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Treatment of shoulder muscles to reduce LTN compression. end of the clavicle. Slightly laterally flex the client's head toward the affected side. Apply a traction force to the skin with your hands, gently pulling them apart (Image 4). Hold this for about 2 minutes. At the end of that period, very slowly and gently let go and once again move the neck and shoulder slowly and easily within a comfortable range of motion to help re- encourage safe and pain-free movement. There can be bind and restriction in the lower portions of the long thoracic nerve as well. These restrictions can be addressed with the client in a side-lying position. Have the client hold one arm across the front of the body and use the other hand to keep the drape in place so the lateral aspect of the rib cage is accessible. With one or both hands, push the surface layer of skin across the lateral rib cage and hold this position for a few moments (Image 5). Then, slowly let go and push in a slightly different direction (Image 6). Pushing and pulling the skin perpendicular to the direction of the nerve can help to mobilize the nerve and make sure it is not being entrapped, bound, or restricted by adjacent tissues. SCIENCE OF NERVES C h e c k o u t A B M P 's l a t e s t n e w s a n d b l o g p o s t s . Av a i l a b l e a t w w w. a b m p . c o m . 101 Serratus anterior treatment (direction 2). Treatment of scalene muscles to reduce LTN compression. Serratus anterior treatment (direction 1). CONCLUSION When you begin to explore the anatomy of the nervous system, it is clear there are many more locations where nerves are vulnerable to excessive compression or tension than most of us realize. While stories of carpal tunnel, thoracic outlet, or nerve root compression dominate most of the focus of nerve compression problems, there is a whole host of other disorders involving other nerve tissues throughout the body. Massage therapists are ideally positioned to help address these complaints, and future versions of this column will focus on these fascinating issues. For a full list of references and some additional information on long thoracic nerve injury, visit our blog at www.academyofclinicalmassage.com. Notes 1. K. E. Keenan and J. G. Skedros, "A Patient with Clavicle Fracture and Recurrent Scapular Winging with Spontaneous Resolutions," Case Reports in Orthopedics (2012): 603726. 2. N. Omar, F. Alvi, and M. S. Srinivasan, "An Unusual Presentation of Whiplash Injury: Long Thoracic and Spinal Accessory Nerve Injury," European Spine Journal 16, supplement 3 (2007): 275–77. 3. J. G. Skedros et al., "Complex Scapular Winging Following Total Shoulder Arthroplasty in a Patient with Ehlers-Danlos Syndrome," Case Reports in Orthopedics (2015): 680252. 4. A. I. Tsirikos and K. Al-Hourani, "Transient Long Thoracic Nerve Injury During Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis: A Report of Two Cases," Indian Journal of Orthopaedics 47, no. 6 (2013): 621–23. 5. P. Shilal et al., "Aberrant Dual Origin of the Dorsal Scapular Nerve and Its Communication with Long Thoracic Nerve: An Unusual Variation of the Brachial Plexus," Journal of Clinical and Diagnostic Research 9, no. 6 (2015): AD01–02. 6. M. Pecina, A. Markiewitz, and J. Krmpotic-Nemanic, Tunnel Syndromes: Peripheral Nerve Compression Syndromes (Boca Raton, FL: CRC Press, 2001). Whitney Lowe is the developer and instructor of one of the profession's most popular orthopedic massage training programs. His texts and programs have been used by professionals and schools for almost 30 years. Learn more at www.academyofclinicalmassage.com. 3 5 4 6