7-1 Kinesiology for Manual Therapies Chapter 7 Deep-Tissue Techniques for the Shoulder Joint Muscles McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

7-2 Learning Outcomes o 7-1 Define key terms. o 7-2 Name three stages of the inflammatory response. o 7-3 List five signs and symptoms of the acute stage of the inflammatory response. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

Learning Outcomes (cont.)  7-4 Demonstrate with a partner the active and passive movements of the muscles of the shoulder joint.  7-5 Identify the locations of the subdeltoid and subacromial bursae.  7-6 Describe and practice safe body mechanics.  7-7 Practice specific techniques on shoulder joint muscles. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

Learning Outcomes (cont.)  7-8 Demonstrate appropriate supportive structures for side-lying positions.  7-9 Incorporate dimensional massage therapy techniques in a regular routine or use them when needed.  7-10 Determine safe treatment protocols and refer clients to other health professionals when necessary. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

7-5 Introduction  Follow treatment protocols and start with the client’s medical history to rule out contraindications and to develop treatment goals. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

7-6 Active and Passive Ranges of Movement  Active movement shortens muscles as it contracts and pulls on the engaged bone.  Demonstrate the active movement first, start with flexion of a nonpainful joint.  Have the client replicate the action. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

7-7 Active and Passive Ranges of Movement (cont.)  Is there any pain or restriction with the movement?  Is the client compensating in the action with other muscles?  Record the findings. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

7-8 Active and Passive Ranges of Movement (cont.)  Passive movement is action that does not shorten the soft tissues; there is no contraction therefore, no shortening.  Pain with passive movement may indicate that other structures could be involved causing the painful movement. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

7-9 Active and Passive Ranges of Movement (cont.)  Other structures could be: bursae – synovial sacs of fluid needed to lubricate joints – ligaments, joint capsules, cartialage, and nerves.  Undiagnosed clients with painful passive movement should be referred. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

7-10 Active and Passive Ranges of Movement (cont.)  Apply passive movement to the pain free joint first.  Ask if there is any pain or restriction with the movement.  Crepitus is any grinding, grating, or popping elicited during movement of a joint. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

7-11 Arc of Pain  An arc of pain is a pain response during a portion of active or passive movement.  Examples include the humerus coming into contact with the acromion in abduction – this sometimes impinges the rotator cuff. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

7-12 Pain  Pain is a warning sign.  Pain is not reliable. The quality of pain can be described as:  shooting or burning  numbness or tingling  a dull ache McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

7-13 Pain (cont.)  superficial or deep  deep in the joint  radiating  hurting in one spot  Pain from muscles, skin, and joints is called somatic pain. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

7-14 Pain (cont.)  Compressed nerve pain is often shooting, radiating, or burning.  Somatic pain can range from a dull ache to deep joint pain.  Care should be used in palpating areas of concern.  Undiagnosed pain is enough for referral. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

7-15 Acute, Subacute, and Chronic  Three stages of the inflammatory response are acute, subacute, and chronic.  The acute stage has all the signs and symptoms of inflammation: redness, heat, swelling, pain, and loss of function. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

7-16 Acute, Subacute, and Chronic (cont.)  RICE stands for: rest, ice, compression, and elevation.  The subacute stage has the same signs and symptoms as the acute but they are not worsening.  The chronic stage of pain reduces signs and symptoms to manageable levels. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

7-17 Acute, Subacute, and Chronic (cont.)  Acute stages are often contraindicated for manual therapies.  Massage therapists should evaluate levels of pain for appropriate treatment goals and possible referrals. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

7-18 More Synergy  The close relationship between the shoulder girdle and shoulder joint reflects a dependency that affects treatment goals.  Start on the foundational shoulder girdle muscle first and work out to the shoulder joint and on opposing muscles to create balance. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

7-19 More Synergy (cont.)  The side-lying posture is useful in a variety of circumstances, especially if the client cannot lay supine or prone on the table.  Pregnancy, shoulder injuries, and conditions reflect a need for the side- lying position. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

7-20 Dimensional Massage Therapy for the Shoulder Joint Muscles  The side-lying position gives the passive movement of the shoulder easy access for the therapist.  Adjust the table height to a lower level.  Support the client with enough appropriate padding for the side-lying position. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

7-21 Dimensional Massage Therapy for the Shoulder Joint Muscles (cont.)  Always use treatment protocols to determine the sequence of a therapeutic session.  Palpate soft tissue.  Use warm-up techniques first, and determine the appropriate pressure.  Passively shorten muscles. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

7-22 Dimensional Massage Therapy for the Shoulder Joint Muscles (cont.)  Follow a dimensional approach and think critically about the involved joints and kinetic chain.  Work on healthy soft tissue and joints first; work on painful areas or those with restricted motion last. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

7-23 Dimensional Massage Therapy for the Shoulder Joint Muscles (cont.) Elliptical movement of the shoulder McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

7-24 Dimensional Massage Therapy for the Shoulder Joint Muscles (cont.) Middle trapezius petrissage McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

7-25 Dimensional Massage Therapy for the Shoulder Joint Muscles (cont.) Upper trapezius petrissage McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

7-26 Dimensional Massage Therapy for the Shoulder Joint Muscles (cont.) Upper trapezius myofascial stretch McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

7-27 Dimensional Massage Therapy for the Shoulder Joint Muscles (cont.) Middle trapezius myofascial stretch McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

7-28 Dimensional Massage Therapy for the Shoulder Joint Muscles (cont.) Opening the scapula McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

7-29 Dimensional Massage Therapy for the Shoulder Joint Muscles (cont.) Supraspinatus trigger point McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

7-30 Dimensional Massage Therapy for the Shoulder Joint Muscles (cont.) Supraspinatus tendon McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

7-31 Dimensional Massage Therapy for the Shoulder Joint Muscles (cont.) Infraspinatus tendon McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

7-32 Dimensional Massage Therapy for the Shoulder Joint Muscles (cont.) Teres minor tendon McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

7-33 Dimensional Massage Therapy for the Shoulder Joint Muscles (cont.) Subscapularis tendon McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

7-34 Dimensional Massage Therapy for the Shoulder Joint Muscles (cont.) Compression of teres major McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

7-35 Dimensional Massage Therapy for the Shoulder Joint Muscles (cont.) Serratus anterior access McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

7-36 Dimensional Massage Therapy for the Shoulder Joint Muscles (cont.) Jostling the deltoids McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

7-37 Dimensional Massage Therapy for the Shoulder Joint Muscles (cont.) Side-lying stretch McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

7-38 Dimensional Massage Therapy for the Shoulder Joint Muscles (cont.) Supine - Compression of pectoralis major McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

7-39 Dimensional Massage Therapy for the Shoulder Joint Muscles (cont.) Jostling and stretching pectoralis major McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

7-40 Dimensional Massage Therapy for the Shoulder Joint Muscles (cont.) Elliptical movement of pectoralis major McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

7-41 Dimensional Massage Therapy for the Shoulder Joint Muscles (cont.) DTF clavicular attachments McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

7-42 Dimensional Massage Therapy for the Shoulder Joint Muscles (cont.) Circular friction sternal attachments McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

7-43 Dimensional Massage Therapy for the Shoulder Joint Muscles (cont.) Unwinding the twine McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

7-44 Dimensional Massage Therapy for the Shoulder Joint Muscles (cont.) Stripping coracobrachialis McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

7-45 Dimensional Massage Therapy for the Shoulder Joint Muscles (cont.) Subscapularis McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

7-46 Dimensional Massage Therapy for the Shoulder Joint Muscles (cont.) Elliptical movement of the deltoids McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

7-47 Dimensional Massage Therapy for the Shoulder Joint Muscles (cont.) DTF deltoid tuberosity McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

7-48 Dimensional Massage Therapy for the Shoulder Joint Muscles (cont.) Rocking and rolling the deltoids McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

7-49 Dimensional Massage Therapy for the Shoulder Joint Muscles (cont.) Humeral tease stretch McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

7-50 Dimensional Massage Therapy for the Shoulder Joint Muscles (cont.) Stretch to side – step 1 McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

7-51 Dimensional Massage Therapy for the Shoulder Joint Muscles (cont.) Stretch to side – step 2 McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

7-52 Dimensional Massage Therapy for the Shoulder Joint Muscles (cont.) Stretch to side – finish McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

7-53 Chapter Summary  This chapter introduces the use of active and passive movement to evaluate for contraindications and to develop appropriate treatment goals.  Arc of pain is defined and the quality of pain is reviewed. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

7-54 Chapter Summary (cont.)  Acute, subacute, and chronic stages of the inflammatory response are reviewed with signs and symptoms. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

7-55 Chapter Summary (cont.)  Synergy between the shoulder girdle and shoulder joint was discussed.  Dimensional Massage techniques for the shoulder joint muscles were explored through side-lying, supine, and prone positions. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

7-56 Chapter Review  The Chapter Review is divided into true and false, short answers, and multiple choice questions.  The questions are designed for the students to test their knowledge. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

7-57 Explore and Practice  Activities in this section are for practice and demonstration.  Every opportunity should be utilized to locate muscular attachments on as many different bodies as possible to support kinesthetic learning. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

7-58 Explore and Practice (cont.)  Use the muscle cards and book in technique classes, for log hours, or for case studies for reference purposes. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved