SHOULDER PROCEDURE. Minimum Prerequisite BRM 2 (1-8) & BRM 3 (1-6)

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Darleen Norton
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1 SHOULDER PROCEDURE Minimum Prerequisite BRM 2 (1-8) & BRM 3 (1-6) Shoulder Procedure (Solo) - SUMMARY With the client sitting, stand at the opposite side to the shoulder being worked on. Cradle the forearm of the side you are working on. Position the forearm horizontally at about mid-chest, maintaining their elbow at 90 and their shoulder open from the trunk. Move 1 - Anterior move performed with the fingers of the opposite hand over the mid-point of the posterior deltoid and triceps tendon, which lies deeper to it. The move is best performed with the thumb of the same hand resting on the humeral head and whilst adducting the shoulder joint to its limit. Move 2 - Once the shoulder has fully adducted to the opposite side perform a percussive strike to the humeral head in the direction of the neck. It is advisable to assess the overall response of your client to Bowen Therapy treatments prior to performing this procedure especially in an acute episode of a long-standing shoulder issue. Conclude that the procedure is best applied at a later treatment session. Shoulder problems can take many weeks to resolve even with successful application of this and other appropriate procedures. The described warming-up exercises will greatly enhance the results of this procedure. The tendons around the joint are easily aggravated and strained therefore it is important to encourage the client to rest and recuperate the area of concern to the maximum. As well as perform the prescribed warming-up exercises each day. Note: Don t overtreat the area with more than 2 Bowen Therapy Shoulder procedures 1 week apart per month - as time between treatments is vital to allow the tendons to regenerate and for calcification and adhesions to resolve. Therefore, it is recommended to perform 2 successive Bowen Therapy Shoulder procedures followed by 3 weeks of rest to the shoulder area. Meanwhile, other Bowen Therapy sessions and procedures can be scheduled and other procedures used during this time. Move 3 - Return the arm into the starting position and perform a supero-lateral move on the anterior deltoid at it s mid-point. Repeat on the opposite side. PAUSE 36 Copyright BTC Canada Ltd.

2 by Jonathan Damonte for The North American Bowen Teaching College Inc. The Starting Point This procedure is best performed with the aid of an assistant who cradles and moves the client's arm and shoulder whilst the therapist performs the procedure. Using an assistant to perform the procedure aids the therapist by allowing them to challenge the muscles and tendons more efficiently than can be achieved when performing the procedure alone. The procedure can be modified to suit the therapist in a number of ways. The Shoulder procedure is performed with the client ideally sitting, though it can be performed with the client standing or laying on their back. Treat both shoulders and always treat the better shoulder first, unless used during sports events where it is best to treat the injured shoulder first and then the better shoulder as the pause can be sneaked in this way and the athlete can resume their sport immediately. Starting Point Move 2 Position Copyright BTC Canada Ltd. 37

mid-chest level. The client's elbow is bent at 90 and the shoulder joint open beyond the trunk of the client. The client's shoulder and arm need to be as relaxed as possible.

3 Modules 1-2 Bowen Therapy Instruction Manual A. Shoulder Procedure - Therapist & Assistant Move 1 The Assistant stands facing the patient and holds the their shoulder and arm at the elbow and wrist with the clients forearm horizontal and at mid-chest level. The client's elbow is bent at 90 and the shoulder joint open beyond the trunk of the client. The client's shoulder and arm need to be as relaxed as possible. The therapist and assistant communicate to the client that their shoulder and arm will be moved across to their opposite shoulder to stretch and open the shoulder capsule being worked on. As the client's shoulder might have limited mobility it is very important they remain relaxed and the assistant and therapist move the shoulder capsule only within its movable limit. The therapist stands behind the client facing the posterior deltoid. Place the palmar aspect of both thumbs onto the posterior deltoid at a point between the axilla and the head of the humerus and 1 fingerwidth distal, while the arm is held by the assistant as described above. Draw skin posteriorly and under the posterior border of the posterior deltoid and long head of triceps brachii tendon, turn both thumb-tips under the defined edges of posterior deltoid and the triceps tendon deeper. With the thumbnails back-to-back the posterior deltoid and triceps tendon are firmly challenged anteriorly, the therapist can now signal the assistant to begin moving the arm and shoulder. While the arm is being moved and when the shoulder is at approximately 90 to the trunk the tension in the challenged posterior deltoid and triceps tendon increases noticeably, it is at this point the therapist releases the challenge anteriorly over the triceps tendon. Move 2 The client s arm is moved in a continuous manner and without pause until it is fully adducted by the assistant at this point the therapist strikes the humeral head with the ulnar side of their fisted hand in the direction of the cervical spine of the client. This blow is designed to jolt any adhered tissues within the client's shoulder capsule Copyright BTC Canada Ltd.

deltoid adjacent and distal from the coracoid process.

4 by Jonathan Damonte for The North American Bowen Teaching College Inc. Move 3 The arm is returned to the starting point and the therapist reaches over the clients shoulder and places the palmar aspect of 2 nd and 3 rd fingers of both hands on a mid-point of the anterior deltoid adjacent and distal from the coracoid process. Push skin slack infero-medially to the inferior border of the anterior deltoid, curl the finger-tips around the inferior border of the anterior deltoid and apply slow gentle challenge supero-laterally to the anterior deltoid, move over the anterior deltoid superolaterally and release the challenge. Perform Moves (1-3) on the opposite shoulder. Provide the client with details on the required exercises and demonstrate these for them each time they come for treatment. Ensure they wait till the next day before attempting these as it important to allow the area worked on to respond fully before it is exerted. Provide A Minimum 2 Minute Pause 1 3 Copyright BTC Canada Ltd. 39

Modules 1-2 Bowen Therapy Instruction Manual B. Shoulder Procedure - Therapist Solo The Starting Point. The client is sitting either in a chair or on the treatment table.

The client's elbow is bent at 90 and the shoulder joint open beyond the trunk of the client. The client's shoulder and arm need to be as relaxed as possible.

5 Modules 1-2 Bowen Therapy Instruction Manual B. Shoulder Procedure - Therapist Solo The Starting Point. The client is sitting either in a chair or on the treatment table. Stand facing the client at their opposite thigh to the shoulder being treated. Cradle the client's arm and shoulder by cupping their elbow and supporting their forearm level with the medial side hand. The client's elbow is bent at 90 and the shoulder joint open beyond the trunk of the client. The client's shoulder and arm need to be as relaxed as possible. Move 1 Use the lateral side hand and lay it on the shoulder so that the thumb is resting on the humeral head and the palmar aspect of their 2 nd, 3 rd and 4 th fingers rest onto the posterior deltoid at a point level between the axilla and the head of the humerus and one finger-width distal. Push skin slack posteriorly, turn the fingertips under the posterior border of posterior Deltoid and Triceps tendon. Firmly, apply anterior challenge to the posterior border of the posterior deltoid and long head of Triceps brachii tendon before beginning to adduct the client's arm. While the arm is being moved and when the shoulder is at approximately 90 to the trunk the tension in the challenged posterior deltoid and triceps tendon increases noticeably, it is at this point these muscles are released. Posterior Deltoid & Triceps brachii - long head Move 2 The arm is moved in a continuous manner and without pause until it is fully adducted at this point the therapist strikes the humeral head with the ulnar side of their fisted hand in the direction of the client s cervical spine (neck). Move 3 The arm is returned to it's starting point and the therapist rotates, while still cradling the client s arm, to stand beside the shoulder being treated. Place the palmar aspect of the 2 nd, 3 rd & 4 th fingers onto the mid-point of the anterior deltoid at a point adjacent and distal from the coracoid process. Push skin slack infero-medially to the inferior border of the anterior deltoid, curl the fingertips and apply slow gentle challenge supero-laterally to the anterior deltoid, move over the anterior deltoid superolaterally and open the fingertips to fully release the challenged muscle. Perform Moves (1-3) on the opposite shoulder. Provide A Minimum 2 Minute Pause The entire Shoulder procedure can be repeated on either arm if necessary to provide an effective release of the muscles worked on. It is common that the tension is so great as to limit their release. Anterior Deltoid Copyright BTC Canada Ltd.

6 by Jonathan Damonte for The North American Bowen Teaching College Inc. Note: When working on a large client the therapist can stand behind the client with one knee bent in order to rest the client's arm onto it. This is to free both hands and be able to address the client from behind to perform Move (1). If the client's shoulder is in spasm and cannot be worked on easily for Move (3) the arm can be rested onto the client's lap. AFTERCARE & EXERCISES Warming-up exercises for chronic shoulder pain & poor mobility performed daily will greatly improve and hasten the clients recovery process. a) Once a day, rotate the shoulder 6 X in a clockwise and 6X in a counter-clockwise direction without strain. If needed the client can bend forward and let the arm hang as the shoulder turns. b) Once a day, rest the arm onto a surface and gently walk into the elbow to stretch the posterior deltoid and then gently walk to turn away from the elbow to stretch the anterior deltoid. Repeat each direction 6X. Perform the Shoulder procedure for 2 consecutive weeks and provide 3 weeks of rest. In other words treat the shoulder area only once a month. REST, RECUPERATE & RECOVER... a b Copyright BTC Canada Ltd. 41

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