Massage & Bodywork

January | February 2014

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technique CLINICAL APPS Melvin's Painful Shoulder By Whitney Lowe Melvin is a 29-year-old male client Anterior deltoid (transparent), pectoralis major, and underlying structures complaining of shoulder pain that has gradually worsened over the last three months. He is physically active and his primary hobby is kayaking, although he does a number of other activities as well. He has a busy work schedule as a veterinarian, so his occupational activities are also physically demanding. 1 Superficial muscles to investigate. Image is from 3D4Medical's Essential Anatomy application, available on the App Store. This is the first installment in a new column called Clinical Apps, where we focus on clinical applications through case studies to address clients' musculoskeletal problems. In this series, Whitney Lowe will take you through the process of evaluating a client's problem and then creating a treatment protocol to meet that client's needs. 100 massage & bodywork january/february 2014 Several months ago, Melvin began feeling pain in his shoulder following a long period of training in preparation for a kayak competition. He describes the pain as primarily in his anterior shoulder region, but claims it is sometimes difficult to pinpoint exactly where the pain is coming from. A number of different activities give him the greatest discomfort, such as reaching overhead, reaching out and lifting, and combing his hair. His primary goal is to get back to a healthy level of activity both at work and in his recreational pursuits. He has regularly used massage for conditioning and relaxation, and wants to know if massage is a good strategy to help him with this complaint. KEY CONSIDERATIONS We've determined Melvin's key area of pain to be in the anterior shoulder region, so that's where we'll focus first. Where a person is feeling pain is not always the primary source of the problem, but it is the best place to begin your investigation. Melvin described his pain as located in the anterior and lateral region of the shoulder. The inclination may be to consider primarily the anterior and middle deltoid muscles, along with the pectoralis major and minor, as these are the primary muscles in the region where the pain is reported. Yet, we must not fall prey to a common trap of being captivated by our lens of bias. A person's lens of bias (and we all have one) is the perspective resulting from your learning and experiences.

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