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MYOFASCIAL TECHNIQUES Resources Neviaser, J.S. 1945. Adhesive capsulitis of the shoulder: a study of the pathologic findings in periarthritis of the shoulder. Journal of Bone Joint Surgery 27:211–22. Neviaser, J.S. 1962. Adhesive capsulitis of the shoulder. Medical Times 90:783–807. upward in the joint instead of dropping downward. This rolling up causes the greater humeral tuberosity to run into the boney acromion or its ligaments, causing discomfort or pain and keeping the arm from raising any higher.1 It is easiest to assess inferior glide of the humerus with your client sitting up straight on the front edge of a seat. Standing at your client's side, use your thumb to feel for the dropping of the humeral tuberosity with active or passive abduction, as described above. Compare the left and right sides—a side-to-side difference is often more significant than the amount of glide. You will find that a lack of glide on one side frequently corresponds to a loss of abduction and/or glenohumeral pain. INFERIOR GLIDE TECHNIQUE If you find reduced inferior glide, more often than not you can restore range of motion by simply encouraging the head of the humerus to drop when the elbow comes out. Use the flat part of your ulna, just in front of (distal to) the point of your elbow, to gently lean on the humerus (Image 3). Without moving your ulna (no sliding, rocking, grinding, etc.), wait for the humerus to respond. Eventually, you'll feel it drop slightly in the joint. Move the arm to another position, farther forward or back, and repeat—waiting in each place as you feel for the humerus to glide inferiorly. Make sure your pressure doesn't cause discomfort here or Inferior Glide Technique. Use gentle, static pressure with the flat of your ulna, just distal to your elbow, to encourage the greater humeral tuberosity to drop inferiorly when the arm is passively abducted. Check various positions of the arm, waiting in each arm position for an inferior release. elsewhere. Monitor your client's seated position during the work as well: make sure the spine is easy and erect and the shoulders are square, so that your gentle downward pressure doesn't collapse the seated posture or cause discomfort. Quite often, this simple technique tangibly improves shoulder range of motion and restores the movement options needed for the change to be sustainable. Other times, additional work (such as the following Glenohumeral Capsule Technique) is required. GLENOHUMERAL CAPSULE TECHNIQUE If shoulder motion is still restricted after performing the Inferior Glide Technique, the Glenohumeral Capsule Technique can help you get more specific. With your client side-lying, raise his or her elbow toward the ceiling (passive abduction). While supporting the arm in this abducted position, 120 massage & bodywork november/december 2009 gently move the forearm around a bit, looking for a position where the humerus balances vertically above the glenohumeral joint (Image 4). When you find this balanced position, you can easily use one hand to passively "swivel" (rotate) and "stir" (circumduct) the humerus at the glenohumeral joint. While moving the arm at the glenohumeral joint, use the fingers and thumb of your other hand to feel around the articulation of the humeral head and the glenoid fossa. With the humerus passively "swiveling" here, you'll be able to feel any restrictions in the soft tissues crossing the joint: the rotator cuff muscles and tendons, the long biceps tendon, as well as ligaments and tissues of the joint capsule itself (Image 5). At their proximal attachments, these ligaments and capsule membranes blend with the outer edges of the labrum, the fibrocartilaginous rim that deepens