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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 . 89 SCIENCE OF NERVES can be performed moving medial to lateral or lateral to medial. One of the key goals of this longitudinal stripping technique is to help encourage mobility between the supraspinatus and the affected nerve. You can further enhance mobility by either actively or passively moving the client's arm through abduction and adduction as you perform the stripping technique. Moving the muscle as you work on it helps increase greater tissue flexibility, as well as mobility of all surrounding structures. A similar technique can be applied to the infraspinatus to reduce hypertonicity and increase mobility between the suprascapular nerve and the infraspinatus muscle. With the client in a prone position, perform a slow stripping technique along the length of the infraspinatus muscle in a fan-shaped pattern with a small contact surface such as a finger, thumb, or pressure tool (Image 6). Make sure to frequently check in with the client about the appropriate depth of pressure and be sure not to apply so much pressure that any of the existing neurological sensations are increased. Be particularly cautious when applying pressure just inferior to the spine of the scapula, as that is where the primary area of nerve entrapment is usually located. Just like with the supraspinatus, it may be helpful to conduct active or passive movement during treatment to encourage full freedom of movement between the infraspinatus and suprascapular nerve. Often, it is most effective to have the client moving the arm in medial rotation so the muscle is lengthening as the technique is applied. Make sure the client is close to the edge of the table to allow full freedom of movement through the entire range of motion in medial and lateral rotation as you apply this technique (Image 7). While suprascapular neuropathy is not as common as other nerve compression problems like carpal tunnel syndrome, it is still valuable to know about its existence and recognize some of the key factors. It is particularly beneficial for massage therapists to be aware of this problem because there are few other treatment approaches that are as effective as massage in mobilizing the nearby tissues and helping the nerve's return to optimum function. The massage therapist who is able to skillfully apply evaluation and treatment strategies for addressing this problem will be a valuable player in clients' return to full function and health—and that means much more success for your practice! Notes 1. M. Pecina, A. Markiewitz, and J. Krmpotic-Nemanic, Tunnel Syndromes: Peripheral Nerve Compression Syndromes (Boca Raton: CRC Press, 2001). 2. K. Yamakado, "The Suprascapular Notch Narrows with Aging: A Preliminary Solution of the Old Conjecture Based on a 3D-CT Evaluation," Surgical and Radiologic Anatomy 38, no. 6 (August 2016): 693–7. doi:10.1007/s00276-015-1614-5. 3. S. Kharay, A. Sharma, and P. Singh, "Unusual Morphology of Scapulae: Incidence and Dimensions of Ossified Ligaments and Supraspinous Bony Tunnels for Clinical Consideration," Singapore Medical Journal 57, no. 1 (January 2016): 29–32. doi:10.11622/smedj.2015103. 4. E. Witvrouw et al., "Suprascapular Neuropathy in Volleyball Players," British Journal of Sports Medicine 34, no. 3 (June 2000): 174–80. doi:10.1136/bjsm.34.3.174. 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. 6 7 Deep stripping to the infraspinatus. Deep stripping to the infraspinatus during active medial rotation.