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68 m a s s a g e & b o d y w o r k j a n u a r y / f e b r u a r y 2 0 2 0 Pin and Rock Gently rock your client's shoulder while your fingers are lightly pressing on the subscapularis, working your way inferior to superior. Rocking is calming and a great way to "introduce" yourself to a muscle. The hand that is rocking the shoulder is the working hand. The hand that is on the subscap is simply exerting a gentle pressure. Do this Pin and Rock technique until you feel some melting in the tissue. Perform it on as much of the subscap as is accessible. Notice whether the scapula is glued to the rib cage. If it is, hopefully it will be more freely movable at the end of your work. Once you have felt some melting of the tissue, you can add small circular movements with your fingertips as you continue to warm up the subscap. Do this with the muscle in a neutral state or, if your client is too sore, a slack state. Try to get as much length and width of the subscapularis as you can. There have been many clients on whom I could just do simple rocking for several sessions. "Ungluing" the subscap and freeing the scapula to glide on the thorax can take time. Honor your client's pain threshold. This builds rapport and trust. The client actively moves the humerus toward her ear in abduction while the therapist works the superior section of the subscap in the supine position. Keep in mind that abduction is usually limited with rotator cuff injuries; work to increase range of movement while respecting limitations. Pin and Move Take the shoulder through both passive and active range of motion while releasing trigger points and knots. Active movement allows you to work through the muscle layers, but begin with passive movement to teach your client the movement pattern, and then allow your client to do it on their own. Keep in mind that most people with rotator cuff injuries have limited range of movement, but active movement is essential for release of stubborn trigger points and knots. Movement choices include (1) internal and external rotation, (2) abduction/ adduction, and (3) any movement of the shoulder joint! Always ask your client what movement they think would work best. You might find that some clients will not be able to tolerate supine subscap work for a variety of reasons. Or, your client may be ticklish, have large breasts, be heavily muscled, or have a glued-down scapula that makes access to the subscap a challenge. You should start these clients in the side-lying position.

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