Naoshu (SI10): The Back-of-Shoulder Point for a Stiff, Aching Shoulder

Where Naoshu Sits

This point sits at the back of the shoulder, straight up from the back crease of the armpit, in the hollow under the bony ridge of the shoulder blade.

The line it belongs to begins at the outer corner of the little fingernail. It runs along the little-finger edge of the hand, up the back of the forearm, through the groove on the inner side of the elbow and up the back of the upper arm. At the shoulder it zigzags across the shoulder blade before climbing the side of the neck to the cheek and the front of the ear. Vietnamese and Chinese texts call it the Small Intestine channel. This is its tenth stop, and it is the first point where the line leaves the arm and reaches the shoulder blade.

The old texts place it directly above the end of the back crease of the armpit, in the depression below the lower edge of the spine of the scapula. The spine of the scapula is the bony ridge that runs across the top of the shoulder blade, from near the spine out to the tip of the shoulder. No measuring is needed. The armpit crease gives you the line; the ridge gives you the height. Where they meet, your fingertip drops into a soft dip.

Underneath, two muscles share the space. On the surface is the back part of the deltoid, the cap muscle of the shoulder, which pulls the arm backward. Deeper is the infraspinatus, one of the small muscles of the rotator cuff that turns the arm outward and holds the ball of the shoulder in its socket. The deltoid is supplied by the axillary nerve, which wraps around the back of the upper arm bone a little below this spot. The infraspinatus is supplied by the suprascapular nerve. The skin is served mainly by the fifth and sixth cervical roots, which is why an ache here sometimes seems to travel down the outer upper arm.

Why This Spot

On the anatomical side, this point sits over the part of the shoulder that works hardest to keep the joint steady. The rotator cuff muscles hold the ball of the upper arm in a shallow socket every time you reach, lift a kettle or hang out washing. With the years, and with long hours of reaching forward, they tire and grow tender. Many people with a stiff, painful shoulder find a sore spot right here when they press the back of the shoulder, even when the pain feels as if it is at the front.

In this tradition the point is described as a gathering place where three channels meet: its own line and two of the deeper vessels said to link the outer side of the body. That is why the old books turn to it for the whole shoulder and upper arm, not only for one small spot. It is commonly used for a shoulder that will not lift, an upper arm that aches, and pain at the back of the shoulder blade.

The name says what it does. Nao is the upper arm; shu is a point where the flow is transported, as if passed from hand to hand. Its Vietnamese name, Nhu Du, carries the same idea.

What the Old Texts Say About Naoshu

The Systematic Classic of Acupuncture and Moxibustion, the Zhenjiu Jiayi Jing compiled by Huangfu Mi in the third century, places this point behind the shoulder, in the hollow below the large bone, and records that it is found when the arm is raised. The same work names it as a meeting point of channels, which became the basis for its broad use around the shoulder. That location has been copied, with very little change, for nearly two thousand years.

The Vietnamese handbook of points and channels by Ngo Trung Trieu, published by Hong Duc, lists it for pain and inflammation of the shoulder joint and the upper arm. The book's quick method for finding it is clear: extend the line of the back crease of the armpit upward, and the point is where that line meets the hollow under the bony ridge of the shoulder blade. That is the method used on this page.

The World Health Organization, in its 2008 standard for point locations, keeps the same two landmarks: directly above the end of the back armpit crease, below the ridge. Teachers in this tradition reach for it whenever a shoulder has stiffened and the arm will no longer rise freely. That reputation comes from long use, not modern trials, but it reflects generations of hands that found this spot sore in people with painful shoulders.

Points That Work With Naoshu

The first partner is close by, lower down. From the back crease of the armpit, measure one thumb-width straight up. That partner sits right above the crease, where the back of the arm meets the trunk. In this tradition the two are commonly pressed together for an aching shoulder, one after the other along the same vertical line.

The second sits in the middle of the shoulder blade. Picture a line from the middle of the bony ridge down to the blade's bottom tip; that partner lies about a third of the way down, in a soft hollow. It is used with this one when the ache spreads across the whole shoulder blade.

The third sits at the front of the shoulder. Lift your arm out to the side and a dip appears at the front of the bony tip of the shoulder. That partner sits in that front dip. Working front and back together is a common way to address a shoulder that aches all the way through.

How to Find and Press Naoshu

Getting Into Position

Sit on a firm chair with your back supported. Let the arm on the sore side hang loosely, or rest the hand in your lap so the shoulder muscles go soft. Reach across your chest with the other hand. If that reach strains your good shoulder, stand with the back of the sore shoulder near a smooth wall and use a tennis ball, or use a long-handled rounded tool.

How to Find It

Find the back crease of the armpit with your fingertips, where the back of the upper arm folds against the trunk. Slide straight up from the end of the crease. Your fingertip travels over soft muscle and then meets a hard edge: the underside of the bony ridge at the back of the shoulder. Stop right below that edge. The soft dip there is the area.

Now probe it with a rounded-tip pressing tool. If you reach with your hand, use the very tip of your middle finger, nail cut short, not the soft pad. Move slowly in small steps around the dip. Most of it will feel like ordinary tight muscle. One spot will sting: a small, sharp, pinpoint tenderness. That spot is the point. If the ache feels deep and spreads a little toward the upper arm, that is common here. An electric jolt down the arm is not; lift off and move slightly.

How to Press It

Keep the tip on the stinging spot and rub in small circles, about the size of a fingernail, roughly one each second. Aim the pressure inward and slightly upward, toward the underside of the bony ridge. Keep the tip on the same spot; do not let it slide around the shoulder. With a ball against the wall, lean in gently and let small movements of your knees roll the ball in place.

How Much Pressure

Sharp under the tip is right. That small sting tells you that you are on the point. The test is what happens when you lift off: the sting should fade within moments. If the pain stays after you lift off, if it spreads, or if the area turns swollen, hot or red, stop and leave it for several days. If you are holding your breath, or your shoulder has crept up toward your ear, you are pressing too hard. Ease off until you can breathe slowly through the sting.

How Long

Work each side for one to three minutes. In the first sessions keep to about one minute, because this point is often tender at the start. As the days go on, add a little time, up to three minutes. Do both shoulders, even when only one complains. Once or twice a day is plenty. Pressing longer does not add benefit; it mostly adds soreness.

When to Do It

Morning suits a shoulder that is stiff on waking, before you start reaching for things. Late afternoon suits the ache that builds after housework, gardening or carrying shopping. Before bed is a good time too, as part of winding down. Do not press in the middle of the night. If a sore shoulder wakes you when you roll onto it, pressing then tends to wake you further. Keep the pressing for the day and the evening.

What This Won't Do

It will not change the reason your shoulder hurts. The usual reasons in later life are wear or tears in the rotator cuff, a stiffened joint capsule, arthritis in the joint, or a neck that irritates the nerves to the arm. A point at the back of the shoulder will not out-argue any of that. Pressing works best alongside the plain things: gentle daily movement through the range you have, exercises from a physiotherapist, not sleeping on the sore side, and keeping heavy loads close to the body.

It will not replace a diagnosis either. A shoulder that suddenly cannot lift the arm after a fall needs to be checked, because the cuff may have torn or a bone may be broken. Left shoulder pain that comes with chest pressure, breathlessness or sweating needs emergency help. A hot, swollen shoulder with a fever needs to be seen the same day. Weakness, numbness or tingling running down the arm into the hand points to the neck and should be assessed. Pain that worsens week on week, or wakes you every night, belongs with a doctor.

Safety First

Do not press over skin that is broken, burned, infected, badly bruised or rashy. Leave the area alone with a recent fracture or dislocation, after shoulder surgery until your surgeon agrees, or with a joint replacement unless your surgeon has cleared it. Skip this point if the shoulder is hot and swollen. If you take blood thinners, bruise easily, have a bleeding disorder, or have fragile bones, use lighter pressure, keep sessions short, and talk to your doctor first.

Stop at once if the pain stays after you lift off, spreads, or if the area becomes swollen, hot or red. Stop too for any electric jolt or numbness running into the arm. Nothing here requires you to push through pain. For the full list of cautions and the situations where pressing on yourself is not appropriate, read the full safety guide before you begin.

Questions People Ask

Where is the Naoshu (SI10) pressure point? Naoshu (SI10) sits at the back of your shoulder. Find the back crease of the armpit, where the back of the upper arm meets the trunk, and follow it straight up. The point is in the hollow under the bony ridge of the shoulder blade. In English it is called the Upper Arm Transport Point; in Vietnamese, Nhu Du.

Can I reach Naoshu with my own hand? Most people can. Reach across the front of your chest with the opposite hand and curl the fingertips over the back of the shoulder. If your shoulders are stiff and that reach hurts, use a long-handled rounded tool, or lean the back of the shoulder onto a tennis ball against a wall.

How long should I press Naoshu? One to three minutes on each side. Start with about a minute, then add a little time over the days, up to three. Once or twice a day is enough. Work both shoulders, even if only one aches.

It hurts more when I lift my arm. Should I still press it? Pressing with the arm resting is fine as long as the sting fades the moment you lift off. Do not press while forcing the arm up into pain. If you cannot lift the arm at all, or it became weak after a fall, have it checked before pressing.

Is this the same as the point in the middle of the shoulder blade? No. That one sits lower and further toward the spine, in the flat middle of the blade. This one sits higher and further out, at the back of the shoulder itself, close to the arm. They are often pressed one after the other.

Can I use it for a frozen shoulder? In this tradition it is commonly used for a stiff, painful shoulder, and many people with a frozen shoulder find the area tender. Use light pressure, keep up the gentle movements your doctor or physiotherapist gave you, and let the pressing support that work rather than replace it.

Other Points in This Library

Each of these sits within reach of the same hand. They are often worked in the same sitting.

This page shares general information about a traditional practice. It is not medical advice and does not replace what your doctor has given you. If you are pregnant, managing a health condition, or unsure whether this applies to you, check with your doctor first.

The whole inner edge of the foot, laid out on one page with photographs, is in The Foot Map — the free book. For every point in this library, see the full pressure point index.

(Point shown: SI10 · Naoshu · Upper Arm Transport Point · Nhu Du.)