Massage Therapy Journal Summer 2024

Summer 2024 • 27

Quick reminder protocol to balance the muscles around the shoulder: 1. Start with the rotator cuff. This group of muscles generates the glide in the shoulder that is necessary to maintain proper mechanics.

problems because when you can’t lift your arm you compensate by lifting your shoulder blade to get your arm over your head. But in my experience, the upper trapezius is not usually a direct cause of problems in the glenohumeral joint. Pectoralis minor can get tense from poor posture, when the chest is caved in and arm placement is in front instead of to the side. Releasing this muscle will bring the shoulders more onto the back than the front, which is crucial for shoulder health. Pectoralis major crosses the front of the shoulder and can be tight in people with hypermobile shoulders, especially because this muscle provides some support across the front of the joint (remember that when the shoulder loses its glide, it’s almost always somewhere in the quarter circle between S-I and L-M). On the other hand, a humerus stuck forward mimics tight pectorals major, so if you see the upper humerus forward, you will make faster progress if you release the humerus back and down. The latissimus dorsi are the back of the armpit. Below the armpit, they angle sharply in toward the bottom of the thoracic spine and the thoracolumbar fascia. Make sure you release them all the way down. This work is easily done in side-lying position, where you can put the heel of your hand on the low outside of the muscle and push its mass toward the thoracolumbar spine. Working the Scapula The shoulder blade moves in many directions, but it’s important to understand that early anatomists, working on a static, dead body, applied the x/y/z axis of science when describing scapular motion instead of looking at the main movements of the scapula in real life. Elevation and depression do occur in the scapulothoracic articulation, but they’re not the main motions by any means. The common real-life movements are upward and downward rotation (when lifting and lowering the arm), and protraction/retraction (when reaching forward and when drawing the arm back to stabilize it, like when you lift).

1

2

2. Move to the deltoids. Palpation may yield pain, as this muscle crosses close to the joint.

3

3. Then, work the scapular stabilizers from the skull to the bottom of the ribcage, including pectorals minor and serratus anterior. 4. Finish with the pectorals and latissimus dorsi , double checking that the lat, pectorals and trapezius are balanced with each other.

4

VectorMine / shutterstock.com

Elevation, depression and anterior tilt (the “transom-window” action of the pectoralis minor) don’t occur frequently in concerted motion, although they do help stabilize and add detail to complex movements, as well as being involved in compensations to poor posture lower in the body and problems with the glenohumoral (true shoulder) joint. Mobilizing the scapula is something almost all massage therapists do brilliantly. Make sure, though, that you include upward and downward rotation in your sequence, spinning the scapula in both directions as if it were a wheel. Retraining the scapula is essential for proper humeral placement, since it is the socket, and retraining the ribs and spine may also be necessary since they support and tether the scapula. In most shoulder injuries, the hips are not seated properly and lead to a lack of support for the shoulder, forcing the muscles to work at bad angles. Massage therapists can help clients effectively manage shoulder injuries that commonly occur in middle age.

amtamassage.org/mtj