(calm piano music)
- Hello massagers, today I'm gonna be showing you
some neuromuscular movements for the shoulder
in supine, prone and side lying position.
So I hope that you guys watch the PowerPoint
where I explain all the steps.
So remember, the first thing you do
is that you do dry work first
before you use any lotions, potions, anything on the body.
You want to do the dry work.
So on the shoulder here,
you could start doing some skin rolling,
some myofascial release.
One of the ones that I like to do is go to the opposite side
and do some nice stretching right here
and move their neck, with your right arm, you're gonna pull.
You're gonna go to the right to the base of the occiput
and support the coracoid process here and just pull gently.
You're starting to use some just static pressure here
to stretch the shoulder and the upper trapezius
and get some movement going here.
This is a very good stretch.
You don't wanna lose touch with your client here.
So, and then to do some warming of the tissue here
you can just do some squeezing here
some (indistinct) here, and really just remember
all you're doing right now is warming up the tissue
creating some myofascial release however you can.
Another one that I like to do is I brace their arm,
put my elbow to their elbow
and support the triceps and then grab the shoulder
and then move the ball and socket here,
the glenohumeral joint to try to loosen it up
for people that have adhesive capsulitis, this is very good.
You can do two or three rotations laterally,
and then two or three rotations medially.
And what I'm doing is with my left hand
I'm assisting right by the scapula and just torquing
towards the midline here.
Getting some movement into that glenohumeral joint.
You can also do a little bit of traction,
when you do traction, the thumb of your client is always up.
And if you are going to go to the back here
the thumb comes down and this is another one too
that you can do, if they can, if they don't hurt too much
then you can do this, this stretch here
and you can also manipulate the scapula from here.
So you wanna just rotate it towards the midline.
If they can, sometimes the client can't,
doesn't have that much range of motion.
So you've got to be real careful.
So and then, like I said, you can do some skin rolling.
You want to do the skin rolling
and you can also do some palpation.
So you can start feeling if you can find
some trigger points here actually,
this feels like it hurts, does that hurt
right there, Leo? - Um.
- Yeah, yeah, I found a trigger point.
Remember that the trigger points feel like
it's a tight muscle tissue, you know tight fibers.
So it feels almost like a knuckle, it's taught.
It's taught fibers.
So you want to go ahead and so now I've palpated it
but I haven't warmed up the muscle too much.
So I'm gonna wait.
I've done my dry work first.
Now I can apply a little bit of lotion or oil
or whatever you're gonna use and do something.
You wanna start stimulating the spindle fibers.
So you wanna do some friction
or whatever it is that you need to do,
to stimulate the muscle tissue.
Here you can stimulate the upper trapezius.
I do my best not to use my thumb so much
because eventually that's really gonna hurt you.
So I use both of my fingers on the posterior
and anterior and just doing some one inch strips
moving my hands one inch at a time
and doing some circular motion against each other.
It's like both my hands are working against each other.
And this really creates some nice tight
and loosening the fibers there, separating the fibers.
You can also do the C clasp right here
separating the upper trapezius
and the levator here
and just moving the fibers in different directions.
I'm gonna show you from the side lying position
how to get to the pec minor.
But for now you wanna do a little bit of traction
and push on the pec major here, warm it up a little bit
because this is where he had the trigger point.
I found it right here.
So now that I've warmed up that tissue
so I'm gonna go to that trigger point.
And first of all, ask him, once I press on it right there
on a scale from one to 10
what number would you say that one is?
- Four.
- Like a four, okay, so it's a four
and I'm gonna hold it from eight to 12 seconds.
They usually start releasing from eight to 12 seconds.
You can go up to 20, like I've mentioned before
some people say 30 and then again, you ask them
after about 20 seconds has it let up?
Is it still the same?
How does it feel now?
Is it better or is it the same?
- It's better.
- It's better, see right away, it released.
And when I'm not talking and I'm really in tune
with a client, then you can really feel it yourself
and the client can feel it.
And it's very important that you get your client
to breath through the trigger points.
So I'm gonna go to another angle
to treat that same trigger point.
I want to bring it down to maybe a three.
So I find it again.
I'm using my thumbs and it is right there.
So this is very good.
He exhaled and so I started pushing there.
So he's trained, he already knows
to take the deep breaths, bring in the oxygen.
So it will help with ischemia, ooh I felt that,
I felt that release, did that feel better?
Yep, yeah, that felt better right there.
So trigger points are kinda tricky sometimes
because they trigger somewhere else.
So let's see if he has any trigger points around here,
around the rotator cuff insertions.
You can get them, even from this angle,
you can go to the posterior and get the supraspinatus
the infraspinatus and the teres minor.
So this is a good way for you to start assessing already
what you feel, what your hands are feeling back here.
So another one that you want to check out
is the insertion of the subscapularis
and pectoralis major, they're right here,
and the insertion of the coracoid process
from the pec minor.
A lot of times the pec minor is really tight in the pecs
and they really pull the fibers down.
So you wanna make sure to check that out
and check for trigger points, see if there's any pain there.
That feels, is that a trigger point right there, Leo?
Does that hurt or that's okay.
- That's okay. - That's okay, yeah.
It's just feels tight, but it doesn't hurt, so that's good.
- There. - Right there?
Okay and what number is that?
- That's a four.
- It's a four, so pretty much it seems like his
are almost going to be all fours.
So then you hold it again, you make sure he breathes
and you hold it from eight to 12 seconds.
And if you don't feel anything, you can go up to 20
and see if he feels that release
like does it feel a little bit better?
So it's static pressure, you just hold it.
You don't increase the pressure.
You don't decrease the pressure until,
he tells you that it's better.
So it released, I like to warm it up,
remember that the neuromuscular therapy
is to retrain the nervous system,
because these muscles that are hypertonic and ischemic.
It's like, they've been on, it's like the nervous system.
Like when you plug something to the wall
and it's on the whole time.
So some of them are just really hypersensitive
from overuse, so whether it's adhesive capsulitis
or bursitis, or whatever's going on
then you just really want to treat all those trigger points.
And from this angle, you can put up their arm
in a high position, bending it right here
and you can really get to the sub scapulars
which I really want to show you.
So you lift their arm and you go to the medial border
of the scapula and their arm is resting right there.
And the scapula is right underneath my fingertips
right here and you can really feel it.
Be gentle when you go in here because this is one
that is really very painful if you just dig in.
So that's why I always like to just,
warm it up a little bit guys,
don't go right away and dig in there, but warm it up.
And you can also work over the sheet
if you're working with a woman.
If you're working with a woman, what you do is you ask her
to cup her breast from the opposite arm
and just cup her breast out of the way.
If you do have a woman that you're working on
but with a guy, you can just pull,
what I'm doing is I'm pulling out the scapula,
I grabbed it from the mid part of the scapula
and pulled it out and I can really access
the subscapularis right here.
People that play tennis or reach sometimes to the backseat
of the car for something might have this muscle
really tight and find some trigger points in there.
Do you have anything in there, Leo that hurts
or not really?
I'm just palpating there,
and if he doesn't, then I'll just come again to this side.
I support by the elbow or I can put my wrist,
my arm right there, my forearm and really just go down
and do some more warming up of the muscle
and just stretching it
and creating here some myofascial release here
and some traction and just really releasing this muscle
which is very important here.
You always want to assist the arm when you bring it back.
And another way to get to the pec minor,
it's underneath the pec major on the ribs.
It's actually better to get it from the side lying position.
But remember the pec major is the one
that makes the axillary fold.
So you want to go underneath that
and I can feel where his pec major ends right there
and then underneath get into,
ooh that it's really tight, does that hurt, right there Leo?
- No, not really.
- No, okay, yeah, it feels tight right there.
He's got strong muscles cause he works out,
but I feel something right there, yeah, right there.
Okay, yeah, I'm right on it.
Is that like, what number is that?
- It's like five.
- Ooh, that's the worst one we have felt.
So I'm gonna stay there for a few seconds
and ask him to breathe.
Usually when I'm not talking and explaining
I brief with them just to show them
how to get that muscle to release
a little bit better, bring in the oxygen
and the blood flow to that area.
And it releases a lot faster
and I felt that go down a lot.
Did that go down a little bit?
Okay, so you can also do the C, right here, the C clasp
and really just massage the pec and the pec minor.
So these are some of the techniques that you can do
to start releasing the shoulder and the trigger points.
And I'm gonna show you now from the side lying position.
(calm piano music)