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Using SMRT on the Shoulder
One of the student therapists in my last class asked me to look at her left shoulder. She had limited flexion and abduction. With palpation and assessment, I believed that she had a facilitated latissimus dorsi on her left side.Assessing the Shoulder
As I began to work on her, most of the class gathered around to see what I was doing. Several things could lead to a facilitated latissimus dorsi. One of these things is an inhibited ipsilateral gluteus maximus which could be inhibited in relation to a facilitated contralateral gluteus maximus.
We had been doing a lot of posterior hip work, so I did not believe this to be the case. It is also possible that latissimus dorsi is facilitated or shortened due to inhibition or lack of tone in the ipsilateral pectoralis major, middle deltoid, or biceps brachii.
Palpation of her left pectoralis major indicated a lack of tone while palpation of her right pectoralis major indicated too much tone. I then felt the right latissimus dorsi and found that it lacked tone.
SMRT in Action
I did two SMRT positions, one for each side. On the left side I moved the upper arm into internal rotation and adduction with a little bit of flexion at the shoulder. On the right side I moved the upper arm into internal rotation and adduction with a little bit of extension at the shoulder.
One of the students asked if maybe I was doing this backward since both muscles did internal rotation and adduction, but pectoralis major did flexion and latissimus dorsi did extension. I explained that my intention was to activate both muscles with an added emphasis on the inhibited muscles on either side.
Increasing or restoring tone in the inhibited muscles would quickly reduce tone in the shortened muscles. Had I just released the shortened muscles, the new muscle length would have been unsustainable. Tone in the shortened muscles would be automatically decreased by bringing the tone up in the hypotonic muscles.
When I released the positions, she moved her left arm and had significantly increased ROM, but not as much abduction as she would have liked. Next I checked the tone in the middle deltoid and it too had decreased tone. I moved from the hand, creating a direct line of lateral compression through the wrist, elbow, and shoulder joints to decrease the space at the lateral aspect of the glenohumeral joint. Then I moved slightly toward adduction.
In this way I shortened both middle deltoid and latissimus dorsi. When I released the position the tone in her left middle deltoid had increased and the tone in her left latissimus dorsi had decreased. Her pectoralis major muscles felt balanced and the tone in her right latissimus had increased. Movement showed that her range of motion was smooth, painless, and full. All of this took about 6 minutes.
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Tags: anatomy, body, continuing education, massage, massage therapy, massage therapy continuing education, pain, shoulder, SMRT, spontaneous muscle release technique
