Issue link: https://www.massageandbodyworkdigital.com/i/1509769
A B M P m e m b e r s ea r n F R E E C E h o u r s by rea d i n g t h i s i s s u e ! 27 Supraspinatus stripping with small contact surface. 1 period. Ultimately, the decision between conservative treatments and surgery should be individualized considering the severity of the disorder and the patient's overall health, activity level, and treatment goals. New studies indicate that conservative treatments may perform just as well as surgical strategies for some problems. 1 Massage can play a key role in conservative treatments if the therapy is well-designed and targeted to the client's individual presentation. Traditionally, massage is lauded for its ability to reduce hypertonicity and help restore overall biomechanical balance. New research indicates that massage can also play a major role in pain management, which can speed the return to function. Interestingly, certain studies hint at the potential of soft- tissue manipulation to boost fibroblast activity, aiding in tissue repair. Even with more significant rotator cuff tears, massage is beneficial in treating surrounding tissues and restoring optimum function. TREATMENT STRATEGIES Following are a few examples of how the rotator cuff might be treated with massage—a diversity of techniques is suitable for addressing these challenges. In the November/December 2022 issue of Massage & Bodywork ("The Ladder of Engagement," page 20), I presented the ladder of engagement concept. The following treatments follow those protocols. The techniques described here are not rigid sequences, but f lexible methods tailored to the problem. I will highlight each method's ladder of engagement level and offer tips for optimal effectiveness in real-world clinical situations. Deep Stripping to Proximal Fibers of the Supraspinatus Treating a supraspinatus injury with massage is challenging. Often, tears occur close to the musculotendinous junction. This area is hard to reach by touch because it's positioned beneath the acromion process. Nonetheless, there are alternative methods to address strains in the supraspinatus. When this muscle tears, other shoulder soft tissues usually compensate, becoming tight or dysfunctional. These areas should also be treated. This technique is beneficial to reduce hypertonicity in the supraspinatus. It also reduces pain in the muscle, making it appropriate for pain management. This technique is most effective with the client in a prone position with their arms at their side. However, if the client is more comfortable in another position, such as sidelying, that also works. The supraspinatus treatment area is relatively small, so the technique is most effective when performed with a small contact surface—the thumb, a fingertip, or a pressure tool, for example. • Position your thumb in front of the trapezius, targeting the more proximal fibers of the supraspinatus near the spine edge of the supraspinous fossa. • Apply a slow, deep stripping technique on the supraspinatus muscle, moving laterally (Image 1). As you move laterally, the space for your pressure application will get narrower as the clavicle and scapular spine converge near the acromion process. A B M P m e m b e r s ea r n F R E E C E h o u r s by rea d i n g t h i s i s s u e ! 27 When combined with massage, stretching can restore normal shoulder mechanics and reduce the discomfort from soft-tissue injury or the resulting muscle hypertonicity. • Don't ride up over the top of the acromion process with your pressure; this can be uncomfortable for the client. This technique is a Level 1 in the ladder of engagement. However, incorporating passive, active, and resisted eccentric shoulder movements allows you to adapt the method to the ladder's higher levels. For guidance on making these adaptations, refer to the previously mentioned article in the November/December 2022 issue. Keep in mind that as treatment advances and the client's function pain improves, the higher ladder levels become increasingly effective.