Massage & Bodywork

NOVEMBER | DECEMBER 2018

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2 3 4 5 The medial clavicular heads should drop down during a shoulder shrug. The therapist's fingers depress the SC joint during arm abduction. The SC joint should move posteriorly during shoulder girdle protraction. The therapist's right thenar eminence depresses the client's AC joint while protracting their shoulder. the superior border of the client's medial clavicle and asking them to shoulder-shrug. If one side does not drop down, there is a ligament or articular disc restriction in that SC joint. Try this on yourself by placing your left index finger on top of your right medial clavicle while you shrug the shoulder. Does it drop down? Image 3 demonstrates a contract-relax technique for correcting a superiorly fixated SC joint. Notice how my fingers gently depress the superior clavicular border as my left hand abducts the client's arm to barrier. The client gently pushes down against my resistance to a count of five and relaxes, and I slowly increase arm abduction to the new restrictive barrier. Repeat 3–5 times and retest. I've found this technique very effective in mobilizing fibrotic soft tissues that restrict shoulder elevation and arm abduction, but not always. The most common restriction seen at this very mobile SC saddle joint occurs during shoulder girdle protraction. To assess whether the client's right clavicle is dropping posteriorly, my thumb contacts the anterior clavicular head and the client is asked to reach toward the ceiling (Image 4). Shoulder protraction should cause my thumb to palpate the medial clavicle translating posteriorly. If it does not move back, the restriction may be triggering an arthrokinetic reflex that alters rotator cuff integrity. To treat a right anteriorly fixated SC joint, the client grasps my neck and I create a counterforce by gently depressing his medial clavicle while my left hand lifts his scapula (Image 5). To enhance this myoskeletal technique, the client is asked to gently pull down on my neck against resistance to a count of 5 and relax. Again, a counterforce is applied by lifting the client's shoulder while gently depressing the anteriorly fixated clavicle. Repeat 3–5 times and retest for improved posterior clavicular glide. Such arthrokinetic reflex techniques are often helpful in relieving protective rotator cuff guarding associated with SC joint fixation. By working with the client's nervous system to increase tolerance, mobilization with movement also psychologically reinforces to the client that they can move their arm through a normal range of motion. Note 1. L. Cohen and M. Cohen, "Arthrokinetic Reflex of the Knee," American Journal of Physiology 184, no. 2 (1956): 433–37. Erik Dalton, PhD, is the executive director of the Freedom from Pain Institute. Educated in massage, osteopathy, and Rolfing, he has maintained a practice in Oklahoma City, Oklahoma, for more than three decades. For more information, visit www.erikdalton.com. Yo u r M & B i s w o r t h 2 C E s ! G o t o w w w. a b m p . c o m / c e t o l e a r n m o r e . 93

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