To complement “Make Space in Your Body: Quick Self Fixes Improve Function” in the September 2015 issue of MASSAGE Magazine. Summary: Teaching clients how to employ Quick Self Fixes can help reduce pain, improve range of motion and strengthen muscles between sessions.
My client reports a nagging, intermittent discomfort in the front of his shoulder. It is aggravated by sleeping on his side, sitting in his favorite lounge chair and performing certain arm movements. He still has full use of the arm, but he is favoring it and avoiding positions that involve external rotation of the shoulder.
My plan is to use Targeted Muscle Testing to assess which tissue layer or structure is the most likely cause of the problem. (Read “Targeted Muscle Testing: A Kinesthetic Approach to Address Muscle Weakness” in the December 2014 print issue of MASSAGE Magazine.)
Once the area is assessed, I will teach the client appropriate Quick Self Fixes, a series of self-treatment options, to enable him to continue addressing the problem if it recurs. (Five Quick Self Fixes for the shoulder are available in the September 2015 issue of MASSAGE Magazine; also see this Biceps Tendon Fix. Video of Quick Self Fixes and the associated Targeted Muscle Tests is available at quickselffixes.com.)
Pinpoint the problem area
First, I ask my client to point to the problem area. He pinpoints a small area just inferior and lateral to the acromium process of the scapula. Immediately, the long-head bicipital tendon is my number-one suspect, followed in descending order by pectoralis minor, pectoralis major, coracobrachialis and subclavius, with additional possible inputs from deltoid, supraspinatus, trapezius and latissimus dorsi.
Use Targeted Muscle Testing
My next step is to muscle test my hypothesis. I perform a light palpation over the skin tone of the area, feeling for areas of tautness or mushiness. Tautness is what massage therapists are trained to search for, but feeling for mushiness yields the best starting point in Targeted Muscle Testing.
I start with the Targeted Muscle Test for the biceps tendon, lining up the start position to the exact spot where the skin over the tendon feels softest. It tests quite weak and a little sore. To determine the boundary of the weakness, I box in the area by lightly testing the arm in a few different degrees of lateral and medial movement. It tests strong within only a few degrees of movement to either side. This data point fits well into the intermittent nature of the discomfort.
To further confirm the extent of the problem area, I test the rest of the muscles on my suspect list. Pectoralis minor and subclavius test slightly weak; but coracobrachialis, anterior deltoid and the clavicular division of pectoralis major all test strong.
I decide to test the costal division of pectoralis major because it moves similarly to pectoralis minor when the arm is raised, but it tests strong. I move to the agonists mentioned at the end my suspect muscle list. They all test strong with no pain, except for the subscapularis test position, which is painful. If a test position is painful, I don’t continue the test; Targeted Muscle Testing is designed to not cause pain.
Explain what’s wrong
This initial assessment takes me less than five minutes to perform, including explaining to the client how the testing gives me information. At this point, I’ve learned that the problem is confined to one small area of the bicipital tendon, with additional input from pectoralis minor and subclavius. It occurs only when the tendon that lies between the acromium and humeral head is compromised during external humeral rotation. I don’t believe there is significant tearing, so this issue falls into my scope of practice.
Teach Quick Self Fixes
Now I’m ready to move onto the treatment plan: Quick Self Fixes. I demonstrate how to do the Biceps Fix, which targets the weak bicipital tendon. The concept is simple: The client pins the biceps tendon just below the humeral head, then actively flips the same arm out and behind the body, moving the shoulder into external rotation and using the latissimus to lower the scapula.
This simple pin-and-stretch movement can often strengthen more than just the biceps tendon. It is a new movement for most clients, so I watch my clients perform it, teaching them any positional changes that might be needed. For example, some prefer a three-fingered pin instead of the thumb, and some might benefit from flipping the arm higher or lower than standard.
Many of the Quick Self Fixes that are based in pin-and-stretch movement can be subtly varied to suit individual bodies. Often, I’ll need to perform the pin on the client’s arm and guide the flip so that the right placement and level of pressure needed can be learned.
For my client with the shoulder discomfort, I also taught a second Quick Self Fix designed to safely open up the acromial-clavicular joint and strengthen the other weak muscles I found. Then I retested and found that biceps brachii, pectoralis minor and subclavius all tested strong. More importantly, the client reported that his discomfort faded almost immediately, and he could move his arm with renewed confidence.
Clients practice at home
Between massage appointments, some discomfort might return—but now my client has a way of handling the problem immediately, which might also help prevent the problem from worsening. Quick Self Fixes are ways of empowering clients to participate in their own healing and help them get their daily tasks done with less discomfort.
In this particular case, the client did not come in for help until after the biceps tendon had developed what I believe to be a small case of tendinosis. The Quick Self Fixes were a useful stopgap measure, but not a full cure. I believe the Quick Self Fixes were useful in realigning the acromial joint connections and reactivating the weakened muscles, but since tendinosis is a degeneration of collagen in the tendon, stretching wasn’t sufficient for full healing.
The Quick Self Fix was still useful for this client. It enabled and empowered him to work the problem as needed, albeit temporarily, and possibly stopped the condition from getting worse.
Also, Quick Self Fixes made exercising the area safer. Finally, using the reverse motion of the Biceps Fix, I designed a resistance-band exercise to safely put a light rotational load on the bicipital tendon at exactly the right angle to encourage his body to build up tendon strength in the targeted area. My motivated client reports far fewer problems using this combined approach.
Barbara Sharp, L.M.T., is co-author of Cassius Camden Clay, D.C.’s Targeted Muscle Testing and Quick Self Fixes curriculum, which is National Certification Board for Therapeutic Massage & Bodywork certified for continuing education credits; classes are available in the Atlanta, Georgia, area. She wrote “Make Space in Your Body: Quick Self Fixes Improve Function” for MASSAGE Magazine’s September 2015 issue.