Hi, everyone.
I'm Ian Harvey, massage therapist.
This is Sam.
Hi.
Today we're going to talk about how to lift up the shoulder blade during a massage.
How to mobilize it and how to work under it.
First, we'll start with four different ways of lifting it up, then we'll talk about why
you might want to lift it, mobilize it and work under it.
Finally, we'll talk about clients whose shoulder blades don't seem to want to move, and what
to do in those situations.
If you'd like to skip ahead, click on the time codes down in the description.
The first way, and my favorite way of introducing this scapular mobilization is in the course
of the rest of my massage.
I don't like to stop the massage, reposition the body, and then do a different technique.
I want it to flow.
To do this, while I'm up here working in the trapezius, I'm working with this shoulder
blade, I can reach down, I'll go into a lunge here, connect to the side of the table and
slip my hand under this acromioclavicular joint.
And just notice that having this little bit of upward pressure here lifts this scapula
up.
This looks like like this under her shoulder blade.
I scoop my hand under and I press up using my fingertips, but I'm not having to use my
muscular effort because my knuckles are pressed against the table and they are like a crowbar
angling upwards.
Angle that upwards, allow your hand to rest and now that you've got this scapula popped
up just a bit, everything that you do medial to it is going to more easily interact with
the medial border of this scapula.
And if you press up even more, and you can also press medially with this hand, you should
pretty easily be able to go under the scapula on some clients, on your more mobile clients.
I'm keeping this inferior portion of the scapula sandwiched between my fingers and my thumb
and as I rock forward it can come up superiorly, and you can make it circular.
Just try not to drive this with the small joints of your arms and your shoulders.
Instead let this come from the rocking of your body.
Now if you're not able easily leverage up that shoulder with this hand, if that's not
comfortable for your unique body or if you just like to bring the shoulder a little further
up toward the ceiling, you can ask your client to raise this shoulder up toward the ceiling
just an inch or two and slip a towel under there.
Or any sort of slim bolster, I like a rolled up or folded up hand towel.
From here, you can use both hands.
And this is a nice way of lifting that shoulder up and then slowly coaxing it away from the
surrounding musculature.
We want these rhomboids and the trapezius and the serratus anterior and all these muscles
that are interconnected to form this web that keeps this scapula in place, we want them
to slowly give up their tone.
We don't want to try to pry this scapula away.
And even if you're not able to get completely under the shoulder blade like this, you can
still make progress toward that.
And here you can do some things like using your curled fingers to pull this shoulder
blade outwards, and you can still do that easy mobilization stuff but now you don't
have to be providing that upward lift.
Instead this hand can just be depressing that shoulder and then releasing to allow it to
go back up toward the ear.
The third way is probably what you learned in massage school.
And that's to lift this arm up, place the wrist in the small of the back and allow this
elbow to drop.
You'll notice, of the three ways that I've shown so far, this has produced the most dramatic
lifting of this medial border of the scapula.
It can indeed make it easiest to work under it.
What I don't like about this is that it tends to require the client to engage some of their
shoulder muscles to keep this hand in place and there are some ways around that.
You can put a bolster right here, you can apply some pressure using your own body.
But I find that this tends to break the flow and sometimes it's a little extreme.
For some clients this will be a little too sharp, a little too intense because these
muscles medial to the scapula are getting a bit more of a stretch than they usually
get, which isn't in itself bad, just that when you apply pressure as well, that can
be a bit intense.
Now I do like this third technique in the side lying position.
So Sam, go ahead and bring this left arm, take this wrist and put it behind your back
and let this shoulder be loosey goosey.
And so now she's not having to use her muscles to keep this arm in place.
And the weight of her own shoulder is going to be helping me get under this shoulder blade.
I'm not going to be able to get as much movement out of this scapula as in some other positions
but this is going to be a new sensation for this shoulder blade and for this shoulder,
because the arm is in this internally rotated position.
And keep in mind that you can use this hand cupped around the acromioclavicular joint
in order to mobilize this entire shoulder girdle.
And you can do some work from the other side of the table using curled fingers and do some
more specific work with this medial border of the scapula.
The fourth way is while the client is supine.
I'm going to walk my way under her shoulder.
To do that, I'm going to alternate hands, one hand is going to allow some space for
the other, it'll walk in allowing space for the other and again, I'm using my knuckles
as a point of leverage.
I'm not having to use my biceps or really any muscular effort in order to create this
shape.
And then crowbar that shoulder up.
Walking under the shoulder like this is a good way of accessing that infraspinatus.
I'm just doing some gentle circles here with my fingertips.
And you can walk even further until you are medial to that scapula.
At this point, I am curling my fingers and I can pull toward myself.
That allows me to get quite a ways under that scapula, and I can do some gentle mobilizations
here just by doing small circles.
And I can slowly crawl my way out.
And once again, my fingers look like this.
I was hooking toward myself and pulling.
It's good to have short fingernails for this.
Let's talk about why we want to work under the shoulder blades or to mobilize the shoulder
blades.
First let's talk about why we wouldn't want to.
I'm not doing this in order to stretch this tissue.
A lot of times people encounter a lot of tension here, a lot of pain and they think, if I could
just stretch this tissue out, it would feel better.
But if the issue is here, I'm thinking locally and acting globally.
I'm thinking of their rotator cuff, I'm thinking of their pecs and I'm thinking of these nearby
muscles as well the epicenter of the pain.
Think of all these muscles that are pulling this scapula forward and rolling those shoulders
forward and work with those as well as this painful area.
I'm not trying to stretch this out.
In fact I think that this area is often chronically overstretched because people are working in
front of themselves, they're curled inward.
Just keep those things in mind.
I'm also not trying to unstick this shoulder blade.
I don't think that this shoulder blade is stuck in place in a structural way.
This work may increase the blood supply to the tissues deep to the scapula, it may promote
the bursae that live under this scapula to become more hydrated, but all of these effects
are temporary and they will go away.
And you could achieve the same things by doing jumping jacks.
I don't think that we are ungluing this scapula.
So why do I want to mobilize this scapula?
Why do I want to lift it?
Because I think it provides some interesting novel stimulus that the client can't get anywhere
else.
So by lifting this and by applying this stretch outwards and by mobilizing it medially and
superiorly and inferiorly, this is the only time some of these stretch receptors in this
local connective tissue and the local fascia are going to be getting any of this interesting
information.
That's us talking to the spinal reflexes, but we're also talking to the brain.
We're talking to the human.
Where else can people learn so much about their own body than through contact?
There are a lot of people who don't know what their shoulder blade is and what it does,
and we can describe it to them non-verbally.
We can let them know that it has this medial border, that it has this lateral border.
And that it can float independently of the ribcage.
And that everything that it does affects the rest of the shoulder and even down into the
arm.
Think of this as a mindfulness exercise for your client.
You're telling them the story of this part of their body.
And that goes for everything else.
We are making them mindful of how their neck connects to this upper back.
How their neck connects to their pecs.
How their pecs connect to their shoulders.
How this low back connects to the hips.
By doing these interesting mobilizations, by interacting with these tissues in new ways,
we're informing the client about their own body.
Now what about clients who aren't this mobile?
Who it's very difficult to lift their scapula up from their back?
My advice is to think about 10 sessions rather than one session.
To introduce them to this medial scapula slowly and gently.
Their first session, second session, third session and as you're doing this you can try
these different techniques to try to get that shoulder blade to pop up just a little bit.
But for many people this scapula is enmeshed in a net of very tight muscle and one session
isn't going to be enough to get this to mobilize.
For clients like this, just think of introducing mobilization.
And that might just mean getting this scapula to glide along the ribcage.
Rather than lifting it, rather than pulling it in this direction or pushing it in this
direction, just introducing this circular movement.
Introducing moves that bring the scapula up toward the ear and that bring the shoulder
down into depression.
And communication.
Some clients will have this scapula in a vise grip and not even know it, and it might be
within their power to let go of some of that tension.
You can say that like, "Sam, go ahead and let this shoulder be loose, just let it flop
around."
Sometimes just a little bit of communication like that can be enough to get this scapula
to move.
As well as non-verbal communication like introducing a little bit of jostling.
Even if this doesn't allow you to scoop this scapula in the first session, maybe after
three sessions of that gentle mobilization, of that gentle communication, you'll eventually
be able to slide right under that scapula.
But if your client's shoulder blade won't come up at all, if you're just able to introduce
that movement and that's all you're still able to do in 10 sessions, I say don't count
that as a failure.
People are made differently.
People carry their shoulders differently based on how they live their lives and even how
their body is built, how they're put together.
Even if you're not able to do a lot of mobilization here, just that little bit that you are able
to do is going to be significant.
It's going to be more than they usually get out of that shoulder blade movement.
Alright y'all, if you have any tips of your own, if you have any ways of working with
those stubborn scapulae and make them a little more mobile, please let me know about it in
the comments.
Consider subscribing and I'll see you next time.
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