This operator's viewpoint photograph shows cross-fibre kneading being applied to the triceps. If the hands were changed over, the biceps and brachialis could be worked in the same way. Similar work on the muscles can be performed with the arm in a neutral position. In the position shown the muscles and fascia are on some tension that can allow more efficient combined technique with stretch as well as cross-fibre work.
Tips: Most useful in cases where the belly of the upper arm muscles rather than the tendons is the target. Least useful in cases of articular dysfunction where the muscles may be less important. Extra considerations: Varying the degree of abduction or adduction will change the initial tension on the muscles to make the technique a combined kneading and stretch procedure.
25.3 • Kneading shoulder prone The posterior parts of the shoulder and muscles are more accessible in this position. Control the arm with your hand so that you can vary the angle at which the shoulder is held to reach the particular tissue desired.
Tips: Most useful where the posterior muscles and the scapula are involved. Least useful where the patient finds prone lying a problem for any reason. Extra considerations: Varying the position of head rotation can change the effect of the technique.
25.4 • Articulation of shoulder sitting Induce antero-posterior and supero-inferior movement in this position. The long head of the biceps is available for friction in cases of tendonitis, as is the rotator cuff tendon behind the shoulder that you can work with your thumb.
Tips: Most useful in any patient who finds a recumbent position difficult. Least useful where shoulder movement of any amplitude must be introduced to make the technique reach the target tissue. Extra considerations: Introduce a traction component with the patient holding a small weight as the technique is being performed.
25.5 • Harmonic technique hold for shoulder supine Clasp the patient's hand between your hands and induce a harmonic oscillation into a pendulum-like movement of the arm into abduction, adduction and internal and external rotation. Flexion or extension can be introduced as well, or combinations of several components are possible. An appropriate rhythm for this technique would be slightly different in each subject but would vary between fifty and a hundred oscillations per minute. The correct rhythm is determined by finding the rate that can be maintained with least effort by the operator.
Tips: Refer to earlier section specifically relating to harmonic technique.
25.6 • Traction of shoulder supine Fix the patient's arm between your upper arm and hand while you apply the other hand behind the head of the humerus. Lean back and allow the fingertips to fall into the space produced by the traction. These fingers monitor the force necessary and can add a small tugging motion to the joint.
Tips: Most useful in mild inflammatory disorders where this gentle oscillation allows circulatory interchange. Least useful in cases of specific individual muscle disorders where this technique is non-specific. Extra considerations: Try varying the angle of rotation of the arm and the abduction and flexion angles as well for optimum effect.
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