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in abduction in order to reach an awkward location or to perform a specific procedure. Holding the shoulder in abduction for long periods can often contribute to rotator cuff disorders such as shoulder impingement syndrome or rotator cuff tendinosis. The space underneath the acromion process is relatively small; when the shoulder is held in abduction there is greater compression on tissues such as the supraspinatus (Image 5). There are also detrimental effects on the shoulder region from the upper- crossed syndrome mentioned earlier. With the head held in greater flexion and the arms and hands out in front of the upper torso, there is a tendency to develop chronic shortness in the anterior shoulder girdle muscles, such as the pectoralis major. Because the upper- back muscles are chronically weakened in the upper-crossed syndrome, the tightness in the pectoralis major magnifies this dysfunctional pattern. Improper positioning of the shoulder and upper-back region can lead to numerous pathologies, including trigger points, tendinosis, and cuff pathology. key Treatment Strategies. Chronic shortening of the anterior shoulder girdle is difficult to overcome for many people. Active engagement techniques that incorporate movement of the arm in a horizontal abduction, along with simultaneous deep longitudinal stripping of the pectoralis muscles, greatly enhances elasticity in the hypertonic myofascial tissues in this region. It is essential to develop a degree of elasticity and freedom of movement in this area in order for postural reeducation to have a lasting effect. Numerous muscles of the shoulder Multifidus 3 The deep multifidus is an important muscle to address in chronic low-back pain. 3D anatomy images. Copyright of Primal Pictures Ltd. www. primalpictures.com girdle can have myofascial trigger points that refer pain down the upper extremity or up toward the cervical or cranial regions. Ischemia from chronic muscle tension perpetuates myofascial trigger points, so it is of prime importance when treating dental workers to address any trigger points in and around the shoulder girdle with static compression and other lengthening techniques that will help neutralize the points. Distal Upper Extremities Biomechanical Challenge. The hands are functionally and biomechanically designed for fine, precise movements. However, in many occupations the individual must hold the hands in these positions for long periods, which stresses the muscles, tendons, and nerves in this region. Vibrations from drills and cleaning tools also contribute to tissue injury; they are a known cause of repetitive motion disorders, such as carpal tunnel syndrome. Wrist and weak and inhibited 4 108 massage & bodywork march/april 2012 The upper-crossed syndrome is a frequent issue for dental workers. hand complaints in dental workers are not as common as those affecting the back and neck, but they are important considerations because effects transmit through the entire kinetic chain of the upper extremity. When there are back