Massage Therapy Journal Summer 2024

26 • Massage Therapy Journal

Supine Position

Massage Protocols for Restoring Glide to the Shoulder Joint Here are two ways to mobilize the shoulder, working with the client in a supine position: With the client’s arm on the table : 1. Find their humeral head, just beyond the tip of the acromion. If you come in with the palms of your hands from the side, you can be sure you’re on the humerus and not on the acromion or collarbone. 2. Test the gliding micromovement of the shoulder by springing down just a bit. This is a very small movement. If you do both sides at once, you’re more likely to feel where there is more or less movement. 3. Start by pressing straight down toward the table, then make your way around to the top of the joint, stopping frequently to push the humerus toward the center of the joint. The shoulder is almost never restricted except in the quarter of the circle between A-P and S-I. 4. Once you’ve found the spot that feels most restricted to you, continue to spring down gently, as you would with those cabinets that you have to push slightly shut to open. Use low pressure and repeat until you feel some play come into the shoulder. With the client’s arm at 90 degrees: 1. Lift the supine client’s arm until it’s perpendicular to the table. 2. Interlace your fingers around the top of the humerus and very gently draw the humerus away from the midline of the body. 3. Repeat that gesture several times while

moving slowly a quarter of the way around the circle of the humeral head until you are drawing the top of the humerus toward the client’s foot. How to Work the Muscles Around the Joint Once the joint’s gliding motion is improved as much as possible, work on the muscles around the joint. Whenever you work on muscles, you are also working on fascia, which is the gristle of the muscle between the skin and the muscle, around the muscle and marbled through the muscle. The rotator cuff may be a good place to start, especially since it’s what generates the necessary glide in the shoulder to maintain proper mechanics and relieve the symptoms of almost all shoulder dysfunction. From the rotator cuff, move to the deltoid muscle, which crosses close to the joint so may yield pain upon palpation. That pain is usually coming from the joint itself rather than from the deltoid. By the same token, working the deltoid allows you to affect the joint directly, which may help greatly. Now, work the scapular stabilizers from the skull to the bottom of the ribcage. Don’t forget serratus anterior, which is well accessed in a side lying position. In slim/flexible clients, you can get all the way up to rib one or two going through the armpit and moving medially along the rib with the client in side-lying. The fibers run directly along the ribs as opposed to the intercostals, which run in between the ribs and do not move the shoulder. The upper trapezius and levator tend to be very tense compensators when there are shoulder

Photos courtesy of Mark Hanson, Wellness Stock Shop

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