Massage & Bodywork

JANUARY | FEBRUARY 2020

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Ta k e 5 a n d t r y A B M P F i v e - M i n u t e M u s c l e s a t w w w. a b m p . c o m / f i v e - m i n u t e - m u s c l e s . 69 Resources Fernandez de las Penas, Cesar, Joshua Cleland, and Peter Huijbregts (Eds.). Neck and Arm Pain Syndromes. Churchill Livingstone, 2011. Osar, Evan. Corrective Exercise Solutions to Common Hip and Shoulder Dysfunction. Aptos: Lotus Publishing, 2012. Sahrmann, Shirley. Movement System Impairment Syndromes of the Extremities, Cervical and Thoracic Spines. St. Louis: Mosby, 2011. Trundle, Terry. Rotator Cuff Syndrome: From Impingement to Post-Operative Rehab (digital seminar). 2009. SOLID PRINCIPLES FOR WORKING THE SUBSCAP There are many effective manual therapy techniques for working with the noble subscap. Align yourself with solid principles when choosing techniques. As engineer Harrington Emerson famously said, "As to methods there may be a million and then some, but principles are few. The man who grasps principles can successfully select his own methods. The man who tries methods, ignoring principles, is sure to have trouble." Following are a few of the principles I follow. 1. Start with the muscle in a shortened state. 2. Pin and Rock. Your first encounter with a stressed myofascial unit should be gentle and nonthreatening. Passively shorten the muscle and gently pin it with multiple fingers for a broad, dispersed pressure. Then, add a slow rhythmic rocking of the joint. Rocking stimulates a parasympathetic response. After all, we are rocked for nine months! (In fact, the first nerves to myelinate in the human fetus are the vestibular nerves, which sense movement. The first thing we are conscious of is that we are moving beings.) Be patient—wait for the tissue to soften and yield before moving to the Pin and Move protocol. Come back to this Pin and Rock maneuver whenever you sense guarding in your client. 3. Pin and Move. When you meet an area of dense fascia, trigger points, tender points, or just plain snarly tissue, integrate active movement. Active movement takes it to the brain by involving the central nervous system, creating longer lasting results. Fascial layers and actin and myosin myofibrils glide across each other as the muscle goes through its shortened, neutral, and stretched states. 4. Work the muscle(s) from as many different positions as possible—supine, side-lying, prone, and even weightbearing. This comprehensive approach can yield tremendous results. I think of the subscap as the psoas of the shoulder because of its sensitivity, the feeling of vulnerability it evokes in the client, and its propensity to stimulate a sympathetic nervous response. Positional release and rocking are two excellent strategies to make subscap work more palatable for the client. The least invasive and easiest way to warm up the subscap is to place your finger pads on it while the arm is abducted and externally rotated. Then, adduct the arm by letting it lie in a comfortable position across your client's chest. This puts the muscle in a slack position (using the principle of positional release). Later on, you'll take the humerus through a range of motion. FINAL THOUGHTS Keep in mind that the shoulder joint is complex, and there may be underlying joint pathology that should be assessed by a doctor. The practitioner is encouraged to always use sound clinical judgment when making decisions about their ability to help each individual. Be sure to refer clients to a qualified professional when the need arises. Let this article be a stepping-stone to developing a finely honed and exquisite skill set for freeing the slippery subscap. Peggy Lamb is the author of Releasing the Rotator Cuff, Releasing the Iliopsoas and Quadratus Lumborum, Stabilizing the Core and the SI Joint, and Stretch Your Clients! (www. massagepublications.com) An educator and bodyworker for over 25 years, she brings her eclectic and extensive background to her teaching for an interesting and enlightening learning experience. She teaches her techniques nationally and internationally to massage therapists, physical therapists, and occupational therapists through Pesi Rehab. Visit her website at www.massagepublications.com or email her at info@massagepublications.com.

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