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F r e e S O A P n o t e s w i t h M a s s a g e B o o k f o r A B M P m e m b e r s : a b m p . u s / M a s s a g e b o o k 89 and meningeal. If you suspect cerebral vascular insufficiency is present in a client, it will be well worth your effort to free the subclavian muscle. The Work: Subclavian Muscle Client Position: Side-lying, with knees flexed 45 degrees 1. Using your thumb, form a wedge between the inferior aspect of the clavicle and first rib at the sternum. 2. With the other hand, elevate the shoulder toward the ear. 3. Search for tight bands moving medially from the sternum toward the coracoid process. 4. Do not forget to use the opposite hand to elevate or circumduct the shoulder while doing this. 5. Cue the client to take slow, deep breaths into the area that was just worked. SUPERFICIAL FASCIA OF THE ARM The fascia of the arms is continuous with the cervical fascia and is often overlooked. As seen in Image 6, you may have the client lay prone, and her head can be turned in either direction. You can experiment with the head position by turning it to the opposite direction and seeing if that shortens the arm you are working on, and vice versa. Take your fingertips right over the attachment of the deltoid muscle in the upper arm and get ahold of as much of the superficial fascia of the arm as you can. While you are moving down the arm inferiorly, several inches at a time, you can have the client lift her head and slowly turn it one way and then the other. Alternately, you will also have her bend her elbow slowly toward the side of her body and back, as well as dorsiflexing the wrist and hand. What is really effective about this technique is that you can work down the entire length of the arm. While around the elbow, it is convenient to work the fascia off the olecranon process. Below the elbow, you can get much more deeply into the interosseous membrane of the forearm. While working deeply in the forearm in this manner, have the client roll her arm very slightly back and forth, or pronate then supinate the forearm, but very slowly so it does not throw your fingers out of position. Although Image 7 does not show it here, you can certainly keep going right down over the retinaculum of the wrist. It is here that you would be more active with wrist flexion while you are working that fascia. This technique is found to be particularly beneficial for anyone who has had a whiplash injury and was the driver of the car. The numerous ways in which back problems occur from lifting can also be addressed very nicely this way. Remember that the fascia of the arm goes in four basic directions when they meet at the shoulder girdle: to the temporomandibular joint (TMJ), to the scalenes, to the upper trunk muscles, and to the lower trunk muscles. You will really enjoy this particular work as a way of finishing any work done on the trunk, neck, or head. As an alternative, you can have the client turn her head slowly while you are working the arm. This will assist the cervical fascia to release. These techniques are effective for local problems in the arm or as a way to finish up neck work. The Work: Superficial Fascia of the Arm Client Position: Prone 1. Fingertips begin in the posterior deltoid muscle, moving superficial fascia down the arm inferiorly several inches at a time. 2. The vector is in and down the arm. 3. The client lifts her head, slowly turning one way or another, as well as dorsiflexing the wrist and hand. 4. While around the elbow, work the olecranon process and deeply into the interosseous membrane of the forearm. 5. Have the client roll her arm back and forth slightly. 6. Use an elbow while working the forearm, if necessary. CLAVIPECTORAL AND DELTOID FASCIA In some respects, these techniques are the same as those of the superficial fascia of the arm. However, these flexors of the arm tend to be the most problematic. You may start with your fingertips or elbow at the head of the humerus, very close to the coracoid process (Image 8, page 90). The deltoid is stretched while the client has her palm down on the table and periodically moves her elbow toward 6 7