The Shoulder

Technique:

• The patient sits with the back against the cough and the arm behind the back.
• In this position, the tendon fills the gap, between acromion and major tubercle.
• Palpation of the tendon
• The therapist stands laterally on the patient's painful side.
• Friction is performed with the index finger of the ipsilateral hand, reinforced by the middle finger.
• The stretched index finger is placed at the medial edge of the supraspinatus tendon.
• The thumb is abducted and placed against the lateral aspect of the upper arm, almost vertically under the index finger.
• The active phase is a lateral pull of the index finger, transversely over the tendon fibres until the lateral border of the tendon is reached.
  The directed pressure is caudally, in the direction of the humeral shaft - easily obtained if the stabilizing thumb is put as low as possible on the upper arm, and the nail of the finger that applies friction is pointing upwards.
• During the second phase (relaxation) the finger is returned to the starting position, without loosing contact between finger and skin.
• These to-and fro movements are repeated with a rhythm of about 60 to 80 movements per minute.
  Movement is performed mainly within shoulder and elbow joints; wrist and hand joints are kept rigid.General principles technique