai routines,
try using it and observe your clients reaction. If your pressure is welcome by his body, your treatment may give good
results. If you notice any improvement, carry on.

Thai routines Possible underlying pathologies

Pain at the midpoint of Muscular hypertonicity and myofascial trigger points
the inner edge of the Muscle strain
shoulder blade Nonspecific neurovascular entrapments
Kyphosis (hunchback)
Scoliosis
Pain at the lower third Muscular hypertonicity and myofascial trigger points
of the inner edge of the Muscle strain
shoulder blade Nonspecific neurovascular entrapments
Kyphosis (hunchback)
Scoliosis
Shoulder pain with Muscular hypertonicity and myofascial trigger points
additional pain while Nonspecific neurovascular entrapments
breathing Costovertebral joints pain
Kyphosis (hunchback)
Scoliosis
Pain next to the lower Muscular hypertonicity and myofascial trigger points
medial part of the Nonspecific neurovascular entrapments
shoulder blade with Scoliosis
additional pain along Kyphosis (hunchback)
the thoracic spine

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 Stiff shoulder with pain Adhesive capsulitis (frozen shoulder)
when raising the arm Subacromial bursitis
Calcific tendinitis
Rotator cuff tears or tendinosis
Shoulder impingement syndrome
Bicipital tendinosis or tenosinovitis
SLAP lesions (glenoid labrum injuries)
Osteoarthritis of the glenohumeral joint
Acromioclavicular sprain
Post shoulder separation
Post shoulder dislocation or subluxation
Muscular hypertonicity and myofascial trigger points
Nonspecific neurovascular entrapments
Scoliosis
Kyphosis (hunchback)
Shoulder pain when Adhesive capsulitis (frozen shoulder)
bending the arm behind Calcific tendinitis
the back Shoulder impingement syndrome
Bicipital tendinosis or tenosinovitis
SLAP lesions (glenoid labrum injuries)
Muscular hypertonicity and myofascial trigger points
Nonspecific neurovascular entrapments
Acromioclavicular sprain
Kyphosis (hunchback)

Shoulder, shoulder blade and upper back pathologies:

Shoulder pains usually involve more than one defined pathology or more than one tissue dysfunction.
Adhesve capsulitis (frozen shoulder)
Severe loss of motion due to adhesions within the glenohumeral joint capsule and ligaments that shrink and inhibit joint
movement, thereby creating pain. This condition may be related to autoimmune failure, and the healing process may
take a very long time.
Subacromial bursitis
The inflammation of the subacromial bursa caused by its compression by the coracoacromial arch due to repetitive
stress or injury resulting in pain and restricted range of shoulder motion especially while raising the arm.
Calcific tendonitis
A tendon condition produced by the deposit of calcium crystals in the biceps tendons or any one of the rotator cuff
tendons, but mostly in the supraspinatus, resulting in pain and restricted range of shoulder motion.
Rotator cuff tears or tendinosis
The most common shoulder disorder, involving minor or progressive damage due to overuse or trauma injuries to four
different muscles and tendons - supraspinatus, infraspinatus, teres minor, and subscapularis - causing pain and restricted
range of shoulder motion, possible joint instability and a clicking sensation in shoulder motions. In severe cases, shoulder
function may be greatly restricted.
Shoulder impingement syndrome
Compression of soft tissue between the head of the humerus and the coracoacromial arch that involves tendon or
bursa inflammation due to postural deviation or different shoulder pathologies. Typical to impingement syndrome is a
mechanical limitation in abduction around the 90 degree angle.
Bicipital tendinosis or tenosinovitis

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 CHAPTER 4 SHOULDER

Front aspect of shoulder tendinosis or tenosinovitis of the tendons of the short or long heads of the biceps brachii
muscle due to cumulative stress caused by occupational or other repetitive motions, creating front shoulder pain and
a restricted range of motion.
SLAP lesions (Superior Labrum from Anterior to Posterior) – glenoid labrum injuries
Damage - usually tears - to the rim of the labrum (cartilage) due to injury, overuse, or degeneration. This condition is
often caused by a sports injury involving a strong pull on the biceps that are attached to the glenoid labrum. Symptoms
include severe pain and a restricted range of shoulder motion.
Osteoarthritis of the glenohumeral joint
Degeneration of the joints (cartilage and ligaments) causing inflammation and joint instability that results in the growth
of osteophytes, the impingement of soft tissue, pain, and a restricted range of shoulder motion.
Acromioclavicular sprain
Sprained ligaments of the acromioclavicular joint due to minor or major injury causing shoulder stiffness and pain. Pain
increases in different movements but mainly in horizontal adduction.
Shoulder dislocation or subluxation
Dislocation or subluxation of the glenohumeral joint caused by an injury. Shoulder dislocation or subluxation is
accompanied by the strain of the rotator cuff muscles. Symptoms include severe pain, and inhibition of shoulder motion.
Do not treat; send to the physician! You may treat chronic conditions following such injuries using the Thai routines,
but exclude the shoulder stretches of the Thai general massage altogether!
Muscle strain
Overstretching of muscles of the shoulder girdle and upper back caused by a severe or a mild injury that may create
pains and stiffness.
Muscular hypertonicity and myofascial trigger points
Tightness of the cervical, thoracic and shoulder girdle muscles which developed as a result of repetitive motion, postural
stress, emotional stress, and injuries. Myofascial trigger points - tender taut bands within hypertonic cervical, shoulder,
shoulder blade and thoracic muscles - may develop creating stiffness and pain as well as referred pain to different
areas of the region.
Nonspecific neurovascular entrapments
The compression of nerve roots in the cervical or thoracic spine (radiculopathy) or peripheral nerves (neuropathy)
and/or blood vessels in the cervical, thoracic or shoulder region . Entrapments are caused by either an injury - creating
an acute condition - or by prolonged stationary postures, postural deviations and/or muscular hypertonicity creating
chronic conditions. Symptoms may include: Pain, burning or tingling sensations, feeling of heaviness and weakness or
numbness in the thoracic, shoulder blade, shoulder regions, or in the arm and hand. Symptoms may increase in different
activities and postures including sleeping postures that create pressure on the affected nerve.
Kyphosis (hunchback)
The exaggerated kyphotic curvature caused by a genetic tendency, systemic conditions (osteoporosis, rheumatoid
arthritis, Scheuerman’s disease), developmental disorders, poor posture and/or advanced age. Kyphosis may be an
underlying cause for different specific pathologies and nonspecific general pathologies creating symptoms such as:
Fatigue, pain in the cervical and thoracic regions, and referred pain to the shoulder blades, shoulders and arms.
Scoliosis
A lateral and rotational deformity, mostly of the thoracic spine but also of the lumbar spine, or in both spinal regions.
Scoliosis is either functional or structural, either inherited or acquired, and is the result of muscular imbalance or bony
deformity of spinal vertebrae. Scoliosis involves muscular imbalance and hypertonicity. Symptoms include lumbar or
thoracic back pain or pain along both the lumbar and thoracic spine, and restricted range of motion. Scoliosis may
be the underlying cause for different lower, middle and upper back pathologies as well as shoulder and shoulder blade
pathologies. However, individuals with scoliosis (even with a serious curvature) that are involved in daily moderate
physical activity and practice a corrective method may not suffer any symptoms at all.
Costovertebral joints pain
An irritated joint between a rib and a spinal vertebra due to pressure created by minor injuries or postural deviations,
involving local and referred pain in different movements of the chest (as in breathing) or the thoracic spine.

70
 Contraindications and warnings
• Do not treat a client if you suspect a Treat at the subacute phase when the pain
shoulder separation, dislocation, or and the spasm subside, and only following an
subluxation evaluation of the condition by a specialist and
After treatment by a specialist, Thai routines with his permission.
will be very beneficial in the treatment of • Do not stretch when pains are created by
symptoms created by the separation, shoulder motions
dislocation or subluxation. Exclude any Careful stretches may be helpful in chronic
stretches of the shoulder. cases.
• Do not stretch the shoulder of a client with • Do not apply direct pressure onto inflamed
a history of dislocation or subluxation areas of the shoulder
• Refrain from working in the acute phase However, a superficial massage in very
of the first 3 days following a shoulder chronic conditions may be helpful.
trauma when the pain and spasms are very • Do not apply pressure that makes your
pronounced client shrink or move away from your hands

Red flags
If these symptoms are present, the client should be referred to a physician for evaluation.
• Recent severe trauma such as a motor • Persistent pain without an apparent cause
vehicle accident or a fall that has appeared suddenly
• Severe pain over a bone • Pain that is not mechanical in nature
May indicate a fracture or an injury to a • Shoulder pain with anxiety, and sometimes
ligament. with sweating
• Severe protective muscle spasm May be the signs of a heart condition.
May hide a severe joint condition. • Any unusual signs
• Constant or progressive pain

Choosing a treatment – basic guidelines

1. First find the movement that creates or aggravates pain. Ask your client to:
Flex his shoulder, raising his arm upward with his elbow straight.
Abduct his shoulder, raising his arm sideways with his elbow straight.
Horizontally adduct his shoulder, trying to touch the other shoulder as though embracing himself.
Extend his shoulder, raising his arm backwards with his elbow straight.
Medially rotate his shoulder, bending the arm behind his back.
2. When shoulder motions are not the major cause of pain, ask your client to show you the location of
the pain:
Is it next to the medial border of the scapula at the midpoint between the upper and lower angles?
Is it next to the medial border of the scapula, but lower than in the above case, located 2 or 3 fingers above the
lower angle of the scapula?
Is the focus of pain between the lower part of the shoulder blade and the spine with additional pain along the thoracic
spine?
Is it on the 2nd back line, level with the medial edge of the scapular spine?
Is it characterized by additional pain that is created when inhaling?
3. Choose one treatment
Once you have found the location and pattern of pain and/or the movement creating it, you can choose the
treatment accordingly. (See diagnosis table.)

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 CHAPTER 4 SHOULDER

4. Start the treatment and verify that you have chosen the right routine
As you press the points, watch your clients reactions and check whether or not the points of the routine you have chosen
are relevant and effective. Please do not bother your client with too many questions too soon! Let him enjoy deepening
states of concentration. He will often need some time into the treatment before being able to express (not necessarily
with words) whether the points are relevant or not. You can often expect ”reliable” reactions only at the second round
of working the points. Use short questions such as: ”Here?” ”Good?” ”Painful?” If the lines and points are relevant and
effective, carry on with your treatment you have chosen the right routine.

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73
 DIAGNOSIS TABLE

ROUTINE - 11 (PAGE 78) ROUTINE - 12 (PAGE 80)

Pain at the midpoint of the inner Pain at the lower third of the inner
edge of the shoulder blade edge of the shoulder blade
• Stiffness with or without pain is present adjacent • Chronic stiffness with pain is located adjacent to
to the medial border of the scapula, at the the medial border of the scapula 1/3rd or 1/5th
midpoint between the upper and lower edges of the way between the lower and upper edges
of the scapula. of the scapula, 2 – 3 fingers above the lower
edge of the scapula.
• Pain may appear suddenly, following a “bad”
movement or following a night of sleeping on • Pain may be the result of months or years of
the shoulder. repetitive movement or stress, and it may
disturb sleep.
• Pain may radiate to the chest.
• There is also pronounced stiffness of the soft
• Pain may increase in neck movements or while
tissue at the area of pain.
trying to touch the other shoulder, as though
hugging oneself (horizontal adduction), or during
a twist.

PAIN LOCATION PAIN LOCATION

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 ROUTINE - 13 (PAGE 82) ROUTINE - 14 (PAGE 84)

Shoulder pain with additional pain Pain next to the lower medial
while breathing part of the shoulder blade with
Under this problem name are two different additional pain along the thoracic
treatment routines for two similar but separate spine
disorders. When the additional pain appears on • Pain is located along the thoracic spine and at
the chest, the routine of the 3 acupressure points the lower medial border of the shoulder blade.
of the back is used, but when the additional
pain appears on the back, the front routine of • There is also pronounced stiffness of the soft
acupressure points on the chest is used. tissue along the lateral border of the shoulder
blade.
• Chronic or acute pain is located at point 3 of the
upper back.
• Additional pain appears upon inhaling, either at
point 3 on the back or at point 1 on the chest.
The pain that appears while breathing is usually
secondary to the predominant pain at point 3.

PAIN LOCATION PAIN LOCATION

3rd back line
2nd back line
1st back line

75
 DIAGNOSIS TABLE

ROUTINE - 15 (PAGE 86) ROUTINE - 16 (PAGE 88)

Stiff shoulder with pain when Shoulder pain when bending the
raising the arm arm behind the back (medial
• Chronic or acute pain is located on the front rotation)
and/or back aspect of the shoulder. • Chronic or acute pain is located on the front
• Pain increases while raising the arm upward aspect of the shoulder.
(flexion), sideward (abduction), while trying to • Pain increases while raising the arm backwards
touch the other shoulder, as though hugging (extension) and more so when bending it
oneself (horizontal adduction) or while bending behind the back (medial rotation).
the arm behind the back (medial rotation)..

PAIN LOCATION PAIN LOCATION

Index finger

Middle finger

Ring finger

PAINFUL MOVEMENTS PAINFUL MOVEMENTS

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77
 Routine - 11 SHOULDER AND SHOULDER BLADE
Pain at the midpoint of the inner edge of the shoulder blade a common condition

3rd back-5
on the top edge of the trapezius •
in line with the medial border of the
scapula • a stiff and tender point,
press downwards cautiously

Scapula-3 (SI-14)
upper angle of the scapula • 1 finger above the scapular
spine • run your fingertip up along the medial border of the
scapula until it turns lateral and disappears under the levator
scapula; press on that spot, not letting the muscle slip
sideways • this is a stiff and very sensitive point that radiates
11
sensations in all directions including to the head

Scapula-4
10 medial to the medial border of the
scapula • level with the medial edge
of the spine of the scapula
9
8 Scapula-5
medial to the medial border of
Scapula-12
1/2 Scapula 7 1 lateral to the lateral edge of
the scapula • level with a line
that runs below the spine of
the scapula • 2 fingers above
6 2 the axillary crease • press
scapula
medial • a very sensitive point
5 3
over the teres minor muscle

4
Scapula-11
lateral to the lateral edge of the scapula
• level with the axillary crease • press
toward the edge of the scapula onto
the bone

Scapula-10
lateral to the lateral edge of the
scapula • 1 finger superior to
Scapula-9 • 1/2 of the way from
Scapula-6 Scapula-8 Scapula-9 the lower angle of the scapula to
midpoint of the medial medial to the medial edge of under the lower angle of the scapula and the axillary crease • press toward
border of the scapula the scapula • 1/5 of the way slightly lateral • find a thin slippery muscle the edge of the scapula onto the
from the lower to the upper bone
angles of the scapula • 1 finger
Scapula-7 superior to the lower angle of
medial to the medial edge of the the scapula
scapula • 1/3 of the way from the
lower to the upper angles of the
scapula • 1 finger under the midpoint
of the medial border of scapula
12

13

Posterior scalene
a tender point aligned with the
lateral edge of the neck • press the
posterior scalene muscle anterior to
the top of the trapezius

Chest-2 (ST-13)
directly below the clavicle • 1/2-way
between the midline and the lateral
borderline of the chest • 3 fingers
lateral to the midline • aligned with
the lateral edge of the neck

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Problem description:
• Stiffness with or without pain is present adjacent to the medial border of the scapula, at the midpoint between the upper
and lower edges of the scapula.
• Pain may appear suddenly, following a “bad” movement or following a night of sleeping on the shoulder.
• Pain may radiate to the chest.
• Pain may increase while trying to touch the other shoulder, as though hugging oneself (horizontal adduction), or during a
twist.

Treatment steps
Precautions:
1. Neck and shoulder treatment • Consult a specialist before treating an acute or a
Position the client seated with legs crossed or questionable shoulder condition.
extended. If the client is uncomfortable sitting on • Avoid stretching when treating acute conditions.
the floor, use a pillow • Treat daily until recovery.
or a chair. Massage • Do not repeat treatment until after the client stops
the neck, upper back, feeling pain (if any) from the previous treatment.
and along the medial • Instruct the client to refrain from any quick or
border of the scapula, sudden movement and from any hurtful activity or
using any technique posture.
with which you are
familiar. Do not Selected therapy points
stretch at all!

2. Acupressure points
Thumb press points 1 through 12 two to 2 4
three times, then point 13 on the chest.
Return to the back to work points 1 - 12 and
then work point 13 again. Press each point for
10 to 15 seconds. Repeat
thumbing the points as long
as improvement occurs,
up to ten repetitions. Stop 5 6
working if the points become
sensitive. Use
the amount
of pressure
that suits your
client.
7 8

11 13

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 Routine - 12 SHOULDER AND SHOULDER BLADE
Pain at the lower third of the inner edge of the shoulder blade a common condition

Scapula-5 Scapula-7
medial to the medial border medial to the medial edge of the
of the scapula • level with a scapula • 1/3 of the way from the
line that runs below the spine lower to the upper angles of the
of scapula scapula • 1 finger under the midpoint
of the medial border of the scapula

Scapula-8
Scapula-6 medial to the medial edge of the
midpoint of the medial border scapula • 1/5 of the way from the
of the scapula lower to the upper angles of the
scapula • 1 finger superior to the lower
angle of the scapula

4
1/2 Scapula 3
1/3 Scapula 2

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Problem description:
• Chronic stiffness with pain is located adjacent to the medial border of the scapula at the 1/3rd or 1/5th point between
the lower and upper edges of the scapula, 2 - 3 fingers above the lower edge of the scapula.
• Pain may be the result of months or years of repetitive movement or stress, and it may disturb sleep.
• There is also pronounced stiffness of the soft tissue at the area of pain.

Treatment steps

1. Neck and shoulder treatment so that he does not have to exert any effort to
Position the client seated with legs crossed or hold up his arm. Using your elbow, work along
extended. If the client is uncomfortable sitting on the medial border of the scapula. Put your
the floor, use a pillow elbow on the client’s
or a chair. Massage back, very gently pulling
the neck, upper back, and stretching the skin
and along the medial downwards. Then press
border of the scapula, onto the soft tissue
using any technique and push upwards,
you are familiar with. strumming the muscles.
Do not stretch at all! Repeat several times.

Precautions:
• Consult a specialist before treating an acute or a
2. Acupressure points
questionable shoulder condition.
In this routine, points 1 through 4 are • Avoid stretching when treating acute conditions.
worked in a different manner. Thumb pressing • Treat daily until recovery.
the therapy points using continuous extended • Do not repeat treatment until after the client stops
pressure will not be effective in treating this feeling pain (if any) from the previous treatment.
ailment. Use the following techniques: • Instruct the client to refrain from any quick or
Stage a: Gently fix the thigh of your client using sudden movement and from any hurtful activity or
your knee. Hold your client’s elbow, pushing his posture.
arm horizontally (horizontal adduction) towards
the opposite shoulder. Then pull to release Selected therapy points
pressure, and then push
again repeating this
movement several times
over. As you push the
elbow, press a therapy
point away from the
shoulder blade toward 1 2
the spine as though you
are strumming a guitar
string. Pull and then
Push the elbow again
and work on the next point. Continue to the
next point. Repeat working the points as long as
improvement occurs and as long as you feel the 4 6
stiff soft tissue at the area of the points slipping
or clicking under your thumb. Work until the
stiff muscles become soft but not more than ten
repetitions. Stop working if the points become
sensitive. Use the amount of pressure that suits
your client.
Stage b: Instruct your patient to put his hand
on the opposite shoulder, and hold his hand

81
 Routine - 13 SHOULDER AND SHOULDER BLADE
Shoulder pain with additional pain while breathing a common condition

3rd back-5
on the top edge of the trapezius •
in line with the medial border of the
scapula • a stiff and tender point,
press downwards cautiously

Scapula-3 (SI-14)
upper angle of the scapula • 1 finger above the scapular
spine • run your fingertip up along the medial border of
the scapula until it turns lateral and disappears under the
1 levator scapula; press on that spot, not letting the muscle
slip sideways • this is a stiff and very sensitive point that
radiates sensations in all directions including to the head

Scapular Spine 3 2nd back-9 (BL-13)

1 finger lateral to the spinous process of T-3
• level with the medial edge of the spine of
3 the scapula • on the highest point of the
paraspinal muscles • press forward

2nd back-10 (BL-14)

1 finger lateral to the spinous process of T-4 •
e
2nd back Line

1 finger below point 3 on the highest point of

1st back Line

3rd back Lin

the paraspinal muscles • level with a line that

runs below the scapular spine • press forward

Chest-3 (LU-2)
right below the clavicle • medial
to the coracoid process, in a deep
Anterior scalenus (ST-12 area) 3 depression just before the shoulder
in the supraclavicular fossa • aligned • press forward and upwards
with the lateral edge of the neck •
press cautiously towards the neck on 2
the anterior scalene • radiates pain to
the arm

1 Chest-6 (ST-15)
2 fingers below the clavicle • in the
second intercostal space • 3 fingers
lateral to the midline • aligned with
the lateral edge of the neck • directly
below point 3

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Problem description:
• Chronic or acute pain is located at point 3 of the upper back.
• Additional pain appears upon inhaling, either at point 3 on the back or at point 1 on the chest.The pain that appears
while breathing is usually secondary to the predominant pain at point 3 on the back. Some clients may even suspect a
heart condition and will go to the hospital when the pain while breathing appears on the chest.
• Various movements may increase the pain in some cases, but not always and not in a fixed pattern.
• This condition is often accompanied by low spirits.

Treatment steps
Precautions:
1. Neck and shoulder treatment • Consult a specialist before treating an acute or a
Position the client seated with legs crossed or questionable shoulder condition.
extended. If the client is • Avoid stretching when treating acute conditions.
uncomfortable sitting on • Treat daily until recovery. In chronic non-acute
the floor, use a pillow conditions, treat twice a week.
or a chair. Massage the • Do not repeat treatment until after the client stops
neck, upper back, and feeling pain (if any) from the previous treatment.
along the medial border • Instruct the client to refrain from any hurtful activity
of the scapula, using any or posture.
technique with which
you are familiar. Do not
stretch at all! Selected therapy points

2. Acupressure points
Treat the opposite side: Use the set of points 1 2
opposite to the appearance of pain. Thumb
press points 1 through 3 of the back when
the pain while breathing appears on the chest.
Thumb press points 1 through 3 of the
chest when the pain while breathing appears
on the back. Press each point for 10 to 15
seconds. Repeat thumbing the points as long 3 1
as improvement occurs, up to ten repetitions.
Stop working if the points
become sensitive. Use the
amount of pressure that
suits your client.

2 3

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 Routine - 14 SHOULDER AND SHOULDER BLADE
Pain next to the lower medial part of the shoulder
an uncommon condition
blade with additional pain along the thoracic spine

Scapula-12
lateral to the lateral edge of the scapula •
2 fingers above the axillary crease• press
medial • a very sensitive point over the teres
minor muscle
1

2 Scapula-11
lateral to the lateral edge of the scapula • level
with the axillary crease • press toward the
3 edge of the scapula onto the bone

Scapula-10
lateral to the lateral edge of the scapula • 1
finger below point 2 • 1/2 of the way from
the lower angle of the scapula to the axillary
crease • press toward the edge of the
scapula onto the bone

84
Problem description:
• Pain is located along the thoracic spine and at the lower medial border of the shoulder blade.
• There is also pronounced stiffness of the soft tissue along the lateral border of the shoulder blade.

Treatment steps
Precautions:
1. Neck and shoulder • Consult a specialist before treating an acute or a
treatment questionable shoulder condition.
Position the client • Avoid stretching when treating acute conditions.
seated with legs crossed • Treat daily until recovery. In chronic non-acute
or extended. If the client conditions, treat twice a week.
is uncomfortable sitting • Do not repeat treatment until after the client stops
on the floor, use a pillow feeling pain (if any) from the previous treatment.
or a chair. Massage the • Instruct the client to refrain from any hurtful activity
neck, upper back, along or posture.
the medial border of
the scapula, the lateral
Selected therapy points
border of the scapula,
and along the Ring Finger Line on the outer arm,
using any technique with which you are familiar.

2. Acupressure points
Thumb press points 1 1 2
through 3 . Press each point
for 10 to 15 seconds.

Optional complementary procedure

3. Strumming the points

Thumb press points 1 through 3 as though
you are strumming a guitar string. Press against
the lateral border of the
scapula. Repeat working the
points using both methods
or the more effective one,
as long as improvement
occurs, up to ten
repetitions. Stop working if
the points become sensitive.
Use the amount of pressure
that suits your client.

85
 Routine - 15 SHOULDER AND SHOULDER BLADE
Shoulder pain when raising the arm a very common condition

3rd back-3 Scapula-3 (SI-14)

4 fingers below the occipital line upper angle of the scapula • 1 finger above the
in the depression between the scapular spine • run your fingertip up along the
trapezius and SCM • 1/2-way medial border of the scapula until it turns lateral and
between the occiput and c-7 disappears under the levator scapula; press on that
spot, not letting the muscle slip sideways • this is a stiff
3rd back-5 and very sensitive point that radiates sensations in all
on the top edge of the trapezius • directions including to the head
in line with the medial border of the
scapula • a stiff and tender point, Scapula-14
press downwards cautiously below the scapular spine • lateral to
1/2 Neck 1 the medial edge of the scapula • find
a shallow depression in a bony angle
formed by the scapular spine and the
medial border of the scapula
2 Scapula-13 (SI-10)
directly above the axillary crease
• below the lower edge of the Middle finger-6
scapular spine • press medially 3 fingers below the lateral tip of the
acromion • in the depression between
3 the median and posterior deltoids
Middle finger-7 (TW-14)
below and posterior to the lateral
4 A edge of the acromion • in a
shallow depression formed when
8 the arm is raised sideways Ring-6 (SI-9)
11 5 a tender point that radiates down
the arm • place your thumb at the
1/2 Scapula 15 9 7 6 axillary crease and press upwards
Scapula-12 onto a muscle tissue at the angle
10 where the arm meets the scapula
14 lateral to the lateral edge of the
or alternatively, press forward 2
scapula • 2 fingers above the
axillary crease • press medial • fingers above the axillary crease
13 a very sensitive point over the
teres minor muscle
12
Scapula-17 (SI-11)
upper third of the scapula, halfway
between its medial and lateral borders
• find a very sensitive point halfway from
Scapula-11 the upper angle of the scapula to the
lateral to the lateral edge of axillary crease • 1 finger from point 8
the scapula • level with the toward the axillary crease • this point
axillary crease • press toward radiates in all directions including to the
the edge of the scapula onto front shoulder
Scapula-6 Scapula-16 the bone
midpoint of the medial 1 finger inferior to Scapula-15
border of the scapula • find a shallow depression in a Scapula-10
bony angle formed by the medial Scapula-9 lateral to the lateral edge of the scapula •
and the lateral edges of the under the lower angle of the 1 finger superior to point 12 • 1/2 of the
scapula • 3 fingers above the scapula and slightly lateral • way from the lower angle of the scapula to
Scapula-15 lower angle of the scapula find a thin slippery muscle the axillary crease • press toward the edge
lateral to the medial border of of the scapula onto the bone
the scapula • 1 finger inferior
to Scapula-14

Chest-3 (LU-2) Index finger-5 (LI-15)

right below the clavicle • medial in the shallow depression formed when the
to the coracoid process, in a deep arm is raised sidewards • below the lateral
depression just before the shoulder • edge of the acromion between the median
press forward and upwards and anterior heads of the deltoid
1
B
Mid in arm-5
Chest-4 1 finger lateral to a line drawn from the axillary
On the borderline between the chest crease upwards to the clavicle • level with the
and shoulder • 1/2-way between the midpoint between the clavicle and the axillary
clavicle and axillary crease 2 4 4 crease • place thumb on the borderline of
the chest and arm, and press laterally on the
tendon of the biceps, onto the humerus

Mid in arm-4 5 5 Thumb-7 (Jianqian)

above the axillary crease • 1 finger 1/2-way between the axillary crease and the
lateral to a line drawn from the axillary 3 lateral tip of the acromion • 2 fingers lateral to
crease upwards to the clavicle • place a line drawn from the axillary crease upwards
thumb just above the axillary crease to the clavicle • at the neck of the humerus •
and press laterally on the tendon of the press in the depression at the medial border
biceps, onto the humerus of the anterior deltoid.

Thumb-6
above the axillary crease • 2 fingers
Chest-5 lateral to a line drawn from the axillary
at the anterior axillary crease when the crease upwards to the clavicle • press
arm hangs in the adducted position • in the depression at the medial border of
press the muscle upwards the anterior deltoid

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Problem description:
• Chronic or acute pain is located on the front or back aspect of the shoulder.
• Pain increases while raising the arm upward (flexion), sideward (abduction), or
while trying to touch the other shoulder, as though hugging oneself (horizontal
adduction) or while bending the arm behind the back (medial rotation).
• The range of movement is slightly to widely restricted. A sharp pain may
accompany the moving of the arm beyond a certain point that varies individually
from one person to another.

Treatment steps Optional complementary procedures

1. Neck and shoulder treatment 3. Shoulder horizontal adduction

Position the client seated with legs crossed or Hold your client’s elbow and push it horizontally
extended. If the client is (horizontal adduction) as far as it will go. Do
uncomfortable sitting on the not push beyond the point of pain. Pull the
floor, use a pillow or a chair. elbow back and then push again repeating
Massage the neck, upper this movement several times. As you push the
back, and along the medial elbow, press
border of the scapula, using point 5 of the
any technique with which back set.Release
you are familiar. Do not pressure as you
stretch at all! pull the elbow

2. Acupressure points 4. Work the biceps and the triceps

Thumb press points 1 through 15 of the back Instruct your client to cautiously place his hand
and 1 through 5 of the front. Try also extra on your shoulder holding the arm straight. Be
points A and B . If effective, use them. In careful not to raise his arm beyond the point of
some cases, using the back set or the front set pain. Work the outer arm along the humerus
of points may be sufficient. For example, when (Index finger line) from the shoulder to the
the pain is on the back aspect only and the front elbow and back up several times using your
set of points seems ineffective, use only the fingertips to pull and roll the biceps away from
back set of points. Press each point for 10 to 15 the arm bone (humerus) with one hand and
seconds. Repeat thumbing the points as long as then to pull and roll the triceps away from the
improvement occurs, up to ten repetitions. Stop arm bone with the other
working if the points become sensitive. Use the hand. Right pulls, and
amount of pressure that suits your client. then left pulls, right, left,
one after the other in a
flowing rhythmic manner.

Precautions:
• Consult a specialist before treating an acute or a
questionable shoulder condition.
• Avoid stretching when treating acute conditions.
• During the entire treatment, avoid moving the arm
Selected therapy points beyond the point of sharp pain.
• Treat daily until recovery. In chronic non-acute
conditions, treat twice a week
• Do not repeat treatment until after the client stops
feeling pain (if any) from the previous treatment.
• Instruct the client to refrain from any quick or
sudden movement and from any hurtful activity or
4 4 posture.

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 Routine - 16 SHOULDER AND SHOULDER BLADE
Shoulder pain when bending the arm behind the back a common condition

Chest-1 (KID-27)
at the lateral edge of the sternum • in
the thin depression below the head of
the clavicle and above the first rib •
radiates to the shoulder

3 Chest-3 (LU-2)
1 right below the clavicle • medial to the
2 coracoid process, in a deep depression
just before the shoulder • press forward
and upwards

Chest-2 (ST-13)
below the clavicle • 1/2-way between
the midline and the lateral borderline
of the chest • 3 fingers lateral to the
midline • aligned with the lateral edge
of the neck

Index finger-4 (LI-12)

2 fingers above the elbow crease
• on the anteriolateral aspect of
the humerus • between the biceps
Index finger

and triceps •shift upwards and

then press • radiates to all fingers
Middle finger

Ring finger

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Problem description:
• Chronic or acute pain is located on the front aspect of the shoulder.
• Pain increases while raising the arm backwards (extension) and more so when bending it
behind the back (medial rotation).
• The range of movement is slightly to widely restricted. A sharp pain may accompany
the moving of the arm beyond a certain point that varies individually from one person to
another.

Treatment steps
Precautions:
1. Neck and shoulder treatment • Consult a specialist before treating an acute or a
Position the client seated with legs crossed or questionable shoulder condition.
extended. If the client is • Avoid stretching when treating acute conditions.
uncomfortable sitting on • During the entire treatment, avoid moving the arm
the floor, use a pillow beyond the point of sharp pain.
or a chair. Massage the • Treat daily until recovery. In chronic non-acute
neck, upper back, and conditions, treat twice a week.
along the medial border • Do not repeat treatment until after the client stops
of the scapula, using any feeling pain (if any) from the previous treatment.
technique with which • Instruct the client to refrain from any quick or
you are familiar. Do not sudden movement and from any hurtful activity or
stretch at all! posture.

Selected therapy points

2. Arm therapy lines

Work the three outer arm lines and the Thumb
line, giving extra attention to the Index finger
line. Start from the axillary crease down to the
elbow and back up - between 1 and 3 times. 1 2
Use any technique
with which you
are familiar.
Thai massage
practitioners:
Thumb press the
above lines. 3 4

3. Acupressure points
Thumb press points 1 through 4 . Press each
point for 10 to 15 seconds. Repeat thumbing
the points as long
as improvement
occurs, up to ten
repetitions. Stop
working if the points
become sensitive.
Use the amount of
pressure which suits
your client.

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