SOFT TISSUE MOBILIZATION AND SCAPULOTHORACIC RELEASE TECHNIQUES

SOFT TISSUE MOBILIZATION AND SCAPULOTHORACIC RELEASE TECHNIQUES

Soft tissue mobilization, according to Johnson's definition: "STM is the treatment of soft tissue taking into account the layers and depth through the initial evaluation and surface treatment, proceeding to the prominence of bones, muscles, tendons, ligaments, etc." The goals of STM in the patient are similar to those of joint mobilization: development of functional scar tissue, elongation of collagen tissue, increase of GAG and facilitation of lymphatic drainage. In overuse syndromes, trauma, post-surgical conditions and abnormal movement patterns of the shoulder, areas of tenderness, and limited connective tissue extensibility can develop. Adhesions within the fascia can reduce the ability of the muscle to widen during contraction and to stretch during passive stretch. Abnormal compensations can occur, which can lead to rupture of the compensatory tissue. Within the shoulder complex, it is important to evaluate various areas of fascial restriction. Scapulo-thoracic release techniques are also described for the muscle-tendon and fascial characteristics of this joint. The following is a description for muscle or space between the structures to be evaluated and mobilized.

Subscapularis

Patient Position

The patient is supine, with the shoulder abducted to tolerance.

Therapist Position

The therapist is facing the patient’s axilla with the mobilizing fingers on the muscle belly of the subscapularis.

Parallel mobilization or perpendicular strumming or directoscillation may be used. Assistive techniques include sustaining pressure while elevating and adducting the shoulder.

Subscapularis Arc Stretch

Patient Position

The patient is supine.

Therapist Position

The therapist's cephalic hand simultaneously raises, externally rotates and distracts the affected shoulder, while the caudal hand (thenar side) stabilizes the lateral edge of the scapula. Both movements occur simultaneously, slightly arched.

Side-Lying Subscapularis, Teres Major

Tilt Stretch

Patient Position

The patient is side lying facing the therapist with hips flexed

to approximately 45 for stability.

Therapist Position

With the therapist facing the patient, the therapist’s caudal hand and upper extremity skin lock on the inferior border of the patient’s scapula. The therapist’s cephalad hand and upper extremity wrap around the patient’s humerus, and the therapist’s elbow and proximal arm control the amount of external rotation. The forces from the therapist’s upper extremities are in opposite directions, or one hand can stabilize and one can be the primary mobilizer. This technique can also be used with contraction-relaxation stretching to increase contractile component extensibility.

Pectoralis Minor

Patient Position

The patient is supine or side lying, with the arm slightly abducted and flexed.

Therapist Position

The therapist’s mobilizing fingers glide along in a superficial vector along ribs 3 to 5 lateral to medial underneath the pectoralis major. Often, the pectoralis minor is bound down and tender in shoulder dysfunction. STM techniques used are direct oscillation, sustained pressure, and perpendicular and parallel deformations. Assistive techniques include inhalation and contraction-relaxation with shoulder

protraction.

Serratus Anterior: Upper Portion

Patient Position

The patient is side lying, with involved side upward.

Therapist Position

The therapist is standing posterior to the patient’s shoulder. The caudal hand elevates the scapula in a cephalad and anterior direction off the rib cage. The therapist can use the fingers of the top hand to roll over and palpate the superior fibers of the serratus anterior that attach to the patient’s first and second ribs, as well as the fascial attachments between the levator scapulae and serratus anterior. STM techniques are sustained pressure and direct oscillation. Assistive techniques include resistive PNF, diagonal contraction-relaxation, and deep breath.

Serratus Anterior: Lower Portion

Patient Position

The patient is side lying.

Therapist Position

The therapist places the mobilizing fingers along an interspace of ribs 2 to 8 on interdigitations of serratus anterior. STM techniques used are parallel techniques along rib contours medially to laterally or laterally to medially. Assistive techniques include deep breath, contraction-relaxation with scapular depression, and rotation of the thoracic spine to the same side. Restrictions may be evident in patients with a previous history of rib fracture or abdominal surgery.

Inferior Clavicle

Patient Position

The patient is supine, with the involved extremity supported by a pillow.

Therapist Position

The therapist is on the same side as the involved shoulder. Palpating medially to laterally or vice versa

along the inferior clavicle, the therapist looks for fascial restrictions and tenderness, especially at the costoclavicular ligament, the subclavius muscle, and the conoid and trapezoid ligaments. This region is important to evaluate and treat in shoulder patients who have a protracted and externally rotated scapula with adaptive shortening of the anterior chest musculature.