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is highly recommended that you bring that muscle back to resting length, and treat the strain prior to attempting joint capsule work. If the client is guarded due to shoulder discomfort during the capsule work, you will not be able to access and release the deep fascial adhesions inside the shoulder capsule.

Adhesions in joint capsule

FIGURE 5-17A

Joint Capsule Release, Compression.

 Ask the client if this is uncomfortable. It usually isn’t, as you are actually shortening the fascial adhesions and taking the pressure off the joint capsule. Have the client relax and visualize the capsule softening and letting go.

 Make contact in the joint capsule, using the cartilage of the humerus to massage the fascia gluing it against the cartilage of the scapula.

 Rotate the arm gently, and then pull back out. Contract the scapula, rotate the humerus, and then decompress the scapula. Continually repeating this sequence allows the head of the humerus to soften and mobilize the fascia deep inside the joint capsule, because what can create myofascial release is heat, pressure, movement, and gentle, slow-velocity fascial stretching.

 Make your plunges nonsynchronized and then slowly stretch the inner fascia and surrounding joint capsule

You must rotate the arm to the left and to the right because there could be multiple adhesions in different direc- tions and also at different degrees of abduction. Most peo- ple have more lateral rotation restriction due to tight medial shoulder rotators, therefore more restrictions will usually be found as you move toward lateral rotation and progress into further abduction. With a large client you can rest the arm on your hip and initiate the plunging action from your hip. You may feel some popping and releasing of the fascia as you create more freedom in the joint capsule. It is critical to perform this work totally pain-free, as even minor guarding prevents effective joint capsule work.

when the client least expects it, to prevent him or her from guarding or helping during this work.

 Rotate the arm externally to the restriction and repeat the plunging technique several times. Then perform a deep fascial and capsular stretch externally. Back off the stretch, return to neutral position, and then pull back out of the joint capsule (Figure 5-17B ■). See video clip at www.myhealthprofessionskit.com

FIGURE 5-17B

Joint Capsule Release, External Rotation.

FIGURE 5-17C

Joint Capsule Release, Internal Rotation.

FIGURE 5-17D

Joint Capsule Release, Decompression.

FIGURE 5-18

Joint Capsule Work, Different Hand Position for Left Arm.  Next, rotate the arm internally to the restriction and

repeat the plunging technique several times, ending with a deep fascial and capsular stretch internally. Back off the stretch, return to neutral, and then pull back out. Repeat the sequence again, if needed (Figure 5-17C ■).

 Decompress the joint capsule (Figure 5-17D ■).

 For hand placement doing the same technique to the left shoulder, refer to Figure 5-18 ■.

CORE PRINCIPLE

You must change the protocol and perform the joint cap- sule work anytime during the session if you find a bone- on-bone-like end feel.

 Use the back of your other hand in a loose fist, leading with your fingers, to perform the velvet glove myofas- cial release technique.

 The first three strokes will overlap as you work distal to proximal up the cervical spine.

 Use slow, smooth, progressively deeper strokes. See video clip at www.myhealthprofessionskit.com To use the velvet glove technique, perform the four strokes as follows:

1. Start just above (superior to) the clavicle and move the back of your hand down over the upper trapezius, hooking the tissue and bringing it toward the table and the spine (Figure 5-19A ■).

2. The next stroke is over the curve of the neck, again hooking the tissue while moving the back of your fist toward the table (Figure 5-19B ■).

3. The third stroke goes over the entire cervical spine. Hook or catch the SCM (sternocleidomastoid)

“Velvet Glove” Technique

George Kousaleos’s “velvet glove” technique is a myofas- cial release technique performed on the upper trapezius and cervical muscles to warm and stretch the connective tissue to be able to affect the deeper muscles. This also helps move the fascia back toward the spine, where it belongs, to allow a more neutral neck posture. Before beginning the velvet glove technique, here are some basics:

 The client is supine.

 Sit at the head of the table.

 The client slowly rotates his or her head, only to where it is comfortable, away from the side you are working on during all four strokes. Tell him or her to keep the neck straight and do not allow lateral flexion to occur. The hair should be heard rolling across the table. Active cervical rotation activates reciprocal inhibition, which may enhance the release. Place one hand on the client’s forehead to control the speed of rotation.

START FINISH

FIGURE 5-19A

Myofascial Release, Upper Trapezius (Ends at Spinous Processes).

START FINISH

FIGURE 5-19B

START FINISH

FIGURE 5-19C

Myofascial Release, SCM and Trapezius.

START FINISH

FIGURE 5-19D

Myofascial Release, Suboccipital Attachments.

and the scalenes to bring them into the myofascial release. This will effectively start to increase blood flow to the area of the SCM and scalene muscles. Stay off the carotid artery. If you feel a pulse, don’t apply any pressure, and reposition your hand. (Figure 5-19C ■).

4. Use your fingerpads and work the suboccipitals under the base of the skull, moving lateral to medial. Tight suboccipital muscles can create ischemic vascular headaches, C1 and C2 immobilization, and pain. For clients who experience migraine headaches, repeat this stroke multiple times (Figure 5-19D ■).

Repeat the entire velvet glove sequence, strokes 1 to 4, sev- eral times. The neck may look like it is sunburned when you are through, as this technique brings increased blood flow (hyperemia) to the area.