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chapter

Dimensional Massage Techniques

for the Shoulder Girdle Muscles
LEARNING OUTCOMES
After completing this chapter, you should be able to:
5-1

Dene key terms.

5-2

List goals of individual techniques.

5-3

Describe deep-tissue therapy.

5-4

Give examples of some general principles of

body mechanics.

5-5

Practice safe body mechanics.

5-6

Demonstrate specic techniques on shoulder

girdle muscles.

Body mechanics

KEY
TERMS

Compression

Deep transverse
friction

Cross-ber friction

Dimensional massage
therapy

Deep-tissue therapy

Elliptical movement

Introduction
Although nothing can replace the kinesthetic quality
of touch, it is important to learn about the body, its
structure, and its functional foundation. The more
knowledge a student retains about how the muscles
work, where they are located, and how they are attached, the more she will be able to demonstrate critical thinking in a therapeutic setting. For the student,
there are two very signicant principles of motion:
Aggregate muscle action: Muscles work in
groups and in paired opposition.

5-7

Incorporate dimensional massage therapy

techniques in a regular routine or use them
when needed.

5-8

Identify two underlying principles for the

theory of dimensional massage.

5-9

Determine safe treatment protocols and refer

clients to other health professionals when
necessary.

Functional unit

Parallel thumbs

Technique goals

Ischemic compression

Sequence

Treatment protocol

Jostling

Splinting

Trigger point release

Myofascial stretches

Stripping

Trigger points

Law of reaction: For every action there is an

opposite and equal reaction.
As discussed in Chapter 2, muscles perform specic roles in relation to the typical diarthrodial
joint. Agonists and antagonists are both prime
movers, but they oppose each other and are usually
located on opposite sides of the joint; synergists assist; stabilizers protect the joint in movement and
allow other muscles to function; and neutralizers
resist actions or act as brakes to stop motion. All
of these actors practice as the muscles pull on the
bones to move the joints. Range of motion, or the

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joints ability to function within its complete range,

is dependent on the functional unit: muscles cooperating to work in groups and in paired opposition. A practitioner cannot ignore the work that the
synergists perform or contribute to a joints range
of motion or to the stabilizers protecting the joint.
When a muscle is injured, the remaining areas of
the functional unit have to compensate for the less
than normally functioning actor. It does not take
long for the whole joint to debilitate. Treating the
whole joint and all the muscles involved in the
functional unit is a dimensional approach.
As the manual therapist works to unwind the
soft tissue in an area of the body, she needs to be
aware of which actions a client performed to overload the muscles, which joints are involved, and
how the joints and muscles are dependent on each

Treatment Protocol
This book assumes that the student has learned how
to perform an appropriate intake, including a medical history, client interview, and appropriate SOAP
notes, and has had practice observing posture, gait,
and the exploration of range of motion of joints. The
treatment protocol below is a synopsis of an overall
approach to a massage session.

Technique Goals and the Mystery

of Deep-Tissue Therapy
Technique goals are the outcomes expected from
choosing techniques for a particular purpose; because
each person is unique, treatment goals should be based

101

other for movement and stability. A practitioner always works on the muscles that operate together
to provide the action and makes sure that the opposing muscles were not shortened or lengthened
in the process of whatever repetitive action or injury took place. The shoulder girdle and shoulder
joint are so dependent on one another that if a softtissue problem of the shoulder joint muscles exists,
the shoulder girdle muscles are apt to be very tight,
even splinting the problem in the shoulder joint.
Splinting is a supportive action that a muscle or
muscles may perform so that another joint and
group of muscles can function appropriately. The
splinting muscle may contract isometrically or
dynamically. To treat all the offending soft-tissue
structures, a therapist must explore the entire kinetic chain right up to the head, neck, and trunk.

on the clients individual needs. A therapists goals are

to lengthen, separate, lift, and broaden bers to release
hypertonicities, increase range of motion, reduce pain
and/or discomfort, increase circulation, and help relieve any joint restrictions. This book assumes that the
student has practiced Swedish techniques (also called
classical Western), such as efeurage, petrissage, friction, tapotement, vibration, and nerve strokes and that
they require no further denition. Prociency comes
with practice; however, for a review of Swedish technique denitions, refer to the Glossary.
Deep-tissue therapy is simply a series of specic
techniques designed to unwind the soft tissue in a particular pattern or sequence with an end result that includes meeting specic goals. Deep does not necessarily
mean a lot of pressure; rather, it means more appropriate pressure that is determined by palpation and the

TREATMENT PROTOCOL

Take the clients medical history, interview the client, and

record SOAP notes.
Observe postural assessment, gait, and the range of motion
of joints.

Use dual-hand distraction methods when possible.

Work individual muscles, their attachments, synergists,
stabilizers, and antagonists; study the functional unit.
Do not overwork areas.

Perform palpation.

Do trigger point work last on passively shortened muscles.

Passively shorten muscles and/or position shoulders and

scapula whenever possible.

Stretch tissue and joints as appropriate.

Work supercial to deep.

Discuss additional massage sessions and suggested selfhelp measures.

Release hypertonic muscles.

Refer to other health professionals when necessary.

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102 part 2 Upper Extremities

clients need. Using deep-tissue techniques means that
the practitioner is not randomly using a sequence but is,
instead, critically thinking about a specic result. Compressive efeurage is an example of a valuable deeptissue technique. Deep-tissue techniques do not have to
be complicated; they are simply additional techniques
that could be part of every practitioners tool belt. Because each client is unique and has his own set of injuries, chronic and/or repetitive conditions, and specic
structure, the same set of techniques is not likely to
work on everyone. Practitioners need to practice with
a wide variety of techniques and modalities in order to
serve the tremendous variations they will inevitably nd
in their clients. The success of a practitioners session
depends on the critical use of her therapeutic skills.
Before beginning with the sequence itself, students
are encouraged to read the following denitions, as
well as Sequence later in the chapter, for more information on how to use the techniques in an orderly,
intelligent fashion.
Dimensional massage therapy is a philosophical
approach to therapy that is based on science, structure, and soft-tissue functions and that uses a variety
of techniques for the clients benet.

DEEP-TISSUE TECHNIQUES
Jostling rattles the bers back and forth and is a
form of vibration. Grasp the muscle loosely closest to the origin, apply a slight traction, and shake
toward the insertion. For a better grasp of the
tissues, do not use lubrication.
Compression efciently speeds circulation to the
area when executed correctly. This stroke can be
combined with petrissage to make a dual-hand
distraction technique. Press the muscle and soft
tissue straight down against the bone, attening
and spreading tissues repeatedly with the palm
and heel of the hand. Make sure that the surface
is not slippery when applying compression.
Stripping is a deep-tissue technique that lengthens
bers and empties or pushes uids. Place your
thumb or forenger of one or both hands at the
distal end of the muscle and then slowly and
deeply glide along the length of the muscle toward
the origin. Use a minimal amount of lubrication.
This technique should be used intelligently in the
order of a sequence.
Deep transverse friction, or cross-ber friction,
is useful at tendinous attachments for releasing
spasms and reducing adhesions; it can often be
substituted with digital circular friction. Apply the
technique against the bers at a right angle with the
ngers or thumb, using enough pressure to separate and atten the bers. Be careful, as the tech-

dai02079_ch05_100-114.indd 102

nique may be painful. Adjust pressure, and use the

technique appropriately in the order of a sequence.
(Note to students: This technique should be practiced only under the supervision of an instructor.)
Myofascial stretches are a series of techniques
designed to stretch and warm up the tissues. The
fascia is literally pulled off the structures in a
rhythmic pace. As the fascia warms, it becomes
more pliable, stretchy, and less stuck to the
underlying soft tissue. Myofascial stretches are
usually performed with little to no lubrication.
Elliptical movement is an alternating clockwise
and counterclockwise distraction movement
sometimes executed on joints such as the shoulder girdle and done most often while the therapist
is engaged with muscles. The two alternating
directions release any tension the client may be
holding onto; this is because the client cannot
focus on the direction of the movement and hold
the tension at the same time. For a better grip, try
to use this technique before applying lubrication.
Trigger points are irritated or hyperactive areas,
often located in hypertonic tissue, that are either
active (refer pain to a specic area) or latent (have
a positive reaction to pain in the area of the trigger point). Sometimes trigger points form palpable
nodules, but most often the therapist must rely on
client feedback. Satellite trigger points are often
located in functional units of synergistic muscles.
Ischemic compression, or trigger point release,
applies digital pressure, whereas a pincer palpation places the tissue between the thumb and the
forenger. The purpose of the digital pressure is
to try to interrupt the pain pattern by robbing the
tissue of oxygen for a short period of time. (Note:
This book does not offer an exhaustive study on
trigger points. Students seeking complete information about trigger points and treatment options for
them should refer to books devoted to that topic.
See Appendix A for suggested texts.)
Parallel thumbs is a deep-tissue technique executed
by alternately applying pressure with the thumbs
in a rolling-over motion. The thumbs face and are
parallel to each other; they should be at a right
angle to the muscle bers.

Sequence
Sequence is a specic series of techniques chosen to accomplish a particular goal in a session. It is determined
by the clients medical history, the structure, and the
area of the body needing the work. Evaluation of pressure and technique may be determined by the stage of
the condition: acute, subacute, or chronic. Therapists

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103

A Few Words about Body Mechanics

How many treatments does a massage therapist complete in a day,
week, month, or year? It would be easy to add them up, but the
equation of repetitive action times the amount of clients sometimes equals injury instead of a successful practice. Fortunately,
good body mechanics that utilize ergonomically safe methods and
practices to execute techniques can prevent injury, support selfcare, provide balanced energy, and promote a long career in the
massage therapy industry.
Practicing aikido, a special form of martial arts, teaches balance, the location of ones center of energy, and effortless movement. Applied to massage therapy, aikido teaches the therapist
how to utilize the bodys momentum for strength by applying an
Eastern philosophy to a Western style of bodywork so that, ultimately, the massage therapist sinks into the soft tissue rather than
pressing into it. Achieving and practicing good body mechanics is
actually quite easy. Lower the massage table to enable your ngertips to just brush the top of the table when you are standing by its
side. Remember that adding a person to the table means you will
actually be working higher. The larger the person, the lower the
table has to be set. If a client requires a side-lying position, the
table should be adjusted to an appropriate lower level.
Aikido teaches that when the body moves, it should be relaxed,
and that strength is not in how much force one uses but is in how the
bodys momentum is utilized. It is a silent strength that comes from
balance and movement from the center of ones energy. The center
of energy in the abdominal area is a Japanese concept referred to as
the hara. Shiatsu (the Japanese rendition of acupressure), aikido,
and other modalities and martial arts utilize this philosophy. The energy itself is called chi (Chinese) or ki (Japanese). How a person
directs her ki forms the basis of her body mechanics.
Here are some general principles of good body mechanics:
Always keep your back as straight as possible. As soon as you
nd yourself bending at the waist, your body mechanics have
been compromised.
Always move with your technique, using the momentum of
movement to assist in the action. Your ki will follow your
momentum as long as you are in balance. For efeurage of the
extremities, for example, keep your back straight and lunge
with your lower extremities, using mostly the quadriceps for
strength. Relax your hands, and use your body weight over
your hands to sink into the soft tissues as your momentum
carries you forward.
Always maintain balance so that you do not fall over if you
need to step back for a moment.
When you are standing straight, bend your knees so that
movement is easier and springier.
Stay over your hands as much as possible. As soon as your
hands are reaching out in front of your body (a position known
as the Superman complex), you have lost the center of balance and have no body strength to support the technique.

dai02079_ch05_100-114.indd 103

Relax your thumbs, hands, and arms between techniques.

Bodyworkers tend to hurt themselves with the repetitive
holding of tension in their hands and arms. Do not hold
your ngers or thumbs in extension while you are executing
techniques.
Always place your feet in the direction you are headed so that
your body can move in that direction efciently and easily.
Try not to press into soft-tissue structures. Lean or sink into
the tissues with your body weight. Ki extends from the center
of your body, allowing you to move into the tissues. You will
be surprised at how much deeper the tissues will allow you
to go when you do not force your way into their bers. It is a
myth that one must be Hercules to do bodywork! Too much
pressure applied incorrectly will cause discomfort and invoke
immediate instinctive tension in the clients tissues. If you do
not have passive tissues to work with, it is very difcult to get
an effective result.
Never sacrice yourself to a technique or to the clients
structure.
Breathe. Students often forget the importance of breathing.
Breathing is rhythmic; it silently teaches grace, promotes
relaxation, and makes centering easier.
Center yourself often. Remember that the person on the table
has engaged your services. Thus, you need to be present for
that person.
If you have no experience with any martial arts, tai chi will add
to your practice by helping you to understand energy, discipline,
balance, and movement. Tai chi is meditation, grace, and dance.
It is good for the soul. In Care of the Soul, Thomas Moore says,
Care of the soul requires craftskill, attention, and art. To live
with a high degree of artfulness means to attend to the small things
that keep the soul engaged in whatever we are doing. Massage
therapy is the art of touching other human beings; thus, therapists
are engaged in a relationship of response. It is the therapists ethical duty to prepare themselves well and practice self-care. Paying
such attention to your craft will feed your soul.
Good body mechanics are the basis of your success with any
type of bodywork. Having someone videotape you working will
help you determine whether your body mechanics are still in good
form. Are your shoulders elevated while you work? Are you bending over at the waist? More to the point, does your back hurt? Do
your forearms or hands hurt anywhere? If the answer is yes to
any of these questions, you need to revisit your body mechanics
and take a critical look at how you are executing your techniques.
Becoming a wounded healer makes it very difcult, if not impossible, to continue in your chosen profession.
If you are already injured, seek a diagnosis and appropriate
care.

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should never dive into the structure. Rather, they should
use supercial strokes to experiment with various palpation skills and to prepare the involved joint or joints
for further deep-tissue techniques. Unwinding an area
involves patience, structural knowledge, and intelligent
use of a sequence of techniques. Warm-up techniques
include an efcient use of efeurage and myofascial
stretches. Depending on the problem, therapists might
begin with techniques that require no lubrication. If
possible, they should place the body part and muscle in
a passively shortened position.
Some of the techniques described below will be old
friends from previous technique courses. Use them
wisely, and combine them with newer techniques to add
variety, ow, and skill to your repertoire. Remember
that all parts of the body are connected entirely: When
a technique is not working on a specic muscle group,
the problem may not be the techniqueit may be the
opposing muscles that are causing restrictions and preventing complete relaxation, or it may be another area
of the body. For example, many people have back and
neck conditions from at feet and gait issues.
The shoulder girdle surrounds the body and provides the mechanism for attachment that allows
muscles to connect to the head and neck and gives
the upper extremity free movement with the ball-andsocket joint. Sequentially it makes sense to start the
client in a supine position to utilize the head to assist
with passively shortening muscles efciently.
The following sequence should give a solid basis
for unwinding the shoulder girdle muscles and setting up a foundation for working on other areas of the
body. Chapter 14 presents postural perspectives and
additional techniques for the head and neck area.

Dimensional Massage Therapy for

the Shoulder Girdle Muscles
SUPINE POSITION
Slide the clients shoulders superiorly to passively
shorten the upper and middle trapezius. Test the trapezius for relaxation.
Efeurage around Shoulders
Use lubrication with this efeurage technique. Stand
with one foot in front of the other at the head of the
table. Place your hands just below the clients clavicle,
facing your ngers of both hands toward the sternum.
Follow the line of the clavicle, and stroke around the
deltoids and up the back of the trapezius to the occipital ridge. Give a slight traction at the end of the
stroke. Really feel the shape of the pectoralis major,
and sink into the tissue there as you begin this stroke.
Use your body weight. Lighten your pressure around

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FIGURE 5.1

Effleurage around shoulders

FIGURE 5.2

Petrissage of the trapezius

the shoulder joint, and use your backward momentum to help draw your hands to the back of the neck.
Repeat several times. (See gure 5.1.)
Petrissage of the Trapezius
Petrissage the clients trapezius, alternately moving your whole body and keeping your forearms in
alignment with your hands. While bracing the head
with your other forearm, petrissage one side of the
trapezius at a time. Repeat on the other side. Remember to relax your hands after the completion of
each technique. (See gure 5.2.)
Closed-Palm Shaping
With the dorsal side of your hand, make a relaxed, loose
st, engage the clients trapezius, and stroke superiorly
and inferiorly, posterior to sternocleidomastoid. Support the head on the opposite side with your forearm
while you complete the stroke. Try to keep the head
in a fairly neutral position, and use care, as always, to
engage the tissues with an appropriate amount of pressure. Repeat on the opposite side. (See gure 5.3.)

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FIGURE 5.3

Dimensional Massage Techniques for the Shoulder Girdle Muscles

Closed-palm shaping of the trapezius

FIGURE 5.5

105

Cup-stripping the upper trapezius

Alternating-Hands Neck Stretch

Start at the base of the neck (C7), and cup the cervical spine with one hand; the spine should be nestled
between your thumb and index nger. As you stroke
superiorly toward the C1 area, the other hand takes
the place of the rst hand, alternating and repeating
the stretch stroke. The clients neck should arch in this
technique, but the head should remain on the table.
Again, the hands are in a straight line with the forearms. Do not compromise your wrists to complete the
technique. (See gure 5.4.)
Cup-Stripping the Upper Trapezius
Place one hand under the clients head to give you access to the neck. Arch the neck, pointing the clients
chin in the air. With your other hand, straddle the cervical spine with your index nger and thumb. Lift the
head slightly, and glide down the upper trapezius to
the 7th cervical. Repeat. This should be a uid movement. (See gure 5.5.)

FIGURE 5.4

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Alternating-hands neck stretch

Edging the Upper Trapezius

Stand at the head of the table behind your client,
who is in a supine position. Bend the clients elbow
to passively shorten the upper trapezius. For the left
upper trapezius, place your right hand under the clients neck, and engage the edge of the upper trapezius
at the occiput on the side you intend to stretch. Place
your left thumb on the clients left upper trapezius
close to the insertion at the clavicle, and draw your
hands away from each other, stretching the trapezius
in opposite directions. Be careful to use slight to no
lubrication with this technique. Repeat with the other
side, exchanging hand positions. (See gure 5.6.)

FIGURE 5.6

Edging the upper trapezius

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FIGURE 5.7

Neck stretch to side

Neck Stretch to Side

FIGURE 5.9

Hands under back

Hands under Back

Rotate the clients head to the side. Standing on the

opposite side of the table (facing the clients face),
place one hand on the shoulder and one hand on the
back of the head. Glide the hand from the shoulder to
the head. Take the other hand off the head, and place
it on the shoulder. Stretch, glide, stretch. Do not bend
the ear. (See gure 5.7.)

This technique connects the lower trapezius with the

upper trapezius and lengthens bers of the erectors.
Place your hands under the clients back, and push
down on your forearms to slide down to the lower thoracic spine. Stroke superiorly in any combination of efeurage, vibration, or circular friction. End with a little
traction on the occipital ridge. Keep your ngers stiff for
extra pressure. Repeat several times. (See gure 5.9.)

Opposite-Side Petrissage of the TrapeziusComb

the Trapezius

Head Rock

Standing to the side of the table, place your inferior

hand under the clients head and grasp the opposite
trapezius. Your ngers will comb and pull on the trapezius while your thumb completes a circular friction between the spine and the scapula. Your superior
hand should brace the head while you complete the
technique. (See gure 5.8.) Repeat the neck stretch
and this technique on the opposite side.

FIGURE 5.8

Opposite-side petrissage of the trapezius

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With the clients head in the palms of your hands,

slightly push on the head with your palms; the chin
will lift. Retract the head with your ngertips by grasping the occipital ridge and bringing the chin back in.
Repeat a few times slowly and with an even rhythm.
(See gure 5.10.)
Head-Forward Stretch with Breath
Have the client inhale. On the exhale, lift the head
forward in a slight passive exion stretch, slowly and
carefully. Ask the client to signal when she feels the

FIGURE 5.10

Head rock

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stretch. Gently and slowly lower the head to the table.

Finish with an efeurage around the shoulders and a
slight traction to the occipital ridge.

PRONE
Myofascial Stretches and Techniques
Picking up the fascia and releasing it from underlying
structures provides a unique opportunity for deep-tissue
work. Technique 1: Push the fascia in a clockwise manner with one thumb into the opposite hand as it gathers
the tissue between the thumb and the forenger. All the
ngers of the gathering hand should help with the momentum of the stroke. Technique 2: Pick up the tissue
with the ngers of both hands in a slight half-moon, and
draw it over the thumbs as the thumbs press forward
toward the ngers. Both of these techniques are done
repetitively over a region. (See gures 5.11 and 5.12.)

FIGURE 5.13

Myofascial pull on the upper trapezius

Myofascial Stretch on the Upper Trapezius

Stand facing the clients side. Straddle the clients
neck with your thumbs parallel to each other on
the closest side of the upper trapezius. Brace your
thumbs on the closest side, and draw the tissue over
your thumbs with the ngers from the opposite side
of the upper trapezius. Repeat several times. (See
gure 5.13.)
Myofascial Stretch on the Middle Trapezius
FIGURE 5.11

Myofascial warm-up half-moon

Stand facing the clients side. Grasp the opposite side

of the middle trapezius, bracing your thumbs on the
dorsal side. Draw the tissue over your thumbs with
the ngers from the ventral side of the trapezius. Repeat several times. (See gure 5.14.)

FIGURE 5.12

Myofascial warm-up technique

FIGURE 5.14

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Myofascial pull on the middle trapezius

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FIGURE 5.15

Movement 1

Range of Motion for the Shoulders

This is passive movement that will interact with the
shoulder joint and shoulder girdle. Keep the movement easy, simple, and uid. This is a simple technique that becomes a sequential automatic function.
With the client prone, stand facing one upper extremity at the side of the table. Bend your knees slightly,
and widen your leg stance. Keep your back straight.
Pick up the clients arm just above the elbow with
both of your hands. The forearm and hand will hang
off the table.
1. Swing the arm passively in a back-and-forth
motion (gure 5.15). Continue to hold and swing
the arm, and with your hand that is closest to the
clients feet, catch the clients ventral wrist.
2. Circulate the arm, rst in one direction and then
in the opposite direction, by leading with the elbow and guiding with the wrist. (See gure 5.16.)

FIGURE 5.16

Movement 2

dai02079_ch05_100-114.indd 108

FIGURE 5.17

Movement 3

3. Place the wrist on the table so that the elbow is

bent out from the table. Place your hand that
is closest to the clients feet on the inside of the
arm grasping the biceps. Take your other hand
and grasp the deltoid area. Alternate movement
of the inside hand and deltoid hand in a one-two
motion. (See gure 5.17.)
4. Draw the upper extremity down by the clients
side. Place one hand underneath the shoulder
and one on the dorsal side of the joint. Passively
move the entire shoulder rst ventrally in a
circle and then dorsally in a circle. Repeat these
motions until they blend quickly into each other
and are done uently and without effort. This
takes a little practice. (See gure 5.18.)
Elliptical Movement of the Entire Scapula
Stand on the opposite side of the table. Place your
superior hand on the middle trapezius above the

FIGURE 5.18

Movement 4

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FIGURE 5.19

Dimensional Massage Techniques for the Shoulder Girdle Muscles

109

Elliptical movement of the entire scapula

spine of the scapula, with the thumb dorsal side up.

Grasp the teres majorlatissimus area with your inferior hand, with the thumb dorsal side up. Alternately rotate the shoulder by passively moving it rst
clockwise and then counterclockwise repetitively.
Another option is to draw the vertebral side of the
scapula over the thumbs in this position. Variation
two-hand elliptical: Anchor your hands on the back
and engage the muscles in alternate directions. (See
gure 5.19.)
Jostle and Stretch the Upper and Middle Trapezius
Facing the client at a right angle, grasp the upper and
middle trapezius on the shoulder closest to its origin loosely with your thumb on the dorsal side and
your ngers on the ventral side. Slightly traction the
muscle, and shake with a drag toward its insertion.
Repeat several times. (See gure 5.20.)
Compress the Rhomboids

FIGURE 5.20

Jostling the middle trapezius

Alternating Petrissage of the Upper and Middle

Trapezius and Compression of the Rhomboids
This is a dual-hand maneuver. Depending on the size
of your client, stand on the same side or opposite side
of the table. Place the hand closest to the head on the
trapezius and the other hand over the rhomboids. Alternately petrissage the trapezius and compress the
rhomboids. (See gure 5.22.)
Claw-Strip the Rhomboids
Place your curled ngers at the origin of the muscles
at the spinous processes on one side of the clients

Where you stand often depends on the size of the client. For this technique, position your hand so that
your palm rests lightly on the rhomboid closest to
you and your ngers rest lightly over the spine. Flatten the rhomboids with a pumping action of your
wrist repeatedly, with the palm and heel of your
hand. Be careful not to use the edge or bony part of
your palm as doing so could potentially hurt the client. (See gure 5.21.)
Efeurage and Circular Friction
Apply regular Swedish techniques. Continue to deepen
your efeurage to a compressive stroke. Friction: Using
the entire ventral surface of your hands, broadly sweep
in a circular motion; move one hand clockwise and
move the other hand counterclockwise over the expanse of the back.

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FIGURE 5.21

Compression of the rhomboids

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FIGURE 5.24

Deep transverse friction of the interspinales

travel in a superior direction up the spine. Keep the

stroke uid and continuous. (See gure 5.24.)
FIGURE 5.22 Alternating petrissage of the upper and middle
trapezius and compression of the rhomboids

body. Apply pressure with your other hand by placing

it on top of the hand that is already in position on the
rhomboid. Draw both hands toward the insertion of
the muscles on the vertebral side of the scapula. You
are essentially stripping the bers, so keep a steady,
even pressure as you draw your ngers toward the
insertion of the muscles. (See gure 5.23.)

Straddle the Spine and Claw Down the Spine

with Support over the Fingers
Start at about C7 if possible, and straddle the spine
with the ngers of one hand. Place your other hand at
a right angle over the hand in position on the spine.
Slowly drag your ngers down the spine to the lumbar region. Efeurage superiorly up the back and repeat. (See gure 5.25.)
Strip the Levator

Place your thumbs between the spinous processes of

thoracic 12 (T12) and thoracic 11 (T11). Make a halfcircular motion with your alternating thumbs as you

Stand to the side of the table, and place your closest

hand on the top of the shoulder, depressing it slightly.
Place your thumb of your opposite hand on the insertion of the levator. Strip toward the origins of the
muscle with a little bit of lubrication. Repeat four
times going toward each origin (C1C4 transverse

FIGURE 5.23

FIGURE 5.25

Deep Transverse Friction of the Interspinales

between the Spinous Processes

Claw-strip of the rhomboids

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Straddling the spine and clawing down

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chapter 5

FIGURE 5.26

Dimensional Massage Techniques for the Shoulder Girdle Muscles

Stripping the levator scapulae

FIGURE 5.28

111

Deep transverse friction of the rhomboid insertion

processes). Be careful not to press hard on C1, as it

moves easily. (See gure 5.26.)

border of the scapula. Start inferiorly and move superiorly. (See gure 5.28.)

Anchor and Stretch the Upper and

Middle Trapezius

Parallel Thumbs on the Lower Trapezius

Stand to the clients side, facing the head. Place your

inside hand with your thumb on the upper trapezius
at the base of the skull. Grasp the middle trapezius
with your other hand, and stretch the two hands
away from each other, stretching the trapezius. (See
gure 5.27.)

Locate the lower trapezius closest to the lowest

thoracic attachment. Place your thumbs facing and
parallel to each other and proceed to apply pressure
alternately, rst with one thumb and then the other,
as one thumb replaces the other in the thumb-overthumb movement. Move toward the vertebral border and the root of the spine of the scapula. (See
gure 5.29.)

Deep Transverse Friction of the Rhomboid Insertion

Open the shoulder region as you normally would to
apply pressure on the muscles in the medial vertebral
region of this bone. As you brace the ventral side of
the shoulder with one hand, apply steady pressure
with the thumb of your other hand to the vertebral

Locate Trigger Points

FIGURE 5.27 Anchoring and stretching the upper and middle

trapezius

FIGURE 5.29

dai02079_ch05_100-114.indd 111

Passively shorten the muscle, if possible. Determine

whether the trigger points are active or latent. Determine pressure tolerance. Apply tolerable pressure until
either there is a release or you have spent enough time
on the area. Remember to use the clients breathing

Parallel thumbs on the lower trapezius

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112 part 2 Upper Extremities

with the application of pressure. Stretch the tissue
after applying pressure.

between the ribs. Draw them toward your body from

ventral to dorsal. Repeat several times.

Serratus Anterior Trigger Point

Vibration and Friction

Locate the trigger point in the axilla region between

the ribs; apply tolerable pressure to this point as the
client exhales. Stretch the tissue. See Chapter 7 for
technique directions for the serratus anterior in the
side-lying position.

These techniques should be interwoven within the

above routine. For example, one can vibrate down the
spine instead of gliding. Intersperse vibration after
deep work to add variety to applied techniques. Make
a habit of locating attachments, and apply deep transverse friction or digital circular friction to them.
Techniques for the pectoral region and serratus
anterior are included in Chapter 7. Chapter 14 has
additional techniques for the soft tissue of the head
and neck.

Claw-Strip the Serratus Anterior and Intercostals

between the Ribs
Stand on the opposite side of the table, and separate your ngers (with one hand on top of the other)

CHAPTER

summary
Introduction
Dimensional massage therapy is a philosophical approach to therapy that is based on science, structure,
and soft-tissue functions and that uses a variety of
techniques for the clients benet. Two underlying principles of motion are important to remember with dimensional massage therapy: (1) aggregate muscle action:
Muscles work in groups and in paired opposition; and
(2) the law of reaction: For every action there is an opposite and equal reaction.
Muscles perform roles in the functional unit. Agonists,
antagonists, synergists, stabilizers, and neutralizers
make up a functional unit.
Treatment Protocol
A treatment protocol is a synopsis of an overall approach to a massage session.
It must be based on a medical history, interview and
SOAP notes, structure of the client, observation skills,
palpation, and a dimensional approach to treatment.
Technique Goals and the Mystery of Deep-Tissue Therapy
Each technique that is chosen for use in a sequence
has a purpose. Practitioners should be familiar with the
use and purpose of each technique to obtain a particular goal or outcome.
Deep-tissue therapy is a series of techniques executed
on soft tissue for a specic outcome.
Deep-tissue techniques include, but are not limited to,
jostling, compression, stripping, deep transverse friction,

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circular friction, myofascial stretches, elliptical movement,

ischemic pressure and pincer palpations for trigger point
therapy, parallel thumbs, and dual-hand distraction combinations.
The therapist must practice safe body mechanics when
performing a sequence of techniques.
To avoid injury, the therapist must use the correct positioning to apply the techniques, adjust the table to the
correct height, stay in balance during the session, and
use body weight and momentum to execute the techniques.
Practitioners must always practice safe body mechanics, or they risk sustaining an injury. Wounded healers
are clients, not practitioners.
Sequence
Always use treatment protocols to determine the sequence of a therapeutic session.
Use warm-up techniques rst, and determine pressure
intelligently.
Follow a dimensional approach, and critically think
about the involved joints and kinetic chain.
Dimensional Massage Therapy for the Shoulder
Girdle Muscles
Try the supine position rst to efciently prepare the
neck and shoulder muscles for further work.
Prone techniques assist with further unwinding of the
shoulder girdle muscles.

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Dimensional Massage Techniques for the Shoulder Girdle Muscles

113

CHAPTER

review

True or False
Write true or false after each statement.
1. Synergists assist only antagonists.
2. Myofascial techniques can help to warm up and
loosen soft tissue.
3. Jostling is a form of ischemic pressure.
4. Compression should be accomplished with a soft
hand attening out the tissue in a pumping action of the wrist.
5. Medical history, interview, and SOAP notes are
all part of the treatment protocol.
6. Deep-tissue therapy is only trigger point therapy.
7. It is a good idea to use a lot of pressure on the
rhomboids because the soft tissue is so thick.
8. It is necessary to passively shorten muscles for
more immediate results with techniques.
9. For good body mechanics, practitioners should
set the table higher than their waist.
10. Deep transverse friction strokes are in the direction of the bers.
Short Answers

4. Dene jostling, compression, stripping, deep

transverse friction, myofascial stretches, elliptical movement, trigger points, ischemic pressure,
pincer palpation, and parallel thumbs.

5. How does a practitioner determine an appropriate sequence for a massage session?

Write your answers on the lines provided.

1. List two principles that assist in critical thinking
for practicing a dimensional approach to massage therapy.
Multiple Choice
Circle the correct answers.
1. It makes sense to unwind the
2. Give examples of agonists, antagonists, synergists, and stabilizers of the shoulder girdle.

a.
b.
c.
d.

upper
lower
middle
none of the above

2. Muscles work in groups and in

3. List some components on which treatment protocols of a session should be based.

a.
b.
c.
d.

trapezius rst.

opposition.

singular
paired
no
none of the above

3. Sequence is:
a. a specic series of techniques chosen to accomplish a particular goal in a session
b. a haphazard approach to massage

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114 part 2 Upper Extremities

c. not necessary
d. determined by guesswork
4. A medical history is:
a.
b.
c.
d.

never necessary
a part of treatment protocol
a ridiculous idea
only necessary if the client is seeing a physician

5. Stripping:
a.
b.
c.
d.

is a technique that shortens bers

is never necessary
is a deep-tissue technique that lengthens bers
can always be used rst

6. Claw-stripping can be easily used on the:

a.
b.
c.
d.

levator scapulae
rhomboids
biceps
pectineus

7. Body mechanics:
a. that utilize ergonomically safe methods to
execute techniques can prevent injury, support self-care, provide balanced energy, and
promote a long career in the massage therapy
industry

b. decribe how to x a car

c. are never useful
d. do not help therapists stay in the eld
8. The coracoid process is palpable on the
of the body.
a.
b.
c.
d.

side

posterior
lateral
medial
anterior

9. The upper and lower trapezius act as agonist

and:
a.
b.
c.
d.

antagonist
stabilizer
synergist
none of the above

10. People often carry their tension in the

trapezius.
a.
b.
c.
d.

lower
middle
upper and middle
upper

EXPLORE
&

practice

1. Palpate bony landmarks of the scapula and

clavicle on a partner.

5. Demonstrate warm-up techniques without lubrication.

2. Palpate the origin and insertions of the shoulder

girdle muscles on a partner.

6. Practice deep-tissue techniques individually and

in a sequence on a willing participant.

3. Demonstrate how to passively shorten the upper

and middle trapezius.
4. Demonstrate some principles of safe body mechanics while you perform massage techniques.

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