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"My levator scapula is killing me," she said. With that opening, it was clear that my client, Mrs. M., had some background in anatomy. The funny thing is, these self-assessments are seldom correct (including my own!). "Tell me more about that," I said. "I'm a physical therapist, and at the hospital I am often pushing and pulling on patients from awkward positions. There often isn't an ergonomic way to move them, and I'm sure that is what started this pain. For the last three weeks, the area of my scapula near the medial angle has been really angry. At first, it was intermittent; now, it is my constant companion." "May I check a few things first before we jump right into treatment?" I asked. I had Mrs. M. sit in front of me while I passively moved her neck, checking her range of motion. Since the right side of her neck was the problem, I expected some limitation in left lateral flexion. To my surprise, I could not perceive any restriction or even a hint of hesitation on her part. I tested lateral flexion again, but this time to the right. Again, no hint of pain or limitation. Repeating left lateral flexion again, this time I put her neck in flexion to pre-stretch her levator scapula. There was still no limitation in left lateral flexion. As the final movement, I raised her right arm overhead, which rotates the scapula into upward rotation. Since the levator scapula helps create downward scapular rotation, this arm position (plus left lateral cervical flexion) creates maximal stretch on the levator scapula. Still, she felt nothing. 30 m a s s a g e & b o d y w o r k s e p t e m b e r / o c t o b e r 2 0 1 7 TABLE LESSONS best practices "Maybe If You Just Press Harder" Touch is a Form of Communication By Douglas Nelson

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