1. Kinesiology for Manual Therapies
Chapter 7
Deep-Tissue Techniques for the Shoulder Joint Muscles
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2. Learning Outcomes 7-1 Define key terms.
7-2 Name three stages of the inflammatory response.
7-3 List five signs and symptoms of the acute stage of the inflammatory response.
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3. 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.
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4. 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.
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5. Introduction
Follow treatment protocols and start with the client’s medical history to rule out contraindications and to develop treatment goals.
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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.
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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.
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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.
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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.
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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.
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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.
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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
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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23. Dimensional Massage Therapy for the Shoulder Joint Muscles (cont
Dimensional Massage Therapy for the Shoulder Joint Muscles (cont.) Elliptical movement of the shoulder
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24. Dimensional Massage Therapy for the Shoulder Joint Muscles (cont
Dimensional Massage Therapy for the Shoulder Joint Muscles (cont.) Middle trapezius petrissage
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25. Dimensional Massage Therapy for the Shoulder Joint Muscles (cont
Dimensional Massage Therapy for the Shoulder Joint Muscles (cont.) Upper trapezius petrissage
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26. Dimensional Massage Therapy for the Shoulder Joint Muscles (cont
Dimensional Massage Therapy for the Shoulder Joint Muscles (cont.) Upper trapezius myofascial stretch
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27. Dimensional Massage Therapy for the Shoulder Joint Muscles (cont
Dimensional Massage Therapy for the Shoulder Joint Muscles (cont.) Middle trapezius myofascial stretch
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28. Dimensional Massage Therapy for the Shoulder Joint Muscles (cont
Dimensional Massage Therapy for the Shoulder Joint Muscles (cont.) Opening the scapula
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29. Dimensional Massage Therapy for the Shoulder Joint Muscles (cont
Dimensional Massage Therapy for the Shoulder Joint Muscles (cont.) Supraspinatus trigger point
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30. Dimensional Massage Therapy for the Shoulder Joint Muscles (cont
Dimensional Massage Therapy for the Shoulder Joint Muscles (cont.) Supraspinatus tendon
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31. Dimensional Massage Therapy for the Shoulder Joint Muscles (cont
Dimensional Massage Therapy for the Shoulder Joint Muscles (cont.) Infraspinatus tendon
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32. Dimensional Massage Therapy for the Shoulder Joint Muscles (cont
Dimensional Massage Therapy for the Shoulder Joint Muscles (cont.) Teres minor tendon
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33. Dimensional Massage Therapy for the Shoulder Joint Muscles (cont
Dimensional Massage Therapy for the Shoulder Joint Muscles (cont.) Subscapularis tendon
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34. Dimensional Massage Therapy for the Shoulder Joint Muscles (cont
Dimensional Massage Therapy for the Shoulder Joint Muscles (cont.) Compression of teres major
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35. Dimensional Massage Therapy for the Shoulder Joint Muscles (cont
Dimensional Massage Therapy for the Shoulder Joint Muscles (cont.) Serratus anterior access
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36. Dimensional Massage Therapy for the Shoulder Joint Muscles (cont
Dimensional Massage Therapy for the Shoulder Joint Muscles (cont.) Jostling the deltoids
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37. Dimensional Massage Therapy for the Shoulder Joint Muscles (cont
Dimensional Massage Therapy for the Shoulder Joint Muscles (cont.) Side-lying stretch
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38. Dimensional Massage Therapy for the Shoulder Joint Muscles (cont
Dimensional Massage Therapy for the Shoulder Joint Muscles (cont.) Supine - Compression of pectoralis major
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39. Dimensional Massage Therapy for the Shoulder Joint Muscles (cont
Dimensional Massage Therapy for the Shoulder Joint Muscles (cont.) Jostling and stretching pectoralis major
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40. Dimensional Massage Therapy for the Shoulder Joint Muscles (cont
Dimensional Massage Therapy for the Shoulder Joint Muscles (cont.) Elliptical movement of pectoralis major
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41. Dimensional Massage Therapy for the Shoulder Joint Muscles (cont
Dimensional Massage Therapy for the Shoulder Joint Muscles (cont.) DTF clavicular attachments
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42. Dimensional Massage Therapy for the Shoulder Joint Muscles (cont
Dimensional Massage Therapy for the Shoulder Joint Muscles (cont.) Circular friction sternal attachments
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43. Dimensional Massage Therapy for the Shoulder Joint Muscles (cont
Dimensional Massage Therapy for the Shoulder Joint Muscles (cont.) Unwinding the twine
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44. Dimensional Massage Therapy for the Shoulder Joint Muscles (cont
Dimensional Massage Therapy for the Shoulder Joint Muscles (cont.) Stripping coracobrachialis
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45. Dimensional Massage Therapy for the Shoulder Joint Muscles (cont
Dimensional Massage Therapy for the Shoulder Joint Muscles (cont.) Subscapularis
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46. Dimensional Massage Therapy for the Shoulder Joint Muscles (cont
Dimensional Massage Therapy for the Shoulder Joint Muscles (cont.) Elliptical movement of the deltoids
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47. Dimensional Massage Therapy for the Shoulder Joint Muscles (cont
Dimensional Massage Therapy for the Shoulder Joint Muscles (cont.) DTF deltoid tuberosity
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48. Dimensional Massage Therapy for the Shoulder Joint Muscles (cont
Dimensional Massage Therapy for the Shoulder Joint Muscles (cont.) Rocking and rolling the deltoids
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49. Dimensional Massage Therapy for the Shoulder Joint Muscles (cont
Dimensional Massage Therapy for the Shoulder Joint Muscles (cont.) Humeral tease stretch
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50. Dimensional Massage Therapy for the Shoulder Joint Muscles (cont
Dimensional Massage Therapy for the Shoulder Joint Muscles (cont.) Stretch to side – step 1
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51. Dimensional Massage Therapy for the Shoulder Joint Muscles (cont
Dimensional Massage Therapy for the Shoulder Joint Muscles (cont.) Stretch to side – step 2
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52. Dimensional Massage Therapy for the Shoulder Joint Muscles (cont
Dimensional Massage Therapy for the Shoulder Joint Muscles (cont.) Stretch to side – finish
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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.
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54. Chapter Summary (cont.)
Acute, subacute, and chronic stages of the inflammatory response are reviewed with signs and symptoms.
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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.
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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.
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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.
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58. Explore and Practice (cont.)
Use the muscle cards and book in technique classes, for log hours, or for case studies for reference purposes.
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