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Passive STR for rhomboids in prone

By Jane Johnson, MSc


Step 1: Position your client in prone on a treatment couch so she is able to flex at the shoulder. To do this you will need to position your client so that her arm can hang off the couch. A safe way to do this is to have her lie at an angle on the couch, feet positioned at the corner opposite to the arm you are working on. With your client in this position, shorten the rhomboids by passively retracting the scapula.

 


Step 1
Step 1

Step 2: Whilst holding the client’s arm to keep the rhomboids passively shortened, gently lock them, directing your pressure towards the spine. As you can see from the skeleton illustration, the ribs curve outward. It is therefore important to direct your pressure towards the spine rather than perpendicularly because pressing into the ribs would be uncomfortable for the client.

Step 2
Step 2

Step 3: Whilst maintaining your lock, gently lower your client’s arm into flexion so that the scapula protracts around the rib cage, stretching the rhomboids.

Relatively speaking, rhomboids are a small group of muscles and cannot be worked in lines as some other muscles can. Change the position of your lock to any point on the rhomboids as you repeat the procedure. If you find using your fist uncomfortable for your wrist, try using your forearm for the lock. Elbows should be used with caution over this bony area.

Step 3
Step 3

 

Tip You may need to practice repositioning your client to ensure flexion at the shoulder. If the client is not correctly positioned, this technique may cause pressure on the brachial plexus in the armpit, which could be uncomfortable.

Advantage You have considerable leverage and will be able to fix the muscles well.

Disadvantages If the client is not correctly positioned, this technique may cause uncomfortable pressure on the brachial plexus in the armpit. • Be careful to use appropriate posture when lifting and lowering the client’s arm. • This technique cannot easily be incorporated into an oil massage because it requires the client to be positioned diagonally on the treatment couch, which would mean moving the client several times during treatment. • With good leverage, some therapists accidentally press too hard; this is especially uncomfortable when working over ribs. • Unless your client is engaged in regular physical activity, it may be unlikely he or she needs the rhomboids stretched. Many clients have kyphotic postures, with protracted shoulders. When the shoulders are protracted, the rhomboids are lengthened. Do you need to stretch them further?

This is an excerpt from Soft Tissue Release.



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