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The Stabilizing Serratus Anterior

We were there before COVID-19 and we will be there after, stronger than ever! The world needs our skilled and compassionate touch.

I love this 3D video of Serratus Anterior – a muscle that is crucial in scapula stabilization. It does a great job of helping you understand all the different functions of this remarkable muscle.

If you are working with anybody with shoulder issues, especially rotator cuff injuries,  it’s necessary to understand exactly how it  functions. 

Notice how it and subscap slide across each other. That’s why joint mobilizations help to hydrate both muscles. 

What’s your biggest challenge in working with the Serratus Anterior? Write in the comments section below.

For all of us now

Pandemic
by Lynn Unger

What if you thought of it
as the Jews consider the Sabbath—
the most sacred of times?
Cease from travel.
Cease from buying and selling.
Give up, just for now,
on trying to make the world
different than it is.
Sing. Pray. Touch only those
to whom you commit your life.
Center down.

And when your body has become still,
reach out with your heart.
Know that we are connected
in ways that are terrifying and beautiful.
(You could hardly deny it now.)
Know that our lives
are in one another’s hands.
(Surely, that has come clear.)
Do not reach out your hands.
Reach out your heart.
Reach out your words.
Reach out all the tendrils
of compassion that move, invisibly,
where we cannot touch.

Promise this world your love-
for better or for worse,
in sickness and in health,
so long as we all shall live.

Scapulae Mobility and the Obstinate Pec Minor!


The obstinate pectoralis minor (PMI) can produce a hailstorm of problems throughout the body especially in the shoulders, arm, neck and respiration. Working with it effectively goes a long way in helping you help your clients with neck and shoulder issues, breathing restrictions and even wrist and elbow pain. If the iliopsoas is the hidden prankster of low back pain (Travell and Simons), the PMI is the hidden trickster of the shoulder girdle. This article reviews the anatomy of the PMI, common pathology and suggestions for working with it.

Imagine three long fingers extending on an inferior and medial diagonal path from the coracoid process to ribs 3-5 (attachments have been found on ribs 2 and 6 on some folks). This multitasking stabilizer connects the shoulder girdle (scapula and clavicle) to the thorax. The PMI seems to glory in pulling the coracoid process towards the ribs (whether it needs it or not) causing a profusion of myofascial and bio-mechanical distortions. PMI drags the glenohumeral (GH) joint with it as it pulls the coracoid process towards the ribs.

Restrictions in blood flow can occur—a portion of the axillary artery lies beneath PMI. Tingling and numbness (the distal portion of the brachial plexus passes deep to the coracoid process) can also result from the pec minor’s predilection for locking short. When the arm is abducted and externally rotated the artery and nerves are stretched around the PMI close to its coracoid attachment –hence the tingling and numbness.

A tight PMI restricts scapular mobility, interferes with the scapulo-humeral rhythm, cause limited humeral mobility and scapular winging. Humeral mobility depends on both scapular mobility and fixation of the scapula at the right time and place.

The GH joint follows the scapula. Wherever the scapula goes, the GH joint is sure to tag along. If the scapula is super-glued to the ribs GH joint movement is comprised. My mantra is “Restore scapula mobility and stability and you’ll go a long way to restoring GH joint function”.

Let’s do this kinesthetic exercise: Place one hand on the greater tubercle on top of your humerus. Now depress and protract your scapula (the actions of PMI). Can you feel how the head of the humerus went along for the ride? Next abduct the humerus to at least ninety degrees. Feels yucky, right? When the scapula is protracted and depressed the GH joint internally rotates and the greater tubercle moves anterior. That yucky feeling is the greater tubercle colliding with the acromion process. Repeated fender benders between the greater tubercle and the acromion process can result in impingement syndrome, impaired rotator cuff function, disturbances up the kinetic chain to the neck and down the kinetic chain to the elbows, wrists and hands.

One of my clients is a hairdresser who had chronic elbow and wrist pain for years. In addition to treating the plethora of trigger points in the flexors and extensors of her wrist and elbows, I treated her massively locked- short PMI, rotator cuff and serratus anterior to restore scapular mobility and weight/energy transfer throughout her upper body. She’s been pain free for several months. If I had just concentrated on her elbows and wrists the results would have been temporary. The moral of this story: always check out pec minor with any neck, shoulder, wrist and elbow pain!

My Releasing the Rotator Cuff book and DVD offers an in-depth protocol for releasing this stubborn muscle. Attract and retain awesome clients with stellar skills in working with the shoulders! As a thank you to my wonderful readers, I’m offering a $25.00 discount on my Releasing the Rotator Cuff package (book and DVD) – your price only $40.90. Purchase

Rotator Cuff Stabilization

I really like this video of an easy exercise that provides stabilization and centration to the humeral head. What do you think?

As a thank you to my wonderful readers, I’m offering a $25.00 discount on my Releasing the Rotator Cuff package (book and DVD) – your price only $40.90. Purchase

Let’s create world peace one shoulder at a time!

The Slippery Subscap – Palpation Tip

Subscap can be a tricky muscle to work with. In my workshops I’ve discovered that approximately 80% of therapists thought they were on subscap, but were on latissimus dorsi/teres major. It’s an easy mistake to make and easily correctable. The reason for this common error is that therapists attempt to enter subscap too far inferiorly. If you do that the ribs will block you and you will mistake the fat lat for subscap. Watch this video for a “out-of-the-box” palpation tip. Also, for those of you who are ABMP members, check out my article, “The Slippery Subscap” in the January 2020 issue of Massage and Bodywork Quarterly. As a thank you to my wonderful readers, I’m offering a $25.00 discount on my Releasing the Rotator Cuff package (book and DVD) – your price only $40.90. Purchase link on the right side of your screen. Let’s create world peace one shoulder at a time!

Iliopsoas anatomy: Amazing 3D video

I love this exceptional video and show it in my Releasing the Iliopsoas workshops. The Claude Bernard University University in Lyon, France has gifted the world with their fabulous array of anatomy videos. You can really go down the YouTube hole watching all of them!

There are some things I would add: the iliopsoas’s job as a stabilizer of the pelvis and low back; its role in centrating the head of the femur in the acetabulum; and that the upper psoas fibers create lumbar flexion while the lower fibers create lumbar extension.

Here’s the You Tube link – there’s lots more videos from this fantastic project of the Claude Bernard University University in France. Enjoy!

What’s your number one challenge working with the iliopsoas? Email me at info@massagepublications.com

I’d love to hear your thoughts! Comment below.

Check out my live seminar schedule here

 

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SALES CONVERSATIONS THAT WORK


This is a bit of a departure for me since I usually write about techniques. But we need clients to do those techniques on! I’m knee deep in a brand new venture, “How to Create a Waiting-List Practice” which is being beta-tested right now. Here’s an excerpt from the training manual.

Recently I had a “sales” conversation. It was a serendipitous chance encounter with an acquaintance of mine at the gym. I was having a knee issue and my PT suggested I use the stationary bike instead of the treadmill. On the bike next to me was a man I know socially. We struck up a conversation. I said that I don’t really like the bike but I was obeying my PT. Commiserating with me, my acquaintance said that he thought he had a rotator cuff injury.

I asked him to tell me more about his symptoms. He did. I then asked him some direct questions: “How is this impacting your daily life? and “What is the one thing you’d like to be able to do that you can’t”. I gathered information.

After hearing his answers I concluded we were a good fit. I explained that I was a massage therapist and specialized in rotator cuff injuries. He jumped on it and asked if I had any openings that day. One of my clients had canceled so I was able to fit him in. He bought a package that day!

Notice that I listened deeply before I ever mentioned I was a massage therapist and have a strong skill set in treating rotator cuff injuries.

Below is a guideline to effective communication to prospective clients. This heart-centered approach is a perfect match for LMTs! (Adapted from Tommi Wolfe’s Top Business Coach Training.)

  • Mindset: Approach the conversation with a spirit of partnership and wanting to help your potential client. You are the professional. You are there to help your client, not to sell. You are not there to be tested, to be affirmed, or to offer a “try before buy” session.
  • Listen: Spend ten minutes deeply listening to understand the prospect’s situation before you even dream of talking about what you can do for your prospect.
  • The Gap: this is critical! You need to help your clients see their problems and what is not working. This is probably the most important step because if they see the gap and know you are the solution the rest is easy. So many people walk around for years with limited range of movement and pain and never seek treatment. Ask questions like: “How is this impacting your daily life?”; “How is your sleep – are you able to get enough rest?”; “What is the one thing you’d like to be able to do that you can’t”; “How long have you had this condition?”.
  • Imagine: Turn the conversation to an upbeat, positive place. Help the prospect envision how awesome their life will be after their injury/issue has been addressed: “Tell me what your life would look like if you were pain free and full range of movement.”
  • Can you help?: Be honest with yourself. Is this someone you can help? If you can’t let them know.
  • If you can help: Tell them, “I think we are a good fit. When would be a good time to get started? I have openings (suggest some dates/times). Then be quiet!!!!
  • Remember: this is NOT about you and whether you are good enough. It is about the prospect and whether they are ready to make the investment. This mentality will help you stay detached and not pursue. You will stay powerful.
  • What's your number one challenge with filling your practice with 5 star fabulous clients? Email me at info@massagepublications.com

      Stay tuned for more deets about "How to Create a Booked-Solid Practice"!

Super Simple (and fun) Guide to Increase Range of Motion

I’ve had the honor and privilege of teaching creative movement and writing in women’s prisons for the last twelve years. (Wondering what this has to do with massage therapy? Read on!)

One of the units I volunteer in is the Female Sex Offender Treatment Program (SOTP). Yes, there are female sex offenders. When I first learned about SOTP I was immediately drawn to facilitate workshops there.

I approached the program director and she loved the idea. Since most Texas prisons have a strict “No Touch” policy, The SOTP program is strictly cognitive based therapy. The program director knows that these women hold tremendous trauma in their bodies and fervently believes that creative movement classes allow their bodies to speak. . (Nearly 100% of female offenders have been sexually abused in childhood.)

I always start my classes with fun icebreaker exercises. I put on some fabulous African drumming music and have them write their name with their tail bones, their belly buttons, elbows, nose, chin – anybody part will do! Before long, everyone is smiling and laughing and magic is happening behind bars.

Create some magic in your office/clinic! Encourage your clients and yourself to move in novel ways like I described above. The body loves circular and spiral movement which stimulates different parts of the brain and gets us out of linear, sagittal plane movement. When we move in a variety of ways different parts of our nervous system are stimulated, giving us a new sense of ourselves, a fresh identity.

I regularly suggest to my clients to put on their favorite music and imagine there’s a paint brush attached to the body part we’re working with and do the following:

  1. Rotator cuff/shoulder injuries: write your name in script with your elbow. Bend elbow and Place fingers lightly on shoulder. For those with limited ROM, start in the pain free range (example 30 degrees of abduction).
  2. Neck: write your name in script with your chin and top of head.
  3. Hips/lower back: write your name in script with your belly button and tail bone.

GUIDELINES

  • Stay in the pain-free range until the body feels ready to perform the movements with more volume
  • If it hurts, make it smaller. Micro-movements are a great start.
  • It should feel good and be fun!

BENEFITS

  • Increases range of motion
  • Introduces novel sensations in the body
  • Increases proprioception
  • Releases endorphins
  • A wonderful alternative to traditional exercises

Super Easy Guide to When NOT to stretch your clients!

As passionate as I am about the value of skilled stretching, I’m equally zealous about when NOT to stretch. A common misconception in the bodywork, fitness and yoga fields is “All muscles should be stretched”. Let’s put that to rest right now. All muscles do not need to be stretched.

One of my clients came in last week with severe rhomboid/middle trap pain on her left side. When I asked her about what she thought caused it, here’s what she told me:

“My mother gave me a gift certificate for a relaxation massage which I used last week. The therapist had just taken a Thai*massage course and wanted to do some stretches before the massage. She did one where she pulled my arms away and across my body, one at a time. When she did my left, I could feel something give and it started hurting about an hour after the massage. I could kick myself for letting her stretch me!” (*I am not dissing Thai massage! I love it and get them often.)

This client is quite savvy and educated about her body. She has weakness in her left scapulae retractors (rhomboid/middle traps) because of an old shoulder injury. She manages it with regular bodywork and carefully chosen stretching and strengthening exercises. Her scapulae retractors do not need stretching. Most people’s do not. Most of the time they need strengthening.

Let’s take a brief and general look at postural and phasic muscles:

Postural muscles: also known as tonic or local muscles have an anti-gravity function – they are heavily involved in the maintenance of posture. They tend to be shortened and tightened. Another way of saying that is they tend to be overly-activated.

Phasic muscles: also known as global muscles have primarily a movement role. They are usually more superficial than postural muscles. A shortened, tight postural muscle generally results in inhibition of its associated phasic muscle which becomes weakened as a result. Think pec major and rhomboids.

Let me emphasize that this chart is a general guideline of common muscles that usually benefit from stretching (postural) and those that do not (phasic). Like everything in life thee are exceptions.

You’ll notice infraspinatus is considered a postural muscle because it’s part of the rotator cuff –a stabilizing structure. Infraspinatus is notorious for being weak, inhibited and locked-long. It rarely needs stretching. You’ll notice I do not include a stretch for it in Stretch Your Clients.

Another example is the cervical extensors. With everyone on their devices these days, do those extensors really needs stretching?

I hope this article helps you make informed decisions when to stretch and when not to stretch. Let me know what you think!

The proper way to cough!

I was teaching a Stabilizing the Core and SI Joint seminar recently and learned a valuable cue from a pelvic floor specialist. In the MET correction for and upslipped innominate (when the ilium slips out of the SI joint), the client is asked to perform a hip-hike for eight seconds and cough and let go of the hip-hike. Why the cough? Good question! There are a few reasons: coughing activates the pelvic floor muscles, the transverse abdominis, the anterior multifidi, the diaphragm and the attachment of the quadratus lumborum to the 12th rib. The QL stabilizes the 12th rib during forced exhalations, such as coughing and sneezing. Ever had a client with low back spasms say “I bent over and sneezed!”?

The pelvic floor specialist noticed that the model’s belly pushed out when she coughed. Allowing the belly to push out weakens the pelvic floor and abdominal group. She suggested to cue clients that when they cough the belly should go in towards the spine to properly activate all the core muscles.

This is one thing I love about teaching for PESI REHAB – the interaction with professionals from other disciplines.

Hope this is useful!