Ken Ross BSc ST, Nat Dip ST

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1 Ken Ross BSc ST, Nat Dip ST

2 Trunk Most people will suffer from back pain at some point in their lives. Good spinal posture places minimal strain on the muscles which maintain the natural curve of the spine The position of the pelvis is affected by the abdominal muscles and the spinal extensors. An increase in the lumbar lordotic curve will result in tight hip flexors and back extensors, weak abdominal muscles and a tendency to compensate through excessive throacic kyphosis.

3 Spinal Extensors Erector Spinae, Iliocostalis, longissimus, spinalis. Quadratus lumborum, multifidus and gluteus maximus. The erector spinae is the main extensor of the back. The Ilocostalis (lateral layer) has attachments the length of the spine. The longissimus (middle layer) and the spinalis (medial layer) Side flexion is produced by contraction of the muscles on one side The quadratus lumborum acts strongly on the non weight bearing side (along with the gluteals on the weight bearing side) to stop the pelvis from dropping When both contract they are responsible for spinal extension and stability.

4 Spinal Extensors Treatment With the subject in side lying position make a reinformed lock just above the sacroiliac joint in the middle of the erector spinae tissue. The pressure should be directed slightly towards the head Instruct the patient to slowly pelvic tilt You can also stretch the tissue by instructing the patient to flex the trunk. Work the length of the spine you wish to treat This is usually until you find an area that is not affected by pelvic movement Then return to the starting position and move your lock medially. Repeat the process moving up the length of the spine

5 Quadratus Lumborum With the client in side lying move your fingers of the edge of the iliac crest dropping down into the thoracic fascia. Swim your fingers deep (reinforced with the other hand if required) behind the erector tissue When you find the QL, apply the lock towards the head. Ask the patient to extend their leg and drop behind the line of the hip. This will tilt the pelvis and stretch the QL.

6 Spinal Flexion Rectus abdominis, external oblique, internal oblique and psoas major As we know if lordosis is present the abdominals are often long and weak. This places a lot of stress on the abdominal wall and surrounding fascia. As a result adhesions can occur leading to further postural imbalance

7 Spinal Flexion Treatment Position the client supine lock into the rectus abdominus on one side starting at the origin at the pubis Instruct the client to produce a small amount of side flexion Progress to the outer borders of the muscle hooking under as it is side flexing away from the lock Remember to assess the tightness of the psoas muscle as it might require treatment along with the abdominal tissue. External and internal oblique's are treated in a similar fashion.

8 Respiration Inspiration : Diaphragm, external intercostals, levatores costarum, serratus posterior superior, pectoralis minor, sternocleidomastiod Expiration: Transverse Abdominmus, subcoastales, transverse throracis, internal intercostals, external oblique, internal oblique, latissimus dorsi and quadratum lumborum (fixed ribs) Treatment of the respiratory muscles is beneficial for anyone with breathing difficulties. STR can have a positive effect for asthma suffers. Athletes will find it useful to have renewed lightness and ease of breath.

9 Respiration Treatment - Diaphragm Ensure the client is in a supine position, knee and hips bent Gently guide a thumb behind and in front of the lower ribs. Ask the client to gently inhale whilst you lock into the anterior attachments Keep holding as you ask the client to exhale. Release For the intercostals lie the client on their side Lock in-between each rib and instruct the client to breath in and breath out.

10 Neck Neck flexors are generally weaker than the extensors which have to work to keep the head up against gravity Neck problems often occur during repetitive or sustained activities. These include cycling, sitting at a desk, painting a ceiling etc General work to all the neck muscles, systemically working the agonists and antagonists will ensure a good recovery from chronic neck pain.

11 Neck Neck flexion: Sternocleidomastoid (SCM), scalenus anterior and longus colli flex the neck. The longus capitis and SCM flex the neck and head. The rectus capitis anterior fibres flex the head and neck and stabilise the atlanto-occipital joint Neck side flexion: The scalenus anterior, scalenus medius and scalenus posterior, levator scapulae and SCM side flex the neck. The SCM, trapezius and erector spinae side flex the head and neck. The rectus capitis lateralis side flexes the head on the neck. When the SCM contracts on BOTH sides the neck and head flexes FORWARD When the SCM contracts on ONE side ROTATION occurs in the OPPOSITE direction

12 Steroncleidomastiod (SCM) Treatment Have the patient in a comfortable supine position Cradle the head with one hand whilst using the other to gently grasp the SCM Maintain this hold and carefully move the neck away from the lock into side flexion or rotation to the same side. It is vital NOT to move too quickly Thickening is often evident toward the skull. Use careful locking away from the bone to free up this congested area. The anterior scalenus can be treated by gliding the lock just off the clavicle and side flexing the neck to the opposite side This is a very sensitive area and treatment should be administered with great care

13 Neck Neck extension: The levator scapulae and splenius cervicis extend the neck. Trapezius, splenius capitis and erector spinae extend the head and neck. Rectus capitis, posterior major, minor and superior oblique extend the head. Neck rotation: The semispinalis cervicis, multifidis, scalene anterior and spenius cervicis rotate the neck. The splenius capitis and SCM rotate the head and neck. The inferior oblique and the rectus capitis posterior major rotate the head on the neck

14 Treatment Lie the patient in the supine position Systematically treat the whole of the back and side of the neck using very small movement patterns (flexion, side flexion, side flexion and rotation) Congestion often occurs between the trapezius and the SCM, within the splenius muscles and the levator scapulae. These muscles may be reached by locking deep into the lateral border of the SCM. The origins of the trapezius muscles should be treated with a lock away from the skull and side flexion to the opposite side. This treatment can also be administered in the seated position.

15 Upper Limb The shoulder girdle is made up of the scapula, the clavicle and the humerus. Muscular imbalance may occur in this area causing postural problems, impaired shoulder movement and pain. Severe shortening and tension in the upper fibres raises the shoulder girdle so that the lower fibres opposing upper movement lengthen and weaken. As compensation the patient can develop a forced erect posture. This leads to the scapulae retractors and back extensors becoming tight and the protractors weak

16 Shoulder Retraction Rhomboid major, rhomboid minor and trapezius Treatment With the subject in a prone position apply pressure with the flat of your hand along the origin of the rhomboids Instruct the client to push their shoulder into the table to produce protraction Ask the patient to place the back of their hand on the small of their back as you support the shoulder You can now work on the rhomboid attachments with the patient protracting the shoulder against the supporting hand.

17 Shoulder Elevation Trapezius (upper fibres) and the levator scapulae As well as elevation, the levator scapulae works with the trapezius to produce neck extension when both sides contract. When one side contracts it produces side flexion.

18 Shoulder Elevation Treatment With the subject in prone support the anterior shoulder buy cupping one hand underneath Hook over and into the upper fibres of trapezius with the other hand Maintain the lock and depress the shoulder with the supporting hand The levator scapulae can be treated using the same technique The lock show be administered at the superior angle of the scapula. If you like you can ask the patient to actively depress the shoulder girdle. This will produce a deeper release.

19 Shoulder Protraction Serratus anterior and pectoralis minor Often highly developed in boxers and throwing athletes Important for stabilising the scapula during movement Weakness can cause scapula winging Requires particular attention following a dislocation

20 Shoulder Protraction Pectoralis minor Treatment With the patient in the supine position Abduct the arm to 90 degrees Delve under the pectoralis major tendon towards the coracoid process Once reached acquire a lock and ask the patient to raise the arm upwards or retract the shoulder towards the table Then release promptly

21 Shoulder Protraction Serratus anterior Treatment Have the client in side lying Slip of the pectorals and lock into the serratus muscle Extend the arm to produce retraction and target the serratus muscle

22 Shoulder Flexion Pectoralis major, anterior deltoid, long head of biceps, coracobrachialis The pectoralis major works in conjunction with the anterior deltoid and the protractors to move the arm forward in movements such as pushing, punching and throwing. It is also a strong adductor, particularly in the horizontal plane

23 Shoulder Flexion Treatment Lie the patient in the supine position Lock in and off the sternum and clavicle and conduct a combination of shoulder extension and abduction to produce a stretch. Progress to treating the whole muscle using the ulnar surface of the palm To treat the deltoid in this position grip the whole of the deltoid and lock proximally. Slowly internal rotate the humerus to produce a stretch The release can also be produce by rotating the arm into external rotation as well.

24 Shoulder Extension & Adduction Extension: Latissimus dorsi, teres major, posterior deltoid and the triceps brachii Adduction: Latissimus dorsi, teres major, pectoralis major and coracobrachialis The latissimus dorsi is the widest muscle of the back and is a powerful adductor and extensor of the shoulder. When the arm is fixed above the head it works with pectoralis major to draw the body upwards. Example chin up. The teres major often termed little helper to the lastissimus dorsi is effective when the scapula is fixed (often by the rhomboids)

25 Shoulder Extension & Adduction Treatment With the subject prone lock into the latissimus dorsi along its length up to the insertion at the humerus. Take the shoulder into abduction Teres major can be treated in the same manner This technique also works well in side lying.

26 Rotator Cuff Subscapularis, Supraspinatus, Infraspinatus and Teres minor These muscles are essential for keeping the head of the humerus in the glenoid fossa during arm movement. They also inhibit upward displacement of the head when the biceps, triceps and deltoids are active. As a massage therapist we should work on all of the muscle collectively to encourage rebalance. With any dysfunction in this area it is imperative to treat the neck

27 Rotator Cuff Infraspinatus and teres minor Treatment Have the subject in a prone position Abduct the arm to 90 degrees Place the lock onto each of the muscles in turn and medially rotate the arm to produce a stretch

28 Rotator Cuff Suprapinatus Have the subject in a prone position Abduct the arm to 90 degrees Be sure that the trapezius muscle hase been adequatley softened. Place a lock with the fingers tips into the supraspinatus fossa Slowly adduct the arm

29 Rotator Cuff Subscapularis Have the subject in a supine positon Abduct the arm to 90 degrees Lock into the anterior surface of the scapula and slowly laterally rotate the shoulder This is a very sensitive area to work on and so each point should not be over treated Be systematic in your approach

30 Elbow Joint stability in the elbow is predominately provided by the collateral ligaments and musculature around the elbow the neck should be considered during any over sue injury to the elbow Inflammation on the lateral or medial elbow relate to the muscles producing wrist movement. Common reasons for injury in this area faulty technique, repetitive gripping or over use of the wrist muscles.

31 Elbow Flexion Biceps brachii, brachialis, brachioradialis, pronator teres The brachialis is the primary flexor at the elbow and controls movement during extension. It has the capacity to develop myositis ossificans so extreme care should be taken following a direct trauma. The biceps brachii is a strong supinator as well as elbow flexor and these actions are often produced together. The brachioradialis works as a flexor when the wrist is midway between pronation and supination

32 Elbow Flexion Treatment With the client in supine and the elbow flexed Grip the belly of the biceps Extend and then pronate to stretch Treat the whole muscle paying particular attention to the origin Careful with locks as this is a sensitive muscle when deep work is carried out. Treat the lateral side and direct the lock under the biceps to work into brachialis

33 Elbow Extension Triceps brachii and anconeus The triceps are the only muscle on the posterior of the upper arm. They are involved in any pushing movements. Punching or throwing can stress the attachments. Actual strains are rare, but bad technique can cause pain and tearing particularly at the musclotendinous junction.

34 Elbow Extension With the client supine Flex the shoulder up towards the clients ear Lock into points along the triceps and flex the elbow Pay close attention to the tendon attachments.

35 Describe when and how you would use Soft Tissue Release. It is great for working on specific areas that cannot be stretched with exercises alone Can be used close to an area that may have been damage without causing any harm A great diagnostic tool. Assessing the texture of the tissue. Does it make the symptoms better? Using the various tools techniques.fingers, knuckles, fist and elbow to produce a change in the muscle or fascia tissue

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