The Shoulder

Procedure:

• The patient lies prone, resting on the elbows, the shoulders vertically above them.
• The upper arm is brought into slight lateral rotation and adduction by asking the patient to hold the edge of the couch.
• The therapist stands at the painful side.
• The thumb of the ipsilateral hand is placed on the lesion, usually behind the acromial angle. Counter-pressure is applied with the other fingers at the front of the shoulder. The thumb is placed at the caudal part of the tender area.
• The active phase of the friction is undertaken in a caudocranial direction by a supination movement of the wrist. The thumb glides transversely over the tendon. The exerted pressure is distal, in the direction of the humerus.
• The passive phase is a pronation of the wrist: the thumb is brought back to the starting position without loosing contact with the skin. To avoid blisters, firm skin contact must be maintained during the whole procedure.