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92 m a s s a g e & b o d y w o r k n o v e m b e r / d e c e m b e r 2 0 1 8 technique MYOSKELETAL ALIGNMENT TECHNIQUES Don't Blame the Rotator Cuff Addressing Arthrokinetic Reflexes By Erik Dalton, PhD 1 The term arthrokinetic reflex (arthro meaning "joint" and kinetic meaning "motion") was coined by University of Pittsburgh researchers to describe how sensory input from joint movement reflexively activates or inhibits muscles. 1 In no other place in the body is this concept more applicable than the joints and connective tissues of the shoulder girdle (Image 1). If sensory input from the sternoclavicular (SC), acromioclavicular (AC), and glenohumeral (GH) joints conveys that the shoulder movement is safe, the nervous system will loosen its governor on rotator cuff strength and range of motion. If the information suggests the movement is dangerous, however, the brain may protectively guard the shoulder via muscle stiffness, pain, weakness, or altered coordination. In these cases, the myoskeletal method aims to first restore shoulder girdle function—by clearing SC, AC, and GH joint fixations—and many rotator cuff injuries involve map problems due to dysfunctional joints. TESTING AND TREATING COMMON SC JOINT FIXATIONS Rotator cuff impingement syndrome occurs when the supraspinatus tendon gets squashed between the humerus and the scapula's acromion process during arm abduction. One of the primary—and frequently missed—causes is insufficient SC joint elevation of the clavicle. The SC joint should always move in an opposing direction to the scapula, but tension, trauma, and suboptimal posture can cause the clavicle to get locked in a superior (or anterior) position on the manubrium, preventing normal downward glide as the arm is raised. In these cases, manual and movement therapy to treat a frayed rotator cuff tendon is pointless until the SC joint fixation is corrected. To begin, we first must determine whether the client's medial clavicular heads drop inferiorly as the client elevates (shrugs) his shoulders. In Image 2, I assess for an SC joint elevation restriction by placing my index and middle fingers on then assess for possible rotator cuff injury. In this column, we'll first discuss SC neuromechanics and biomechanics, and then I'll demonstrate a couple of my favorite techniques to help your clients presenting with rotator cuff impingement syndrome. MOVEMENT MAP ISSUES Articular mechanoreceptors in shoulder girdle ligaments and joint capsules transmit movement information to the brain at a speed of 300 miles per hour. The brain uses this data to create a movement map, or an idea of the type of movement taking place. Depending on the stimulus or lack thereof, these receptors can inhibit or facilitate surrounding muscle tone. A simple way to think about this is that "jammed joints" typically result in weaker muscles, whereas mobile joints promote stronger muscles. So, when a joint has been strained or locked in an abnormal position, it causes a map clarity issue, resulting in mild muscle strength alterations and loss of functional range. This is a protective mechanism the brain uses when it can no longer predict the movement that's occurring. In my experience, The sternoclavicular (SC) joint should elevate during shoulder abduction to avoid impingement syndrome. SC joint Rotator cuff tear

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