LOS DETERMINANTES DEL CRECIMIENTO

19

The soft tissue articulation of the scapulo- thoracic junction is frequently involved in ten- sion states and postural control of the pectoral girdle. Fibrotic muscle bands are frequently found under the scapula, and these can limit mobility and be a source of symptoms in themselves. Restricted mobility of the scapula can put undue strain on the shoulder joint itself. In cases of shoulder dysfunction this can make the difference between comfort, reason- able usage, and mechanical problems.

From a practical viewpoint the difficulties lie mostly in finding ways to access the area underneath the scapula. Techniques must be used which allow the scapula to be partly

separated from the thoracic wall to allow the operator's fingers or hand access to the muscles. Very tight fascial states will make this difficult, but these patients are the subjects most likely to benefit from such approaches.

There are few special precautions when working on this area except to be aware of the forces being put through the shoulder joint. It is necessary to avoid excessive stress on the gleno-humeral joint in the process of reaching the scapulo-thoracic junction. Deep emotional tension often manifests here, and release of the muscles can produce emotional release, so the thinking practitioner should be prepared for this possibility.

19.2 • Kneading and stretching rhomboids and subscapularis sidelying Push the patient's shoulder

and upper arm toward the table with your thorax and arm to wing the scapula. Then push the finger tips up into the space formed so that they can work directly on the muscles. Kneading can be per- formed directly or the whole scapula can be lifted while being held against your chest to perform stretching. If you sidebend your body it is possible to work the upper or lower parts of the area.

Extra considerations: Can be used as an

inhibition technique with sustained pressure.

19.1 • Kneading of soft tissues on superior and medial part of scapulo-thoracic junction side- lying Fix the scapula slightly down toward the

table with the stabilizing hand while the other applies kneading to the horizontal fibres of trapezius, and the rhomboids. As these muscles are involved in respiration, it may be best to use the exhalation phase of breathing to enhance the relaxation response.

Extra considerations: Try holding the muscles

on tension and moving the whole body against the tension in very tight subjects rather than moving the muscles against the body.

19.3 • Articulation of scapulo-thoracic junction sidelying Fix the scapula and shoulder between

your thorax and finger tips and rhythmically roll the patient's upper body into rotation. This will have the effect of mobilizing the scapula on the thorax.

Extra considerations: Try taking the whole

19.4 • Articulation of scapulo-thoracic junction sidelying This slightly complex hold will reach the

scapulo-thoracic junction in a number of ways depending on the pressures used. Press against the lateral border of the scapula with your lower arm while moving your body in a circle. This will produce a completely different effect than if you compress your upper arm hand against the lower arm elbow and then perform rotary movements. With some experimentation of different directions of pressure of the arms, hands and body it is possible to vary this technique in many subtle ways and, therefore, its effect on the tissues.

Tips: Most useful where stretch rather than

kneading is the preferred method. Least useful where there is shoulder dysfunction making this position difficult for the patient.

Techniques for the scapulo-thoracic area 145

19.5 • Kneading and articulation of scapulo- thoracic junction prone Abduct the patient's arm

to an appropriate point and rotate it as necessary with your lateral hand. You can reach the deep interscapular muscles and pull the scapula into different degrees of rotary movement.

Tips: Least useful where prone lying is a problem

for any reason. Extra considerations: Try chang- ing the patient's head position to vary the tension on the scapular muscles.

19.6 • Kneading scapular muscles prone Pull

the shoulder toward you and backwards to wing the scapula and apply the thumb of the other hand to work on the muscles that have been taken off tension.

Tips: Most useful in very tight subjects and

where it is required to work on the posterior thoracic wall. Least useful where prone lying may be a problem and where operator thumb strength may be insufficient for the technique.

19.8 • Kneading and friction of scapulo-thoracic junction prone Perform the work with fingertips

applied to the soft tissues. This allows a wider spread of pressure that may be less uncomfortable than thumb pressure. Some operators will find this easier to perform if their thumbs are too mobile for the other holds.

19.7 • Kneading and articulation scapula prone

Place the patient's arm in strong internal rotation and pull the shoulder toward you and backwards to make the subscapular muscles more accessible. The thumb is performing the kneading work.

TECHNIQUES FOR THE CERVICO-