(piano music)
- Hi my name is Maria Natera and today
I'm going to be showing you some techniques
for the rotator cuff and a little bit
of anatomy and physiology.
I like to start off right away,
I've used some oil, my own special blend of essential oils
and I am going to do a little bit
of effleurage and petrissage to warm up
her muscles and I like to go to the supraspinatus
right here on the posterior part.
The infraspinatus and the teres minor.
So from this position you can access
all the posterior muscles and also
some of the anterior muscles.
Now the four rotator cuff muscles
are the supraspinatus, infraspinatus,
teres minor, and subscapularis.
Out of all of the four muscles
three of them are in the scapular fossa
except for the teres minor.
You also have your coracoid process right here,
that's part of the scapula, her acromion process
which really shows nice on her and her clavicle.
Right here on the coracoid process
you have three attachments.
You have the origin of the pec minor
on ribs three, four, and five, and it
inserts at the coracoid process.
And the origin of the biceps the short head
of the biceps starts at the coracoid process
and inserts at the radius and the coracobrachialis
origin right here, and it inserts
at the medial shaft of the humorous.
So while you're here you can go ahead and massage
this too because a lot of people
have you know a lot of pain right here.
Especially if they have been playing tennis
or baseball players, or reaching even
to the back seat of their car.
When they hyper-extend their arm.
This area here may get injured and strained
and what I want you guys to understand
is that the rotator cuff muscles
sandwich the scapula in between,
so you have three in the back and one
in the front on the anterior part of the scapula.
The other three on the posterior part of the scapula.
Out of the four rotator cuff muscles
three of them are on a scapular fossa
and one of them is not which is the teres minor,
is the only one that's not in the scapular fossa.
So while you are here, you can go ahead
and do a little friction and petrissage and effleurage.
This also has the largest tendon attachment
of the subscapularis which is right here.
So I'm gonna put her arm in a high position
to show you how you can access
the subscapularis, so I'm gonna reach
on the back part of her arm and reach
to the medial border of her scapula,
pull it out laterally, and I'm gonna palpate
her subscapularis and we drew it for you
so you guys can really get a better view
'cause most people it's hard for us
to picture, you see pictures of muscles
and you can't figure out how they, which one it is.
So right here is the subscapularis
and I can feel her scapula right underneath my hand.
So you can go ahead and palpate very gently.
You have your axillary artery right here
so you wanna make sure that you don't feel a pulse
and if you feel a pulse you stay off of it.
So you can do some pressure, a little bit
one inch strips, you can apply pressure
with the palm of your hand and just massage it
and be very gentle 'cause this is really tender
on people that are injured.
And so you can see the muscle fibers
going up and then it inserts right here
at the lesser tubercle of the humorous
and you can work this one inch strips,
your hands, you can do a little bit of friction.
You can do some effleurage and petrissage right
there to really make sure you get this.
People with adhesive capsulitis,
which means frozen shoulder, you can also
help them because these muscles here
are really tight and if you loosen them up
you'll be able to get more mobility in their rotator cuff.
Remember that this is a ball in socket joint,
so it's got the greatest range of motion,
however, it's also the easiest to dislocate.
So you wanna be careful and gentle
and here the clavicle is the easiest bone to break.
Now I'm gonna show you another way
that you can access the subscapularis.
You put her, the clients arm on your shoulder
and you reach underneath to grab the medial
part of the scapula and you pull out laterally.
You ask your client to move this arm
to the opposite shoulder, so it brings
out the scapula and I'm really in there.
I am going in about three or four inches now.
It's loosened up a little bit,
so I can really go in there and massage
medially, laterally, you know just gently though.
However much pain tolerance your client can handle.
You don't wanna go above a five or a six
on a scale from one to 10 because then
you engage the nervous system and it starts
releasing endorphins and you don't wanna do that.
You wanna create healthy patterns not more pain patterns
where the nervous system gets involved.
So you can still see the subscapularis
here that we drew underneath.
I am getting the lateral border
and I am trying to reach in as far as I can,
as far as she'll let me, by the time
you've worked this for a couple
of minutes, it's loosened up so I can really get in there.
So this is another angle that you can
get to the subscapularis and the posterior supraspinatus
and teres minor are on the posterior part.
(jazz music)
Okay, so now we've turned your client
on a side lying position.
You wanna make sure that you're supporting
the cervical, that her back is nice and straight
from C1 to C7, from T1 to T12 and the lumbar area.
And you wanna have the top leg supported
and the bottom leg straight, so that she
doesn't put pressure on her hip.
From here you can really access
all the three posterior rotator cuff muscles.
From here you can really see the scapula
and you can see the supraspinatus,
the infraspinatus, and the teres minor.
We have the spine of the scapula right here
and the supraspinatus is on this fossa.
The infraspinatus is in this fossa.
And the only one that's not in a fossa is the teres minor.
You can really warm these muscles up,
you even have access here to the levator scapula.
You can do one inch strips, you can massage
the upper trapezius right here,
and you can really get to the supraspinatus
right here on top.
And as you can see it goes from
the medial part and underneath acromion process,
that's why it's not drawn all the way,
'cause it goes underneath acromion process
and it inserts at the greater tubercle of the humorous.
So it goes from here, it goes underneath
and it inserts right there.
This originates here and it goes also
to the greater tubercle of the humorous
and the teres minor is from here,
is the pink one all the way to the greater tubercle.
So this is the attachment, so when they tear
the attachment it will be right here in insertion.
So you can access all three muscles from this
angle and you can massage them.
You can do with your knuckles.
You can do some figure eights.
You can do some skin rolling from this angle.
You can also access the serratus posterior superior,
the rhomboids minor, rhomboids major,
the erector spinaes and all I'm doing
is just pushing a little bit right here
so her scapula can really come out.
And you can get to the, all the rotator cuff
muscles, the three posterior ones.
To access the subscapularis you put her arm,
she can hold it by the elbow, make sure it's
in a straight line, that it's not way over here
or way over here, that it's also in nice angle
so you're not hyper-extending her arm.
And you're gonna reach, you're gonna put,
you don't wanna do 90 degree angles
you just wanna push lightly and
go on the anterior part of the scapula
and that's another way that you can access
the subscapularis which is right here.
And like I said you can do one inch strips,
palpating gently, you can do the money,
like a money sign right here with your thumb
and your fingers to really access even
the teres minor and major right here and the subscapularis.
So this is another angle that you can really get
in there to palpate the subscapularis.
So this is from the side lying position.
So I am just working right here
all along the scapula and accessing
the three major muscles of the rotator cuff
and then you can access the anterior one,
the subscapularis right here.
(jazz music)
Okay, so now we've turned her into a prone position.
And I've got again some of my special blend
of oils with essential oils and you can really
see her scapula here, you can see the supraspinatus,
the infraspinatus, and the teres minor,
which are the three posterior rotator cuff muslces
and right here you can also access the upper trapezius
and the levator scapula, if you just push up lightly
you can get to the origin of the levator scapula
underneath 'cause this muscle,
a lot of times when they have pain
up on top of the shoulder it's either
the supraspinatus or the levator scapula.
So you can access that right here,
you can do one inch strips all the
way up to the occipital ridge,
and that really relieves a lot of pain.
You can get to the rhomboids right here
and the erector spinaes.
The most superior muscle is the trapezius,
which starts from T12 to here to here.
So you're covering like three or four
layers of muscles, remember muscles are in layers.
So right here you're accessing again,
the rotator cuff muscles and they originate
right here on the medial part of the scapula
and they all insert at the greater tubercle of the humorous.
So you wanna make sure and get the tendon
attachments right here because that's
one of the places where it really hurts
when people have problems with their shoulder.
You also wanna move their arm forward
to reach, I'm gonna show you another way to reach
the subscapularis so the arm is just hanging lightly
off the table, you're gonna pull on the medial
part of the scapula, just a little bit out.
And you're gonna curve your fingers very gently
so where you can palpate real gentle
on the anterior part of the scapula.
You can really see, now that her
muscles are warmed up I can really get in there.
I'm going in like three or four inches.
If you can see my fingers are really in there
and I can really go back and fourth,
medial, laterally, horizontally,
I can also do the money sign right here.
Money, money, money, to be able to get the
teres minor, the teres major.
Now but just remember that the four
rotator cuff muscles are the supraspinatus,
the infraspinatus, teres minor, subscapularis,
and the scapula is sandwiched in between
the three posterior and one anterior of the scapula.
You always wanna assist your clients
arm when you bring it back and if you are gonna
continue doing a little bit of effleurage
and petrissage on their arm remember
that we always go centripetal towards the heart
on all of the appendages on all of the arms and legs.
We go towards the heart, pressure must be towards the heart
because we have little valves that close
to prevent back flow from going back,
so you don't wanna do damage and go against
those valves, you wanna be able
to go forward and towards the heart
which is called centripetal and when you are done
make sure that you, you know, reach closure
with your client, that you do your nerve ending strokes
and we've really accessed the scapula right here.
And I wanted to thank Angel our beautiful model today.
(jazz music)
I hope you learned some new techniques
to help you become the best therapist
that you're meant to be, look out for my next video
and please subscribe to my YouTube channel
so you can keep updated.
Thank you for hanging out with me today
and see you next time.
(jazz music)