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The Scapulo-Thoracic Joint

Last week I reviewed general functional anatomy concepts of the shoulder and reviewed a myofascial release technique for the shoulder girdle.  This week I want to discuss another amazingly effective technique for improving function of the shoulder girdle.  This technique focuses on the myofascial tissues between the thoracic spine and the scapula to optimize function of the scapulo-thoracic joint.  Remember, the biggest set up for shoulder injury and cause of upper back and shoulder pain is a restricted scapulo-thoracic joint.  So, releasing restrictions in the myofascial tissues of this pseudo- joint will optimize thoracic spine, rib cage and shoulder function.

The technique I use is strain-counterstrain for any myofascial knots found between the thoracic spine and the medial border of the scapula.  Your patient can lie comfortably in the supine position on their back.   Ask the patient to reach their arm across their chest toward the opposite shoulder.  This causes the scapula on the side you will be treating to move laterally away from the spine.  The practitioner now can place one hand on the elbow of the patient and passively exaggerate the adduction of the arm while feeling with the pads of their other hand the patient’s myofascial tissues of the thorax between the thoracic spine and the medial border of the scapula feeling for myofascial “knots”.  When you feel a “knot”, then poke into it and watch your patient’s face for the telltale signs of a strain-counterstrain tender point:  grimacing in pain L.

Once you have found a strain-counterstrain tender point the positioning to turn it off and allow it to release is as follows:

  1. Side bend the patient away from the tender point by simply sliding their head, neck and upper torso away from you on the table down to the point.
  2. Abduct their humerus until it is involved in the side bending of the upper torso.
  3. Allow the forearm and hand to fall comfortably toward the patient’s feet so that the shoulder (gleno-humeral joint) is internally rotated.  This position you will feel causes the ribcage under the tender point to lift slightly from the table (which means the ribcage is rotating away from the tender point).

 

This position will shut off any and all strain-counterstrain points in the myofascial tissues between the thoracic spine and the medial border of the scapula, which is a big area.  For your records you will need to contemplate what tissue you feel is hypertonic and being treated.  It may be the serratus posterior superior or the rhomboid muscles.  It may be a rib or the intercostal rib muscles.  It may be the paraspinal long restrictors or deeper short restrictors of the thoracic spine.  Any or all of these can be hypertonic and stuck in a strain pattern and causing myofascial restriction, because remember none of these muscles exist without the fascia that surrounds them that interconnects all.

Whether you start with this or end with this technique after releasing thoracic, neck and rib somatic dysfunctions will depend on the individual patient and your findings; but either way you and your patients will find this to be an amazing technique that will improve breathing, lymphatic drainage, movement and overall function of the thoracic spine, rib cage and shoulder girdle.

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