Issue link: https://www.massageandbodyworkdigital.com/i/1515580
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 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 CLINICAL EXPLOR ATIONS movement or coordination problems that occur with or without pain. The goal of palpation in the assessment is not so much to feel tightness or problems in a specific tissue but more about feeling the motion of the underlying bones during movement. The practitioner places their hand over the client's scapula, then watches and feels for how well coordinated the scapular movement is, especially during f lexion or abduction. It's beneficial to compare the movement pattern with the opposite side, as long as there is no similar problem on the opposite side. TREATMENT STRATEGIES FOR SCAPULAR DYSKINESIA Treatment strategies for SD initially focus on structural factors that cause pain avoidance. If an internal joint structure is at fault, such as the labrum or joint capsule, tissue involvement should be addressed first. Then, attention can focus on restoring proper movement patterns and reestablishing proper coordination. An accurate evaluation by another health- care professional is recommended to identify any structural issues involved. In many cases, rehabilitative exercises with a physical therapist address the dysfunctional motor patterns. When exercise is a primary treatment strategy, ensure proper movement patterns are used in the strengthening exercises. Reinforcing dysfunctional movement patterns can cause further problems. Stretching and other f lexibility exercises are also commonly a part of this strategy. Although there is little research on massage treatment in SD, massage therapy still has a role in treatment. As with stretching, massage can be quite helpful in reducing hypertonicity in affected muscles and helps restore proper biomechanical balance around affected joints. Massage also reduces general pain and increases comfort in the body. Massage and soft-tissue treatment strategies that employ neurological engagement during the treatment are beneficial. Modalities such as facilitated stretching, often called proprioceptive neuromuscular facilitation (PNF) or muscle energy technique (MET), use active muscle contraction and stretching or soft-tissue mobilization. Different techniques, including active engagement methods, involve contracting muscles actively while applying a soft-tissue treatment (Image 4). These approaches are especially effective in improving proprioception, directing the brain's focus to the areas engaged in movement. Such active neurological methods are especially beneficial when issues stem from neurological coordination. Additionally, increasing the range of motion is an important aspect. Direct manipulation of soft tissues provides a wealth of sensory feedback to the central nervous system. This inf lux of sensory information plays a crucial role in reestablishing correct neuromuscular coordination in SD. CONCLUSION A comprehensive understanding of scapular movement and its potential issues will help you deliver precise and effective treatment to improve your client's range of motion and help address SD. It's essential to acknowledge that sometimes the most beneficial course of action may involve referring the client to another specialist. Recognizing dysfunctional scapular movement patterns enables you to offer the most suitable treatment or guide them to the right practitioner for optimal results. In both scenarios, you are fulfilling the client's health-care needs, demonstrating your commitment to thoroughly assessing their condition, and providing valuable advice. Effective treatment options, such as the mentioned massage therapies, will help relieve your client's pain and dysfunction. Whitney Lowe is the developer and instructor of one of the profession's most popular orthopedic massage training programs. His text and programs have been used by professionals and schools for almost 30 years. Learn more at academyofclinicalmassage.com. Active engagement treatment of the rhomboids. 4