Shoulder: Lowe Orthopaedic Massage: Theory And Technique

Question 1

Frozen Shoulder/Adhesive Capsulitis: Massage

( injury conditions)

Answer 1

a. Myofascial release of shoulder region: place a moderately light tangential (tensile) force on the subcutaneous fascia; enhances its pliability

b. Sweeping cross fibre to anterior chest muscles: produce extensibility in superficial fascia; increasing levels of pressure to access deeper muscles
c. Static compression for anterior chest muscles: reduce muscular hypertonicity in a specific location; start with broad contact surface and progress to smaller contact surface; maintain pressure for 8-10 seconds

d. Deep stripping on pectoralis major: small contact surface, move in a medial or lateral direction, short stripping movements

e. Static compression on subscapularis: address hypertonicity and trigger points

f. Capsular stretching: focus on lateral rotation first, abduction second, medial rotation third

• Cautions & Contraindications:

-stretching can perpetuate the condition or make it worse; be conservative

Question 2

Rotator cuff strain: Massage

( injury conditions)

Answer 2

a. Deep stripping to proximal fibres of the supraspinatus: reduce muscle tension, reduce pull on region of torn fibres

b. Deep stripping to the deltoid muscle: help decrease muscle tightness that might contribute to lifting the humerus superiorly in the glenoid fossa

C. Deep friction to the supraspinatus tendon insertion: lateral and inferior to acromion process, stimulate fibroblast activity

d. Static compression on infraspinatus and teres minor: reduce tension on damaged muscle/tendon Deep stripping on infraspinatus and teres: from proximal to distal fibres or vice versa

f. Deep friction to posterior rotator cuff region: apply to area of primary tenderness; longitudinal or transverse; can include stretching and active engagement methods

g. Active engagement lengthening to posterior rotator cuff muscles: encourage tissue lengthening; used in later stages of rehabilitation or when injury is not severe

h. Static compression on subscapularis: reduce tension to aid in healing fibre tearing or disruption

i. Deep friction on distal subscapularis: distal fibres and musculotendinous junction

• Caution & contraindications: - accurate assessment is essential , determine severity of the injury

Question 3

Shoulder Impingement: Massage

( injury conditions)

Answer 3

-same as for rotator cuff disorders

Cautions & Contraindications

-use caution with pressure around the subacromial region and over bursa

Question 4

Subacromial bursitis: Massage

( injury conditions)

Answer 4

-massage on bursa is contraindicated

-techniques to reduce causative factors that lead to compression (muscle tension)

-address imbalances

Question 5

Bicipital tendinosis: Massage

( injury conditions)

Answer 5

a. Sweeping cross fibre to biceps brachii: reduce tension in the muscle to reduce tension in the tendon; keep patient’s elbow flexed to keep muscle pliable and extended for better fibre spreading

b. Deep longitudinal stripping to biceps brachii: increase pliability and reduce tension; elbow extended

C. Active engagement shortening: while muscle is under active contraction, the effect of the pressure applied is magnified

d. Pin and stretch for biceps brachii: enhance tissue elasticity and pliability

e. Active engagement lengthening with additional resistance: greater effects of muscle lengthening

f. Deep friction to biceps tendon: perform longitudinally, not transversely

• Cautions & Contraindications:

-reduce pressure of frictions while patient is taking pain medication

Question 6

Shoulder separation: Massage

( injury conditions)

Answer 6

a. Myofascial release of shoulder region: reduce overall muscle tension around shoulder and encourage proper healing of the sprain at the AC joint; applied in multiple planes to provide greatest mobility enhancement; place a moderately light tangential force on the subcutaneous fascia

b. Sweeping cross fibre to anterior chest muscles: reduce limited motion in the shoulder, reduce tension in shoulder girdle muscles near AC joint

c. Deep stripping on pectoralis major: medial to lateral or vise versa

d. Deep stripping to proximal fibres of supraspinatus: reduce tension in the muscle

e. Deep stripping on upper trapezius: help normalize tension and decrease any biomechanical dysfunction resulting from injury

f. Deep friction to the ligaments of the AC joint: enhance ligament healing and create pliability

• Cautions & Contraindications:

-use caution with techniques or movements that put pressure on or cause movement to the AC joint

-do not put too much pressure on the distal end of the clavicle when applying frictions

Question 7

Glenohumeral dislocation/ subluxation: Massage
( injury conditions)

Answer 7

a. Sweeping cross fibre to anterior chest muscles: restore proper biomechanical balance; reduce tension in superficial fibres of pectoralis major and anterior deltoid

b. Deep stripping on pectoralis major: medial to lateral or vise versa

c. Deep stripping on infraspinatus and teres minor: helps normalize tissue tightness

d. Sweeping cross fibre to biceps brachii: reduce tension in the muscle to reduce tension in the tendon; keep patient’s elbow flexed to keep muscle pliable and extended for better fibre spreading

• Cautions & Contraindications:

-watch for apprehension signs that indicate movement or position that could jeopardize joint stability

-use caution with ROM that push humeral head against edge of glenoid labrum

Question 8

Shoulder assessment:

Answer 8

-third most common musculoskeletal disorders after lumbar and cervical spine

-evaluation of pathologies begins with a fundamental understanding of the motions of the shoulder

-four articulations: scapulothoracic, sternoclavicular, acromioclavicular and glenohumeral
-most movement occurs at the glenohumeral joint with some contribution from the scapulothoracic articulation
-glenohumeral joint has greatest range of motion of any joint
-motion at the sternoclavicular and acromioclavicular joints is minimal so are not calculated in clinical
-soft tissues play a critical role in maintaining joint integrity

-this places the shoulder at risk for soft-tissue injuries

-acute injuries result from blows to the shoulder, falling on an outstretched arm, or forceful movements that dislocate/sublux the joint

-chronic injuries result from the movement requirements in repetitive upper-extremity activities and when the joint held for prolonged periods in a position that impinges the soft tissues

• Movements and Motion Testing:

1. Single-Plane Movements:

+ Glenohumeral joint: flexion, extension, medial and lateral rotation, abduction and adduction

-two accessory motions: horizontal abduction (horizontal extension) and horizontal adduction (horizontal flexion); start with the arm abducted to 90 degrees instead of in neutral position

+ Scapulothoracic articulation: elevation, depression, protraction, retraction and upward/downward
rotation

-a functional rather than anatomical joint; ROM values are not calculated, no joint capsule so no capsular pattern

-motion is important in evaluating certain shoulder disorders

Glenohumeral joint:

-flexion and extension occur in the sagittal

+ plane flexion = 160-180°

+ extension = 60°

-medial and lateral rotation occurs in the transverse plane
medial rotation = 90
lateral rotation = 90
-abduction and adduction occur in the frontal plane
abduction = 180
adduction = 50-75
-horizontal adduction and abduction occur in the transverse plane no specific values given