By Warren I. Hammer

This version has chapters written via specialists within the tools of handbook remedy and offers step by step directions on the right way to learn sufferers utilizing a logical series of passive, contractile, and unique exams, and the way to narrate the findings to biomechanical difficulties and lesions. It contains diagrams, images, illustrations, and precis charts. Chapters from the 1st version were revised and up to date and fabric has been further on myofascial liberate, somatics, post-facilitation stretch, hypo and hyperpronation of the nutrition, pressure and counter pressure, gait.

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Extra info for Functional Soft Tissue Examination and Treatment by Manual Methods: The Extremities

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R , J . fulcrum so that the deltoid can rotate the arm upward. '_ A . '. " logically a decreased width (5 rom or less) of the humeral Figure 3-10 Rotators of arm from above. Source: Reprinted with pennission from GP Bogumill, "Functional Anatomy of the Shoulder and Elbow" in Symposium on Upper Extremity Injuries in Athletes, (p 203) by the American Academy of Orthopaedic Surgeons, SI. Louis, 1986, The C. V. Mosby Co. acromial space may indicate a cuff rupture. If rotator cuff function is impaired even slightly for any reason the corre­ sponding normal fulcrum of the humeral head will be lost, and abnormal upward displacement (deltoid shear) of the humeral head will be allowed21 (Fig.

Humerus, resulting in impingement. As Noah and GidumaJ26 capsule should he thought of as a conjoined tendon containing explain, the deltoid's action, when unopposed, leads to secon­ the insertions of the capsular (cuff) muscles. The inner surface dary impingement. Garrick and Webb27 state''that most cases of the capsule is lined with synovium and extends into the of impingement syndrome are simply the result of insuffi­ lining of biceps tendon sheath, which is considered an exten­ ciency of the stabilizing muscles of the shoulder, which per­ sion of the joint cavity.

Joint play techniques, stretching tech­ niques, trigger point techniques, and all other treatments must take into account all the viscoelastic elements in the connec­ tive tissue of ligamentous joint capsules, tendons, and mus­ cles. Muscle and joint tissues both contribute to total stiffness, and neither is so dominant that alterations in the other are tion (Fig. 3-15A) and medial rotation a n d adduction (Fig. 3-15B) may also be used. Because active motions stress both contractile and inert tissue, active testing is used as a baseline to assess the present status of the shoulder against future progress.

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