The overall goal of the General Shoulder Protocol is to bring the muscle groups of the shoulder back to normal resting lengths, create structural balance, normalize range of motion, and joint capsule release for pain-free movement.
There is a specific order for releasing and balancing the muscle groups of the shoulder:
- Pectoralis Major
- Pectoralis Minor
- Biceps and Coricobrachialis
- Upper Trapezius and Middle Deltoid
- Triceps Brachii and Posterior Deltoid
- Scapular Reposition
- Supraspinatus and Upper Trapezius
- Infraspinatus and Teres Minor
The protocol can change, however, depending on the problems found in the initial range of motion assessments.
- Client History
To obtain a thorough medical history including precautions and contraindications for treatment of the client’s shoulder condition.
- Assess Active Range of Motion (AROM)
To assess range of motion of single-plane movements, performed solely by the client, to identify tight or restricted shoulder muscle groups.
- Assess Passive Range of Motion (PROM)
To assess range of motion ‘end feel’ of single-plane movements performed on the client. Pain during passive movement predominantly implicates inert tissues. However muscles ant tendons that contract in the opposite direction are stretched at the end-range of passive movement.
- Assess Resisted Range of Motion (RROM)
To determine if there is a muscle-tendon strain and, if so, exactly where it is located.
You must be aware of the difference between soft-tissue restrictions, muscle strains, emotional guarding, and joint capsule adhesions.
If there is a muscle or tendon injury, it should be treated last, after you have balanced out opposing muscle groups and addressed the problems in the muscle belly leading to the muscle injury. Do not treat strains and sprains while those structures are still under stress or mechanical load.
Balance out opposing muscle groups to bring them back to their normal muscle resting lengths before trying to soften and mobilize scar tissue.
If at any time you feel a bone-on-bone-like end feel, stop the protocol and go to the joint capsule work. But, if the client has tested positive for a muscle-tendon strain, you should bring that muscle back to resting length, and treat the strain prior to attempting joint capsule work. If the client is guarded due to shoulder pain during the capsule work, you will not be able to access and release the deep fascial adhesions inside the shoulder capsule.
If you feel as if you are chasing the client’s pain, because the location keeps changing, it is most likely caused by myofascial restrictions. These tender points are myofascial pain patterns that cannot be effectively treated like muscle-belly trigger points. Once the opposing muscle groups of the shoulder are balanced, the tender points will often disappear.
- Area Preparation
To warm and mobilize the superficial fascia before restoring normal muscle resting length.
- Myofascial Release
To warm up, soften, and mobilize the fascia… and to move the fascial layers back to normal, neutral position.
- Cross Fiber Gliding Strokes/Trigger Point Therapy
To tease apart tight muscle bands and, release trigger points (if found) in the muscle belly.
- Multidirectional Friction
To soften the collagen matrix by working in multiple directions to prepare for a more functional mobilization of scar tissue fibers.
- Pain-free Movement
To determine if the client can actively move through the full range of motion without pain. This gives permission to proceed with pain-free eccentric scar tissue alignment techniques.
- Eccentric Scar Tissue Alignment
To apply pain-free eccentric muscle contraction by lengthening the muscle against mild resistance to realign or redirect the scar tissue.
- Stretching (During Therapy)
To restore normal resting muscle lengths.
Stretching (Client Self-Care)
For the client to perform stretches to create normal muscle resting lengths in shortened or contracted muscle groups.
- Strengthening (Client Self-Care)
To strengthen weak, inhibited muscle groups around a joint creating muscle balance throughout the body…’structural integration’.