okay so now that he is on the prone position again you want to do some some um skin rolling and some
track and let me show you the sea bowing sea bowling is you make like a little triangle with
your hands and then you pull up it's like you make a triangle and then you pull up
you're trying to warm up the tissues before you apply any oil so this is something that you can
and i i combine it with a with a skin rolling and what it is is yours your muscles i mean your
fingers are doing the walking up or down the skin and my thumbs are dragging and my fingers
are doing the walking or like i said you can do the the uh c bowing and you can also do some
some seas with your fingers so the sea bowling is you just lift
lift and pull or skin skin rolling to warm up all the tissues when
i'm i'm not going to go into too much detail i'm just showing you again
that's what you do before you apply the oil okay and then now you can also do some manipulations
you know right now that his skin is still dry i can grab his shoulder i'm going to support
support at the coracoid process in the front grab the scapula and just roll it around
just roll the shoulder around try to get some manipulation here around the uh the shoulder joint
okay let me show you from the other side see if i can do this one
you can see it may be better so what i'm doing is with my left hand i'm cupping here
bending this arm just a little bit grabbing here at the lower medial part of the scapula and just
moving that shoulder joint
i prefer to do that than to do this you never really want to do this it's
there's people that can't so i just like to bend
right here and then just really be able to get underneath here and pull down
what i'm doing is i'm lifting with my with my left hand and then with a right hand i'm pulling down
just moving that shoulder joint moving that's trying to get some movement right into that
scapula look at how far i can lift his scapula to the rhomboids
so this is all done before you apply any oil move back to this side so treat this one left
just moving that that scapula around as much as you can so now that i've
warmed it up now i can you know get to the warming up of the muscles okay and then
then we'll get to our specific work and look for trigger points
you can treat the erector spinach but we're focusing today on the shoulder
so we can look now that we've warmed up the tissue we can look for trigger points and remember you
use moderate speed if you go too fast you're going to go over them and not feel anything if you go
too too fast like when you're warming up the muscle it's kind of hard to tell where the
trigger points are but once you are going to start the trigger points or static pressure you want to
keep it at a moderate speed not too fast not too slow and let me see
and of course the medical history before will tell you if you know they have shoulder problems so
if they have any trigger points an active trigger point is when the client can feel it
they tell you i hurt right here that's the active trigger point the latent trigger point would be
is somewhere that i touched that he didn't know it was hurting and that's a latent trigger
point it's dormant until you touch it does that hurt right there yeah i can tell i can
feel so i'm gonna again i'm gonna hold static pressure there for 8 to 12 seconds up to 20.
and a lot of times what i like to do is you know i i do a little bit holding it stay you
know static i do a little bit of rotation did it go down a little bit or not really
remember it's better to treat the same trigger point from three different areas from the prone
supine and sideline position than to stay on and you know and overwork it so let me show you guys
another technique that you can do um also bringing the arm off the table always supporting the arm
off the table right here and you can really see the scapula so this is also another good way to
get to the subscapularis i am pushing down with my left hand and cupping my my right
hand fingers right underneath the subscapularis right here getting to all this muscle fibers
and get to the lat to the teres minor teres major
the origin of part of the deltoid and the posterior part
the rhomboids you know there's just so many things that you can do here to help
people with shoulder problems you know whether it's bursitis or adhesive capsulitis or
you know that they just have tightness you come from the opposite side of the table also
and just rake up and it's better to do all this like moving slowly one inch at a time when it
strips
so let's suppose that i'm the trigger point i found on on the right side let's say
it's on the same side so i would come from this side this trigger point that he had here that
was like a four i'm going to find it again and get it from this side and see if it's released
sometimes i can go back to the same trigger point you know like three oh that's a bad one huh right
there oh is that 20 is that more than a four yeah oh cow back off is that better right there okay
okay
a little bit of traction there if the client can handle that and you want to do a little bit of
traction you always support at the elbow bring the arm back now let's get to treat some trigger
points that we have most people have trigger points up in the upper trap that refer into the
head so you want to make sure and check now for trigger points in the upper trap what i'm doing
is i'm pressing with both my left and my right hand my fingers towards each other to check to
see if there's any trigger points there or you can also you know treat it just with one hand
except for now that my thumbs hurt me more i use my fingers does that one hurt right there
yeah okay so i'm going to hold that again 8 to 12 seconds ask him to breathe
and did it does this one refer anywhere else or is it just right there
i think you reverse yeah it usually refers up a little bit
you know usually trigger points travel towards the you know towards the head
okay you can also with my forearm i'm pushing on the inferior part of the scapula and so this
brings up his it lacks the muscles up here and i can really get underneath underneath and get the
levator this is a great one to be able to get to the levator scapula and to see if there's
any trigger points especially people that you know that shrug their shoulders a lot you know
while they're on the computer or whatever type of work that they're doing usually with our phones
so you want to make sure and treat the levator scapula from this angle right here another one
too is that you want to unfurl the upper trap so this is what i'm doing my thumb is on top
and with my bottom fingers i'm i'm moving them like this like unrolling the upper trap
now you don't want to forget you know the track the trapezius goes all the way down to
t12 and most massage therapists not i shouldn't say this but i found that when i've received
massages that most people work the upper trap and they forget to work the lower the lower you know
trapezius the lower fibers and the medial fibers so it's always good to feel where the trapezius is
and you know and if not you can have him go like superman you know he's he's too relaxed so you
you want to make sure and get underneath and get the fibers of the trap the lower fibers of
the trapezius two on both sides you know you can go underneath and if you find any trigger points
and he he's got something going on right there right does it hurt yeah you know when your fingers
this is what i mean guys let your fingers do the the the you know the the talking for you or
you know feel with feel with your fingers let your fingers tell you listen with your fingers
because your fingers will tell you there's if he flinches a little bit i can feel that and
that tells me there's something going on there so i want to make sure and go back and treat it
treat that trigger point is it referring anywhere no no that was just right there okay
so these are just tight bands and another thing that i had mentioned in the powerpoint as you can
tell when there's ischemic ischemia and a muscle because it's not as pink it's a little bit lighter
in color and you know and it's cooler to the touch but you can develop your fingers to be able to
feel that and and tell where there's not enough blood flow so remember guys first is you treat
without any oil you do the myofascial stretching skin warming up the skin rolling the c bowing then
you warm up the tissue and the last but not least is you treat the trigger points and the active
trigger points are the ones that your client tells you whether where they hurt when they walk in and
the one ones that you can't feel are the ones that you discover after you've started working on them
and when they have trigger points i can spend the whole hour you know just treating one
area i can spend the whole hour treating the shoulder because i'm going to get it from the
sideline from the supine in the prone position so that would be some of the treatments for the
shoulder and treating the uh with with uh remember this is incorp incorporating it with other
techniques you don't just have to do this but trigger points is usually you know incorporated
into the uh myofascial release or medical massage or clinical massage and what it is it's very
specific work that's what it is for me it's not about how much you know pressure you can you
know you you put on the client or what you want to do sometimes we just want to go in there and
get treated all but it just really depends on the client and always keep it at a you know four or
five or a six never go above a six it's better to go back and treat it from different angles than to
go in right away and you know and and because you're trying to decrease the um the neuromuscular
connection you know you're trying to retrain the nervous system so that it doesn't fire
all the time so that's it for the prone physician and until the next time create a great
day
you