ACTIVE ISOLATED STRETCHING - AMTA Massage · PDF fileACTIVE ISOLATED STRETCHING . for the...

ACTIVE

ISOLATED

STRETCHING

for the Shoulder

with Joshua Morton, LMP, MAISS, MMLT

Principles of AIS

• Identify – Identify the tissues to be stretched.

• Isolate – Isolate the tissue to be stretched by using precise movements and body

positioning.

• Innervation – Activate reciprocal innervation using active muscular contraction.

• Inhibition – Activate reciprocal inhibition with active muscular contraction.

• Intensify – Intensify the stretch with gentle assistance using a rope or your

hands. Breathing - Exhale during the stretching phase of the movement and inhale during the returning phase. Full, deep breaths deliver more oxygen to the blood. Oxygenated blood in turn has access to newly opened tissues that have been deprived of oxygen due to fascial restrictions. Stretch Reflex - The stretch reflex is an automatic mechanism in your muscles that protects your body against harmful stretches. When a muscle is stretched too far, too quickly or for too long, the stretch reflex contracts the muscle to avoid being overstretched. A muscle is stretched TOO FAR when it goes beyond its tensile strength and flexibility at a given moment. A muscle is stretched TOO QUICKLY when the joint cannot adjust quickly to rapid, bouncing movements. A muscle is stretched TOO LONG when the stretch is sustained for more than 2 seconds. After 2 seconds of sustaining a stretch, the stretch reflex engages and the muscle contracts eccentrically, which means it is stretching and contracting at the same time. Observing and respecting the stretch reflex is what truly sets AIS apart from every other stretching modality and system. Reciprocal Inhibition - Reciprocal inhibition is a neurological action that occurs during muscular contraction. Here is how it works: When one muscle contracts, the opposite one receives a neurological signal to relax (to be inhibited) so that movement can occur. Reciprocal Innervation - Reciprocal innervation is similar to reciprocal inhibition but it affects the muscle that is moving the joint by sending it neurological signals to contract so that movement can occur.

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Numerous Repetitions - This is very important. Tissues that are chronically tight and/or have specific physical limitations require many repetitions and sets to achieve substantial change. If one side is particularly tight compared to the other side, it may take as much as five times more effort to create balance. Check in with yourself and/or your client regularly to be sure you are not pushing too far. Give the tight tissues a break and move on to other stretches so that you can revisit the tighter areas again. You will achieve greater endurance and better results. The same is true for strengthening exercises. Remember: Gain is NOT achieved through pain.

Key Points for Success with Active Isolated Stretching

BE ACTIVE – This work is always most effective when you are working with the client not for the client. BE PRECISE – Exactness can be the difference between fully releasing the tissue or not. BE GENTLE – It is always better to “err” on the side of caution than to push hard into tight tissues. Pulling too hard with the rope or being too forceful with your assist will lead to injured tissues, leaving your client sore following treatment, rather than free and stable. Especially tight tissues should be handled with very light pressure and exactness. BREATHING – The ideal breathing pattern is to breathe out on the stretch and in on the return. Remember: “Exhale on the Effort.” It is often helpful for the therapist to breathe as well; this will act as a gentle reminder to both the therapist and client to take regular full breathes. CONTINUOUS ARC – The assist, whether from the practitioner or the rope, should always follow the arc of the stretch. TRACTION – Whenever possible add gentle traction to the stretch. It creates space in the joint, soothes the nervous system and creates the most complete stretch. STRAP USAGE – The strap is the ASSIST not the ACTION! Keep the stretch active; don’t be passive, whether you are stretching yourself or being given assistance from a practitioner. BODY MECHANICS – Check your body position as well as the client's often throughout each stretch. Do not hurt yourself with poor body mechanics. Remember, you should be at ease with your client. CUEING – Remember to use both verbal and physical cueing.

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POSITIONING – Your client should be in as anatomically neutral a position as is comfortable. Your client’s breast bone should be up, shoulders should be back and their abdominal muscles should be contracting with each repetition. This is to stop their torso from rotating and/or bending, their lumbar spine from hyper extending, and their thoracic spine from flexing. To reduce the tendency to contract their cervical muscles while exercising the shoulder muscles, have your client tuck their chin towards their chest. These rules apply for both stretching and strengthening exercises. STRETCHING TISSUE THAT CROSSES MULTIPLE JOINTS – When working with tissue that crosses multiple joints it is very important to be certain each joint is fully extended, flexed, or rotated, to ensure the stretch targets the full length of the tissue. It can be preferable to allow some element of compensation in order to achieve this if your client is very tight or fatigued. For example: When stretching the Right ITB it is preferable to use one hand to guide the leg, the other to hold the knee in a locked position and let the non-exercising leg go. This is needed if your client is unable to perform the stretch due to pain, weakness, paralysis, neurological or orthopedic complications.

For more information on Active Isolated Stretching: www.aisnorthwest.com

Joshua Morton can be reached at:

206-992-4029 OR

[email protected]

Login and Password for student page

stais iugSHU73

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mailto:[email protected]

Client: Locks their R elbow, keeps their arm against their ribs, and extends their R shoulder, reaching backwards up and away from their body at a 45 degree angle. Practitioner: Give gentle assistance at the end of the movement.

Client: Sitting with their arms resting at their side, R palm facing forward. Practitioner: Stand behind your client, to the inside of their R arm. Place your L hand is on their R scapula. Grasp their humerus with your R hand, just below their elbow.

Repetitions: Two Sets of 8-10

Shoulder Extension 1 & 2 - Oblique w/Abduction; Seated

Emphasized Muscles - medial belly of biceps and coracobrachialis

Precaution: If your client has hyperextension of their elbow, place your hands evenly over their elbow covering equally above and below the joint. Precaution: Be sure your client rotates their thumb medially (towards the body) to position their shoulder. It is possible to dislocate the humerus if you turn the palm laterally (away from the body) and then extend. Traction: To create traction, gently pull down and out at your client’s wrist or elbow if they suffer from hyperextension.

#2 - REPEAT the above sequence with the palm facing backwards.

COMMON COMPENSATIONS: Watch for your client extending their head, arching their back, rotating their shoulder, flexing and/or rotating their torso.

# 1 Advanced Movement: (Front Arm Line) As your client’s flexibility improves have your client extend their wrist and fingers first at the beginning of the movement and then at the end of the movement. # 2 Advanced Movement: (Back Arm Line) As your client’s flexibility improves have your client make a soft fist and flex their wrist first at the beginning of the movement and then at the end of the movement.

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Client: Locks their R elbow, keeps their arm against their ribs, and extends their R shoulder, reaching backwards and up. Practitioner: Give gentle assistance at the end of the movement.

Client: Sitting with their arms resting at their side, R palm facing their body. Practitioner: Stand behind your client, to the inside of their R arm. Place your L hand is on their R scapula. Grasp their humerus with your R hand, just below their elbow.


Shoulder Extension 3 & 4 - Single Arm, Seated Emphasized Muscles - proximal tissues of biceps

Precaution: If your client has hyperextension of their elbow, place your hands evenly over their elbow covering equally above and below the joint.

Technique Tip: Your L hand acts to stabilize the scapula and to prevent shoulder rotation. Traction: To create traction, gently pull down and out at your client’s wrist or elbow if they suffer from hyperextension.

Key Point for Success: Do not push into your client with your L hand. If you do you will notice them pushing back into you.

COMMON COMPENSATIONS: Watch for your client extending their head, arching their back, rotating their shoulder, flexing and/or rotating their torso.

Advanced Movement: (Front Arm Line) As your client’s flexibility improves have your client tuck their thumb into a soft fist and add ulnar deviation at the end of the movement.

Mr. Stretchy says: Biceps are often a forgotten muscle of internally rotated postures. Getting these tissues opened up can make the difference between success and failure in changing posture!

#4 - REPEAT the above sequence with their palm facing away from their body.

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Client: Locks their R elbow, keeps their arm against their ribs, and extends their R shoulder, reaching towards their spine at a 45 degree angle. Practitioner: Give gentle assistance at the end of the movement.

Client: Sitting with their arms at their side, R palm facing forward. Practitioner: Stand behind your client, to the inside of their R arm. Place your L hand on their R scapula OR hold back their L shoulder. Grasp their humerus with your R hand, just below their elbow.


Shoulder Extension 5 & 6 - Oblique w/Adduction; Seated

Emphasized Muscles - lateral belly and proximal tissues of biceps and coracobrachialis

Precaution: If your client has hyperextension of their elbow, place your hands evenly over their elbow covering equally above and below the joint. Precaution: Be sure your client rotates their thumb medially (towards the body) to get into position. It is possible to dislocate the humerus if you turn the palm laterally (away for the body) and then extend obliquely, away from the body. Traction: To create traction, gently pull down and out at your client’s wrist or elbow if they suffer from hyperextension.

#6 - REPEAT the above sequence with their palm facing backwards.

Technique Tip: Place your L hand on your client’s L shoulder if they have trouble keeping their torso from rotating.

Mr. Stretchy says: Be sure to hold on to your client’s humerus to help them keep their elbow locked.

Point of Information: These stretches are especially effective in alleviating pain at the coracoid process.

COMMON COMPENSATIONS: Watch for your client extending their head, arching their back, rotating their shoulder, flexing, laterally flexing and/or rotating their torso.

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Client: Locks their elbows, keeps their arms against their ribs, and extends their shoulders, reaching backwards and up. Practitioner: As your client reaches back, place your hands on their humeri just above their elbow. Give gentle assistance at the end of the movement.

Client: Sitting with their arms resting at their sides and their palms facing towards their body. Practitioner: Stand behind your client, on the inside of their arms. Your hands are grasping their elbows, equally above and below the joint.

Mr. Stretchy says: Remember to judge your client’s R.O.M. by the angle of their arm in relationship to the tilt of their scapula, not to its position to their torso.


Shoulder Extension 7 & 8; Both Arms, Seated

Emphasized Muscles - proximal tissues of biceps

Precaution: If your client has hyperextension of their elbow, place your hands evenly over their elbows covering equally above and below the joint. Traction: To create traction, gently pull down and out at your client’s wrists or elbows if they suffer from hyperextension.

Point of Information: The biceps brachii is one of the most common muscles injured in the shoulder. Technique Tip: Don’t let your client “wing out” their arms as they reach their arms backward.

Advanced Movement: (Front Arm Line) As your client’s flexibility improves have your client tuck their thumbs into soft fists and add ulnar deviation at the end of the movement.

#8 - REPEAT the above sequence with the palm facing away from your body.

COMMON COMPENSATIONS: Watch for your client extending their head, arching their back, flexing their shoulders and/or rotating their shoulders.

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Shoulder Horizontal Abduction 1 & 2 - Seated Emphasized Muscles – 1 - linear fibers of pectoralis major,

2 – oblique fibers of pectoralis major

Client: Retracts their scapula and reaches backward with their R arm. Practitioner: Give gentle assistance at the end of the movement.

Client: Sitting with their arms at their side, have your client lift their shoulder to a 90 degree angle in a “thumbs up” position. Then have your client rest their arm behind the chair or stool to help stabilize their torso. Practitioner: Stand behind your client off to their R. Place your L hand on your client’s R scapula. Wrap your R hand around the inside of your client’s elbow. This will allow their forearm to rest in the “crook” of your elbow.

Mr. Stretchy says: Sometimes your client will feel this stretch in their biceps; have them bend their elbow to keep the stretch in their pecs. Traction: To create traction, gently pull out and up at your client’s elbow.


Key Point for Success: Be sure your client starts their movement with scapular retraction. Technique Tip: The Pec. Mj. is a flexor of the shoulder; be sure your client allows you to hold up the weight of their arm to avoid eccentric loading of the tissue you are stretching.

Alternate Position: Practitioner: Stand behind your client with your L ilium against their R scapula. Reach your L hand around to your client’s opposite shoulder to hold it in place. Use your R hand as above. This position is an excellent alternative for clients with neurological problems, severe weakness and/or shoulder injuries.

Advanced Movement: (Front Arm Line) As your client’s flexibility improves have your client add wrist extension first at the beginning and then at the end of the movement. This advanced movement is exceptional for relieving nerve entrapment.

#2 - REPEAT the above sequence with your client reaching their arm obliquely up and back at a 60 degree angle.

Point of Information: Complete treatment of the pectorals is a key part in treatment of postural and neurological disease affecting the arm. Technique Tip: Have your client turn their head to the L to help keep their torso from rotating into the stretch.

COMMON COMPENSATIONS: Watch for your client extending their head, arching their back, rotating their torso and/or shoulder.

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Shoulder Horizontal Abduction 3 & 4; w/Spinal Extension; Seated

Emphasized Muscles – 3 - sternal attachments of pectoralis major 4 - costal attachments of pectoralis major

Client: Retracts their scapula and reaches backward with their R arm. As they reach backward, have them extend their spine into your thigh. Practitioner: As your client reaches their arm backwards, extend your back to allow room for their spinal extension. Give gentle assistance at the end of the movement.

Client: Sitting with their arms at their side, have your client lift their shoulder to a 90 degree angle in a “thumbs up” position. Practitioner: Stand behind your client, turned partly to the R. Wrap your R hand around the inside of your client’s R elbow. This will allow their forearm to rest in the “crook” of your elbow. Reach your L hand around to your client’s opposite shoulder to hold it in place. Place your L thigh firmly against your client’s spine.


Advanced Movement: (Front Arm Line) As your client’s flexibility improves have your client add wrist extension first at the beginning and then at the end of the movement.

#4 - REPEAT the above sequence with your client reaching their arm obliquely up and back at a 60 degree angle.


Point of Information: Excellent exercise to aid rehabilitation following open-heart surgery. Traction: To create traction, gently pull out and up at your client’s elbows.

COMMON COMPENSATIONS: Watch for your client flexing their neck and/or rotating shoulder.

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Shoulder Horizontal Abduction 5 – “Thumbs Down”; Seated

Emphasized Muscles - clavicular fibers of pectoralis major and subclavius

Key Point for Success: Be sure your client starts their movement with scapular retraction. Key Point for Success: Be sure to keep your client’s thumb in a downward position with your assisting hand. Technique Tip: The Pec. Mj. is a flexor of the shoulder; be sure your client allows you to hold up the weight of their arm to avoid eccentric loading of the tissue you are stretching. Technique Tip: Have your client turn their head to the L to help keep their torso from rotating into the stretch.

Client: Retracts their scapula and reaches backward with their R arm. Practitioner: As your client extends their shoulder, gently grasp their wrist. Give gentle assistance at the end of the movement.

Client: Sitting with their arms at their side, have your client lift their shoulder to a 90 degree angle in a “thumbs down” position. Then have your client rest their arm behind the chair or stool to help stabilize their torso. Practitioner: Stand behind your client off to their R. Place your L hand on your client’s R scapula. Grasp your client’s wrist with your R hand as they abduct and extend their humerus.


Point of Information: This stretch is part of the treatment for anterior shoulder impingement. Traction: To create traction, gently pull out at your client’s wrist.

COMMON COMPENSATIONS: Watch for your client extending their head, arching their back, rotating their torso and/or shoulder.

Precaution: Keep your client’s shoulder at less than a 90 degree angle. Due to the movement of the humerus and the scapula irritation of the joint capsule can occur due to the humerus butting into the acromion.

Advanced Movement: (Back Arm Line) As your client’s flexibility improves have your client make a soft fist and flex their wrist at the beginning and at the end of the movement.

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Shoulder Horizontal Abduction 6 & 7; Both Arms; Seated

Emphasized Muscles – 6 - linear fibers of pectoralis major, 7 – oblique fibers of pectoralis major


Client: Lifts their arms to a 90 degree angle in a “thumbs up” position. Then have your client reach backward with both arms. Practitioner: As your client reaches backward, reach both hands around the front of their humeri, just above their elbows. Give gentle assistance at the end of the movement.

Client: Sitting with their arms resting at their sides. Practitioner: Stand behind your client.


Advanced Movement: (Front Arm Line) As your client’s flexibility improves have your client add wrist extension at the beginning and at the end of the movement. Traction: To create traction, gently pull out at your client’s elbows.

#7 - REPEAT the above sequence with your client reaching their arms obliquely up and back at a 60 degree angle.

COMMON COMPENSATIONS: Watch for your client extending their head, flexing their torso forward and arching their back.

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Key Point for Success: Be sure your client starts their movement with scapular retraction. Key Point for Success: Be sure to keep your client’s thumb in a downward position with your assisting hand. Technique Tip: The Pec. Mj. is a flexor of the shoulder; be sure your client allows you to hold up the weight of their arm to avoid eccentric loading of the tissue you are stretching.

Client: Lifts their arms to a 90 degree angle in a “thumbs down” position. Then have your client reach backward with both arms. Practitioner: As your client reaches back, gently grasp their wrist. Give gentle assistance at the end of the movement.

Client: Sitting with their arms resting at their sides. Practitioner: Stand behind your client.


Shoulder Horizontal Abduction 8 - “Thumbs Down”; Both Arms; Seated

Emphasized Muscles - subclavius and the clavicular attachments of pectoralis major

COMMON COMPENSATIONS: Watch for your client extending their head, arching their back, flexing their torso forward and rotating their shoulder.

Mr. Stretchy says: Remember to keep your client’s arms below a 90 degree angle!

Advanced Movement: (Back Arm Line) As your client’s flexibility improves have your client make soft fists and flex their wrists at the beginning and at the end of the movement. Traction: To create traction, gently pull out at your client’s wrists.

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Shoulder Horizontal Abduction 9 – Both Hands; Behind Neck, Seated

Emphasized Muscles - pectoralis minor

Key Point for Success: In order to access the pectoralis minor, you must create an upward traction in the shoulder. Traction: To create traction, gently pull out and up at your client’s elbows. Technique Tip: Be sure your client starts their movement with scapular retraction. Technique Tip: The Pec. Mj. is a flexor of the shoulder; be sure your client allows you to hold up the weight of their arm to avoid eccentric loading of the tissue you are stretching.

Client: Brings their elbows obliquely backwards at a 45 degree angle towards your head. Practitioner: Give gentle assistance at the end of the movement.

Client: Sitting with their hands clasped behind their neck. Practitioner: Stand slightly sideways and behind your client. Place your ilium against your client’s spine. Place your hands on the inside of your client’s humeri.


Point of Information: A tight pectoralis minor places pressure on the vessels and nerves that feed the arm and hands.

COMMON COMPENSATIONS: Watch for your client extending their head and arching their back. Mr. Stretchy says: Pushing the elbows

directly up towards the ceiling will result in impingement of the shoulder joint; be careful with your line of assist!

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Client: Rests their R elbow on your chest or L coracoid process. Next your client places their humerus in a position of 85 degrees of abduction, 85 degrees of horizontal abduction with their elbow open to 95 degrees of extension. Practitioner: Wrap your L hand around your client’s R shoulder from the back to the front. Be certain to wrap around far enough anteriorly to cover the joint capsule and into your client’s axilla. Your L forearm then “clamps” down over the posterior of the joint capsule of the shoulder and scapula. Place your R hand on the dorsal surface of your client’s wrist.

Client: Sitting with their arms at their side. Practitioner: Kneel to the R side of your client behind their arm and facing them.


Shoulder Internal Rotation 1 & 2 - Seated Emphasized Muscles - external rotators

Client: Keeps their elbow and wrist relaxed and then internally rotates their shoulder, bringing their palm down towards the floor. Practitioner: Give gentle assistance at the end of the movement.

Precaution: If your client has a past history of shoulder dislocation, observe great caution. If you cannot maintain shoulder stability using these practitioner directions, use Table Shoulder Internal Rotation. Key Point for Success: If you find it difficult to kneel, perform this stretch with both you and your client standing.

Point of Information: Clients who have suffered shoulder dislocation are often very apprehensive. Remember to be gentle and move slowly through the movement if needed. Point of Information for #2: This is an excellent stretch to open up the posterior of the joint capsule. Technique Tip: For both variations the stretch can be delivered with the arm straight. This can be especially useful when treating frozen shoulder.

COMMON COMPENSATIONS: Watch for your client flexing their torso, adducting and/or flexing their shoulder and flexing or extending their elbow.

#2 REPEAT the above sequence moving your client’s shoulder forward to 90 degrees.

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Client: Rests their R elbow on your chest or R coracoid process. Next, your client places their humerus in a position of 85 degrees of abduction, 85 degrees of horizontal abduction with their elbow open to 95 degrees of extension. Practitioner: Wrap your R hand around your client’s R shoulder, from the front to the back. Be certain to wrap around far enough posteriorly to cover the posterior of the joint capsule and into your client’s axilla. Your R forearm then “clamps” down over the anterior joint capsule. Place your R hand on the palmar surface of your client’s wrist.

Client: Sitting with their arms at their side. Practitioner: Kneel to the R side of your client behind their arm and facing them.


Alternate Position: This is a good position for those with fibromyalgia, adhesive capsulitis and shoulder replacements. Client: Keeps their elbow alongside their rib cage, with their elbow flexed to 90 degrees.

Client: Keeps their elbow and wrist relaxed then externally rotates their shoulder, bringing their palm up and back. Practitioner: Give gentle assistance at the end of the movement.

Precaution: If your client has a past history of shoulder dislocation, observe great caution. If you cannot maintain shoulder stability using these practitioner directions, use Table Shoulder External Rotation.

Shoulder External Rotation; Seated Emphasized Muscles - internal rotators

COMMON COMPENSATIONS: Watch for your client arching their back, adducting and/or flexing their shoulder and flexing or extending their elbow.

Point of Information: Clients who have suffered shoulder dislocation are often very apprehensive. Remember to be gentle and move slowly through the movement if needed. Key Point for Success: If you find it difficult to kneel, perform this stretch with both you and your client standing. Technique Tip: This stretch can be delivered with the arm straight. This can be especially useful when treating frozen shoulder.

Mr. Stretchy says: If your wrists are struggling with this one, you’ve got some work to do on yourself! Have a look at the self-stretches for your hands and wrists.

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Client: Keeps their elbow straight and flexes their shoulder up towards the ceiling. Practitioner: As your client flexes their shoulder, place your R hand on the posterior of their humerus, above the elbow. Give gentle assistance at the end of the movement.

Client: Sitting with their arms resting at their side, R palm facing forward. Practitioner: Stand off to the R side of your client. Place your L hand on your client’s acromion process.


REPEAT the above sequence turning your client’s palm #2 - towards the body, #3 - backwards and then #4 - away from the body.

Shoulder Flexion 1 - 4; Seated Emphasized Muscles – 1 - latissimus dorsi, 2 - subscapularis,

3 - teres major/infraspinatus, 4 – teres minor

Traction: To create traction, gently pull out and up at your client’s elbow. COMMON COMPENSATIONS: Watch for your client extending their neck, abducting their shoulder, arching their back and/or rotating their torso.

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Client: Flexes their R shoulder, extending through their elbow, lift their arm up towards the ceiling and to their opposite shoulder. Practitioner: As your client flexes their shoulder, maintain a gentle and firm pressure on your client’s wrist to maintain full flexion of their elbow. Give gentle assistance at the end of the movement.

Client: Sitting with their arms at their side, have your client flex their R elbow and rest their palm on their shoulder. Next, have your client abduct their humerus 45 degrees away from their body. Practitioner: Stand off to the R side of your client. Place your L palm flat on your client’s R wrist. Place your R hand on the back of your client’s elbow.


Shoulder Flexion w/Elbow Flexion 5 & 6 - Seated Emphasized Muscles - proximal and medial tissue of triceps

Strap Usage: With your R palm facing your humerus, grasp the strap in your R hand. Reach your L hand around your back and grasp the other end of the strap.

COMMON COMPENSATIONS: Watch for your client extending their head, arching their back, extending their neck and/or internally rotating their shoulder.

Mr. Stretchy says: Make sure your client knows the proper angle of assist for the strap - towards the opposite hip.

#5 Key Point for Success: Keep your client’s arm in a neutral position for best isolation. #6 Key Point for Success: Keep your client’s elbow close to their ear; their biceps should brush their cheek. Traction: To create traction, gently pull out and up at your client’s elbow.

#6 REPEAT the above sequence with your client’s elbow pointing straight ahead.

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Client: Turns their head to the L. Flexes their R shoulder, extending through their elbow, as they lift their arm up towards the ceiling. Practitioner: As your client flexes their shoulder, maintain a gentle and firm pressure on your client’s wrist to maintain full flexion of their elbow. Give gentle assistance at the end of the movement.

Client: Sitting with their arms at their side, have your client flex their R elbow and rest their palm on their shoulder. Next, have your client adduct their humerus 45 degrees across their body. Practitioner: Stand off to the R side of your client. Place your L palm flat on your client’s R wrist. Place your R hand on the back of your client’s elbow.

Mr. Stretchy says: Remember the radial nerve entrapment of the triceps? This is the stretch to take care of that!


Shoulder Flexion w/Elbow Flexion 7 - Obliquely In: Seated Emphasized Muscles – posterior joint capsule, proximal and lateral tissue of

triceps

Traction: To create traction, gently pull out and up at your client’s elbow. COMMON COMPENSATIONS: Watch for your client extending their head, arching their back, flexing their neck, abduction and rotating their shoulder.

Precaution: If your client complains of shoulder pain during this stretch, allow their shoulder to internally rotate enough to eliminate the pain. Precaution: If your client complains of bicipital pain, double check the position of their humerus; you may have it rotated externally too far. Key Point for Success: If your client experiences pain in their shoulder during this stretch, it is a likely sign of bicipital tendonitis. Technique Tip: Keep your client’s arm in a neutral position for best isolation.

Alternate Position: Practitioner: Stand behind your client, off to their L side with your R hip against their L shoulder blade. Hold your client’s R elbow against their chest with your L hand. Hold your client’s R wrist gently with your R hand.

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Client: Keeps their elbow straight and flexes their shoulder to 90 degrees, in a “thumbs up” position. Next, keeping their scapula down; have your client adduct their humerus, bringing their arm across their body to their opposite shoulder. Practitioner: As your client adducts their shoulder, reach your L hand around to their humerus, above the elbow. Give gentle assistance at the end of the movement.

Client: Sitting with their arms at their side and their R palm facing their body. Practitioner: Stand behind and to the L of your client. Place the palm of your R hand on your client’s acromion process.


Shoulder Horizontal Adduction 1 - 4; Seated Emphasized Muscles – 1 - infraspinatus, 2 – middle deltoid,

3 – supraspinatus, 4 – teres major Unstabilized – mid-trapezius, rhomboid major and minor

Precaution: If your client experiences pain in the bicep or pectoralis tissue, place your thumb between the tissue and their humerus as your client adducts. When their humerus comes into contact with your thumb, take your thumb away. If that does not eliminate the impingement, repeat horizontal abduction and shoulder extension stretches until the biceps and pectorals are released. Key Point for Success: To access the tissue of the rotator cuff and the posterior of the joint capsule, your client’s scapula must stay down and retracted. Key Point for Success: To access the rhomboids and trapezius tissues, allow your client’s scapula to move freely. Technique Tip: The Post. Deltoid and Supraspinatus are abductors of the shoulder; be sure your client allows you to hold up the weight of their arm to avoid eccentric loading of the tissue you are stretching. Mr. Stretchy says: Keep your client’s arm straight to fully access the fascial lines.

REPEAT the above sequence in the #2 “palm down”, #3 “palm away”, #4 “palm up” position.

COMMON COMPENSATIONS: Watch for your client flexing and/or rotating their torso and elevating their shoulder. Traction: To create traction, gently pull out at your client’s elbow.

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Client: Keeps their elbow straight and flexes their shoulder to 90 degrees, in a “thumbs up” position and turns their head to the L. Next, keeping their scapula retracted, have your client reach their arm across their body. When they have come across their body as far as they can, have them direct the movement straight up. Practitioner: As your client adducts their shoulder, reach your L hand around to their humerus, above the elbow. Give gentle assistance at the end of the movement.

Client: Sitting with their arms at their side and their R palm facing their body. Practitioner - Stand behind and to the L of your client. Place the palm of your R hand on your client’s acromion process.


Shoulder Horizontal Adduction 5 – Obliquely Up; Seated Emphasized Muscles – infraspinatus

Precaution: If your client experiences pain in the bicep or pectoralis tissue, place your thumb between the tissue and their humerus as your client adducts. When their humerus comes into contact with your thumb, take your thumb away. If that does not eliminate the impingement, repeat horizontal abduction and shoulder extension stretches until the bicep and pectoralis are released. Key Point for Success: To access the tissue of the rotator cuff and the posterior of the joint capsule, your client’s scapula must stay down and retracted. Key Point for Success: To access the rhomboids and middle trapezius tissues, allow your client’s scapula to move freely. Traction: To create traction, gently pull out and up at your client’s wrist.

Mr. Stretchy says: Keep your client’s arm straight to fully access the fascial lines.

COMMON COMPENSATIONS: Watch for your client flexing and/or rotating their torso and elevating their shoulder.

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Client: Keeps their elbow straight and flexes their shoulder to 90 degrees, in a “thumbs down” position. Next, keeping their scapula retracted, your client reaches their arm across their body. When they have come across their body as far as they can, have them direct the movement straight down. Practitioner: As your client adducts their shoulder, reach your L hand around to their humerus, above the elbow and add traction as your client moves down towards their L knee. Give gentle assistance at the end of the movement.

Client: Sitting with their arms at their side and their R palm facing away from their body. Practitioner - Stand behind and to the L of your client. Place the palm of your R hand on your client’s acromion process.


Shoulder Horizontal Adduction 6 – Obliquely Down; Seated Emphasized Muscles – supraspinatus and posterior deltoid

Precaution: If your client experiences pain in the bicep or pectoralis tissue, place your thumb between the tissue and their humerus as your client adducts. When their humerus comes into contact with your thumb, take your thumb away. If that does not eliminate the impingement, repeat horizontal abduction and shoulder extension stretches until the bicep and pectoralis are released. Key Point for Success: To access the tissue of the rotator cuff and the posterior of the joint capsule, the scapula must stay down and adducted. Key Point for Success: To access the rhomboids and middle trapezius tissues, allow your client’s scapula to move freely.

Traction: To create traction, gently pull out and down on your client’s elbow. Mr. Stretchy says: Traction is the key to success with these stretches. Be sure to pull from your client’s elbow to get the best results! COMMON COMPENSATIONS: Watch for your client flexing and/or rotating their torso and elevating their shoulder.

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Client: Keeps their elbow straight and their scapula down as they abduct their humerus. Practitioner: As your client abducts their shoulder, place your R hand on their humerus, above their elbow. Give gentle assistance at the end of the movement.

Client: Sitting with their arms at their side and their R palm facing forward. Practitioner: Stand behind, to the R side of your client. Place your L hand on their acromion process.


Shoulder Abduction 1 & 2; Seated Emphasized Muscles – 1 - latissimus dorsi, 2 - teres major

Precaution: If your client has a shoulder impingement, move very gently through this movement, especially in the “thumbs” down” position as the joint space is already compromised. Key Point for Success: Be careful not to place your stabilizing hand on the scapula in the way of humeral movement Traction: To create traction, gently pull out and up at your client’s wrist. Mr. Stretchy says: Keep your client’s arm straight to fully access the fascial lines.

#2 - REPEAT the above sequence with the palm facing backward.

COMMON COMPENSATIONS: Watch for your client flexing their torso, laterally flexing their spine and rotating their shoulder.

#2 Advanced Movement: (Front Arm Line) As your client’s flexibility improves, have your client tuck their thumb into a soft fist and add ulnar deviation at the end of the movement.

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Client: Keeps their humerus against their ribs and bends their elbow. Practitioner: Keep your client’s humerus against their ribs with your thigh. Hold the client’s R wrist with your L hand.

Client: Sitting with their L hand holding the ends of the strap and their R hand grasping the loop of the strap, palm facing backward. Practitioner: Stand behind and facing your client off to their R side. Place your R hand on your client’s R shoulder. Place your R thigh against your client’s R arm.

Point of Information: Clients who have suffered shoulder dislocations are often very apprehensive. Remember to be gentle and move slowly through the movement if needed.


Posterior Hand Clasp

Emphasized Muscles – anterior joint capsule, coracobrachialis, coracoid attachment of biceps brachii

Client: Reaches their fingers up towards C-7. Practitioner: Give a gentle assist at the end of the movement.

Precaution: This is often very tight and sensitive tissue. It requires a very soft touch. Precaution: If your client has a past history of shoulder dislocations, observe great caution. Place your R palm over their anterior of the joint capsule to maintain joint stability. Traction: To create traction, gently push your thigh into your client’s humerus.

Advanced Movement: As your client’s flexibility improves, reach your R hand behind their head to hold back their L shoulder

Strap Usage: Hold both ends of the strap in your L hand and throw the loop of your strap over your L shoulder and grasp it in your R hand.

COMMON COMPENSATIONS: Watch for your client arching their back, rotating their torso, internally rotating and/or abducting their shoulder.

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ACTIVE ISOLATED STRETCHING - AMTA Massage · PDF fileACTIVE ISOLATED STRETCHING . for the...

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