Issue link: https://www.massageandbodyworkdigital.com/i/68165
MYOFASCIAL TECHNIQUES the side of your table, with the table edge positioned directly below (anterior to) the glenohumeral joint. In this way, gravity and the edge of the table help open up the back side of the rotator cuff. With some tables, you will need to add a folded towel or other additional padding over the table's edge so that it is comfortable for your client. With the arm hanging, work laterally on the posterior side of the scapula with the knuckles of your soft, open fist (Image 3). Feel for release in the infraspinatus, teres major and minor, posterior deltoid, and their fascias. If you observed restricted abduction or reduced inferior glenohumeral glide (as discussed in our last article), be especially sure to work the supraspinatus muscle along the superior margin of the scapula—it plays an important role in these motions. Your client can assist the release by gently swiveling his or her arm (active rotation of the humerus), while continuing to let the arm hang. Other movement variations include slow, active glenohumeral circumduction, as well as gentle reaching overhead (glenohumeral flexion). When using these movements, you can change the direction of your pressure from lateral to medial, so as to encourage the soft tissue of the posterior scapula to release medially and inferiorly (away from the direction of reaching). All active movements should be slow and gentle enough that the muscle's contraction doesn't push you out of the place you're working. Using just the initiation of hand or arm movement— the first few millimeters—can make this clearer for your client. Ask your client to begin the movements very gradually, reaching with just the hand, and then just the hand and forearm, before engaging the shoulder muscles at all. On clients who are larger than you are, you may find advantage in gently using your forearm (not the point of the elbow) in place of the soft fist. Work slowly and sensitively here—the Posterior Rotator Cuff Technique. With your client's arm hanging, use the knuckles of a soft fist or other tool to release any restrictions between humerus and scapula. Active client movements can include arm rotation, extension, or reaching overhead. axillary and suprascapular nerves are in this area, as is a bursa between the tendons of the triceps' long head and the teres major (Image 1); all of these structures can be quite tender and the forearm is a powerful tool. SUBSCAPULARIS TECHNIQUE Once you have thoroughly addressed the posterior side of the rotator cuff with the previous technique, you'll want to balance the shoulder girdle by working the front side of the GHJ, too. The subscapularis, being the deepest muscle on the anterior side of the GHJ (Image 4), is a good place to start, especially since it helps centralize the humeral head in the glenohumeral fossa by helping keep the humerus from riding up in the glenohumeral fossa during arm motion—in other words, it plays an important role in coordinating glenohumeral glide. There are several ways to work the subscapularis, but one of my favorites is pictured in Image 5. Sit or kneel on the table just behind your side-lying client. Cradle his or her arm in the crook of your elbow, and with this same arm, lay your hand palm down on the ribs of the axillary space. Although this will be your working hand, it stays relatively soft and relaxed, using no more effort or stiffness than necessary. With your other hand behind the shoulder, roll the scapula over this working hand, so that the tips and lateral edges of fingers of 110 massage & bodywork january/february 2010