The most common request I receive as a massage therapist is to work on a client’s upper back and shoulders. In fact, the shoulder rub is a cliché of the massage profession. Most massage therapists can relate to being at a party, introducing themselves as a massage therapist, and in jest, someone offering his or her shoulders to rub.
Many people store tension in their upper back and shoulders, a.k.a. “the weight of the world on your shoulders” syndrome. In truth, many of my clients who chronically complain of tightness in the back of their shoulders are unaware of how much tension they are storing in the front of their shoulders. Accumulating tension in the shoulders can actually start a step deeper, in the tightening of the chest muscles.
Many clients who have upper back and shoulder tightness have shoulders that round forward. This rounding can be caused by a tight chest and diaphragm pulling the shoulders forward over the heart. In this case, the backs of the shoulders work doubly hard to hold themselves up, since there is no longer support from an open and functioning front body.
I’ve had many clients who just wanted me to pound away on their tight shoulders and upper back. This approach, though I’m sure it would feel good for the client, is only treating the symptom and not the cause.
When the front and back bodies are balanced, the shoulders can slide down the back. The shoulders have no real job in our overall structure; they just hang. The shoulder doesn’t need to support anything—it’s simply a shirt on a hanger—unless the front is collapsing, in which case the back of the shoulders become responsible for themselves.
In short, tight shoulders are a symptom and a tight chest may be the root cause. There is a popular adage in Chinese medicine about the importance of treating the root and not the branch. If you treat the branch, in time your client will develop the same complaint again and again; if you treat the root, your client will come to you the next time he or she has an ailment, knowing you have solutions that work.
Auth Method
The Auth Method is a system of massage that takes the practitioner’s body into consideration. The method was developed with the belief that with the right tools, technique, and body mechanics, performing massage can be effortless. One of those tools is using the forearms instead of the hands as your primary massage tool. When using your forearms, it is advised to use the upper third of your forearm, because you’ll have more leverage than when using the middle or lower forearm. The forearms are perfect for chest massage because they are less pokey than the fingers or elbows and they allow the practitioner to work a larger portion of the chest at once.
When practicing the Auth Method, it is not necessary to use muscular force; simply drop your body weight onto the tissue, and you’ll naturally sink to the most superficial layer of tight tissue. As that tissue releases, you will sink into the next layer. This patient process of working layer by layer creates a massage experience that is deep without being painful for the client or strenuous for the practitioner.
Working the Chest
Position your client comfortably in the supine position. Undrape the arm and upper chest by folding over one corner of the sheet or towel. Begin with basic effleurage and spread oil over the upper chest, arm, and hand. Standing alongside the client, abduct the client’s arm out to 90 degrees with his or her elbow bent to 90 degrees as well, holding the client’s right hand with your left hand and vice versa. Give a gentle rocking of the arm to ensure it is relaxed. Rest the client’s upper arm on the table, still holding the hand with the elbow bent. Gently place the upper part of your forearm on the client’s chest just above the drape and just medial of the sternum. Your hand should be just below the elbow or upper arm. Your whole lower arm will be in contact with your client (Image 1, page 63). Begin your stroke by following the fibers of the pectoralis major muscle, moving along the medial border of the sternum up toward the clavicle. Move laterally along the posterior clavicular border, passing just under the shoulder joint and onto the attachment of the pectoralis on the intertubercular groove of the humerus. The stroke can be continued all the way down to the elbow, although the latter half of the stroke is performed with light pressure (Image 2). If needed, the beginning part of the stroke over the pectoralis muscle can be performed with deep pressure. Simply hover your upper body over the stroke, dropping your body weight onto the chest. I find it doesn’t take much body weight to deliver the pressure needed to work deeply in this area. When you reach the end of the stroke, lift your arm up off the body and start from the beginning. Repeat this stroke a couple of times, varying the location of your forearm stroke to ensure that the whole area has received adequate work.
Passive Movement
Passive movement is a great way to intensify this stroke. By moving a joint that articulates with an area of tension, the tissue loosens from the inside out. This can be necessary for areas of built-up tension, but it’s also an easy way to work deeper on your client without putting additional stress on your own body. Try the stroke again, but this time, instead of holding the client’s arm stationary, move the hand forward toward the table (Image 3). This will open the shoulder joint and put the pectoralis muscle on a mild stretch. While continuing your stroke, take the client’s arm back to its original position, releasing the stretch. When moving the client’s arm back and forth, the pectoralis muscle oscillates between a relaxed and stretched state, assisting in the release of tension in this area. Positioning a muscle “off the stretch” softens the muscle and allows the practitioner to work deeper. Positioning a muscle “on the stretch” makes the muscle more taut and intensifies bodywork on the stretched area. Play with this movement a couple of times to get the hang of this tool. Be sensitive with your pressure when stretching.
To create a deeper stretch in the chest tissue, move your client’s hand forward toward the table and then begin to straighten the arm, bringing the pectoralis into an even deeper stretch (Image 4).
In addition to massaging the pectoralis major, massaging the anterior deltoids, diaphragm, and pectoralis minor will also assist in bringing the shoulders back and opening the chest. Encourage your clients to take a deep breath into the chest after this work. They are likely to comment how much easier it is to breathe deeply. With their chest more open, it will be easier for them to bring their shoulders back, releasing tension in the back of the shoulders.
Shari Auth is a licensed massage therapist and acupuncturist, and is certified in the Rolf method of structural integration. She is the creator of the Auth Method and has a full-time practice in New York City. Auth teaches continuing education workshops and has a DVD, Auth Method of Therapeutic Massage: A Guide to Using the Forearms. For DVD and workshop information, visit www.authmethod.com. To contact or learn more about her practice, visit www.shariauth.com.