Questions: How can I use movement to help a client who has chronic shoulder tension? I remember learning “arm drops” in my training, but I haven’t seen much benefit from that exercise. What are some other ways to use movement to help my client with the tension in her upper trapezius muscles?

Answer: In teaching Arm Drops during Rolf embodiment classes, I’ve described the intervention as a way of helping clients find a sense of connection and continuity between the spine, scapula and arm, and of finding central support for arm movement. The purpose of the “drop” is to insure that the new connection isn’t replaced by habitual patterning when the arm is lowered. The drop also heightens awareness of inhibitions around the shoulder joint. You’ll find a section about Arm Drops in my book Balancing Your Body,(1) but I rarely teach that classical exercise by itself any more. I’ve found other ways to address movements of the arms and shoulders that are, I think, more interesting and more practical.

Clients’ problems with their arms and shoulders have to do with what they’re  doing with their hands – how they’re physically handling tools and other objects, or people – in their daily lives. There can be a world of meaning encoded in the way a person engages the world through touch. I think this is why the Arm Drop exercise alone seems unfulfilling – it doesn’t lead to a tangible way for the hand to relate to the world.

The following is a broad introduction to shoulder-girdle stabilization and hand use. I’ll describe a sequence I use often, modifying it to suit individual clients’ needs. I may introduce the sequence during a Rolfing session, teach parts of it during several sessions, or let it fill a session devoted only to movement.

Step 1 – Finding the Scapulae

Many clients complain about their shoulders without having a clear sense of the component parts. I often start with simple anatomy, having the client touch his own clavicles, scapulae and humeral heads. I assist the client to sense the scapulae by palpating around the edges and doing some passive movement, pointing out the glide (or lack thereof) of the inside surface of the blade against the back ribcage. For simplicity, I name the acromion process “the outer corner” of the scapula, and the inferior angle “the bottom corner.” Then I ask the client to move the scapulae herself, noticing what happens to those two “corners.”

Step 2 – Seated Work

I briefly explain that the shoulder blade needs to be secured to the spine in order to provide leverage for the movements of the arm. I invite the client to raise her arm forward, noticing what part of her body she uses to lift the arm. Because most clients complain of neck tension to some degree, awareness that she’s recruiting neck muscles to stabilize her arm provides incentive to explore better ways to secure the scapula.

Touching the bottom corner of the scapula, I ask my client to draw it lightly down toward the tail and then release it without engaging the upper shoulder muscles. Since it’s easy to forcibly thrust the scapulae down, the difficulty of moving just a little can be surprising. The complete exercise is to lightly and repeatedly “pulse” the scapula toward the tail. Gentle tapping or massage of the lower trapezius muscle helps the client feel what she needs to activate.

I believe it’s important for people who overuse the upper trapezius and levator scapulae muscles to become familiar with the precise sensation of recruiting the lower trapezius. The goal of the pulses is to stimulate sensation and activity in this muscle so it can contribute to support of the scapula. If the upper trapezius is strongly habituated, it can take time for it to disengage. Because lower trapezius is frequently tight yet weak and uncoordinated, it can take time for it to come alive. For some clients this may be all we do for one lesson. I assign scapula pulses for client homework.(2)

In a similar way, I assist the client to engage under-active rhomboids by lightly tapping the outer corner of the scapula. As with lower trapezius, these muscles are frequently tight, yet weak and uncoordinated. I emphasize the rhomboid or trapezius cues depending on the client’s pattern. Occasionally I use both. (While the activation of serratus anterior is critical for balanced shoulder support, I usually teach that in a separate lesson, relating it to core support issues. It’s important not to overwhelm the client with too much sensory information at once.)

Step 3 — Supine Work

For the next step I like the client to rest in the supine position so she can more readily focus on her sensations. I teach her to initiate flexion at the shoulder with a tiny movement of whichever scapula “corner” has brought the best organization to the shoulder girdle in the earlier exploration. With my hand under the client’s scapula I lightly touch the corner, inviting a tiny impulse of the scapula into my hand. Once that movement feels clear I move my hands under the arm and forearm on that side, instructing the client to let me have the weight of her arm. Then, just as the client initiates the movement of the scapula, I slightly raise the arm from the table. After repeating this several times I have the client experiment with the timing on her own. The goal is to raise the arm from the table by first engaging the newly found support of the scapula. As the client brings her arm up to a right angle with the shoulder, I use my hand to invite the head of the humerus to rest back into the shoulder socket.

Up to this point, the work has been a variation on the classic Arm Drop exercise. During the supine work the client’s knees may be bent, straight or supported over a bolster. It is important that as the client engages her scapulae she does not arch the thoracic spine and puff the chest forward. The spine should remain grounded and the sternum at rest.

Once the shoulder engagement begins to feel familiar to the client, I ask her to raise her arm in a more habitual way. It’s important for the client to sense the difference between the two ways of moving. Clients usually report that the old way makes the arm feel heavier or the neck more tense.

Step 4 – Bridge to Practical Action

With my client still resting supine, I invite her to play with the common action of pointing at something. I might say, “Imagine you’ve never seen a ceiling fan before. Show it to me.” She points at the fan, experimenting with engaging the new pattern of shoulder support while doing something practical. Then we compare the feeling of doing it the new way with her habitual way of pointing at something.

Step 5 – Bridge to Relationship

With the client still supine, I have the client raise her hand in front of her shoulder, elbow somewhat bent, and place her hand against my own. Then I invite her to push me away. I usually have a client explore this first with eyes closed so she can sense into the combined actions of stabilizing and pushing something. Then we work with eyes open, and finally, when the action feels secure, with eye contact during the push. The action should occur without disturbing the body’s core. This action is the physical equivalent of saying “stop.” The capacity to make the gesture while remaining open and self-supported contributes to the capacity for setting personal boundaries. Some clients may be ready to bring this emotional connection to consciousness; others may not, but will still benefit from the exercise.

Step 6 – Moving with Gravity

Now the client is seated, facing the table. I make sure she has good sitting support.(3) During some previous lesson I will have introduced the experiences of omni-directional spatial orientation and grounding, so my client has familiarity with those resources before we begin working with expression in the arms.

I invite the client to explore movements of the scapula, distinguishing them from thoracic flexion and extension. Many people have historical voices in their heads saying, “shoulders back.” Usually the historical response is an exaggerated movement of the scapulae combined with spinal extension. Most people will agree that such effort feels forced, inauthentic and unsustainable. Thoracic extension that thrusts the heart forward (as taught in many yoga classes) is not authentic openness. Instead, a relaxed sternum combined with shoulder engagement that distributes shoulder-girdle support behind the heart region allows space for both receptivity and generosity.

Next I ask the client to reach for a small toy I’ve placed on the table. I watch for scapular stabilization of the arm gesture, for participation of the hip joints in bending forward, and for a sense of aliveness and receptivity in the hands. I also notice how the eyes are involved in reaching for the toy. The coordination of reaching out to obtain something is a complex kinetic orchestration of vision, hand awakening, hip flexion, spinal extension, shoulder-girdle stabilization and release, shoulder flexion, and elbow, wrist and hand extension. These basic elements occur concurrently when the movement is unimpeded. Yet the rhythm or timing of various parts will vary depending on whether one is reaching for the salt or reaching for a loved one’s hand. Needless to say, the brain can’t consciously track all of that, nor should it try. It’s not a matter of gaining control over the movement, but rather of releasing blockages that prevent the natural coordination of reaching out from occurring. To aid this process, I try to see or to feel in my own body what aspect of the movement is impeded. Is there a lack of aliveness in the hand? A failure to rest into the pelvis? Over-focus in the eyes?  Depending on what I observe, I may work further with the arm motion, review sitting and bending,(4) spend some time enlivening the tactile sense of the hands,(5) or revisit awareness of spatial orientation and body weight.

Once the new way of reaching feels good to the client, we review her habitual way of reaching out for something, comparing the feel of the movement with that of the new pattern. We also compare the emotional tones that may be associated with the two ways of moving.

To work with the action of pushing away, I sit beside the client and lightly place one hand on her back to remind her of support of the scapula, while giving her my other hand to push against. As with the supine exploration, I may let the client first explore pushing without eye contact. As always, we explore the old and new ways of doing the action. Most clients readily observe that their usual way of pushing away involves pushing back (retracting and bracing the heart area) rather than effectively signaling “no” or “stop.”

I choose whether to focus on pushing or reaching depending on the client’s resources – if reaching is connected and graceful, we might spend more time investigating pushing. If pushing is clear and strong, we’ll spend more time with reaching out. The client’s occupation may also influence my teaching emphasis.

The action of showing or pointing at something is another gesture that can be full of meaning for people. It invites a triangular relationship between staying home in oneself while splitting attention between the object being shown and the person it is being shown to. In any of these basic gestures, poor coordination in performing the actions may be a physical manifestation of poor support for self-expression. When working with support for these simple gestures we may well be assisting the client to accrue physical sensations that correspond to emotional support.

Clients seem to take away whatever they need from these upper-extremity and shoulder sequences. During the reaching exploration, one of my clients discovered that by being in haste to manipulate things she seldom registered the sensation of touch. This important connection has helped her gradually dismantle the chronic tension in her shoulders. For another client, the feeling of shoulder support for pushing helped her refine certain arm-balancing yoga asanas. Another woman found that engaging good shoulder support let her soften her sternum. “Oh,” she said, “to be open means to be able to receive, not just to give.”  It’s the truth of a sentence like that one, flowing straight out of a client’s physical experience, that keeps me showing up to do this work.

NOTES:

1. Bond, Mary, Balancing Your Body: A Self-Help Approach to Rolfing Movement. 1993, Rochester, VT: Healing Arts Press, pp. 117-118.

2. Bond, Mary, The New Rules of Posture; How to Sit, Stand and Move in the Modern World. 2006, Rochester, VT: Healing Arts Press, pp. 118-119.

3. Ibid., pp. 62-64.

4. Ibid., p. 65.

5. Ibid., p. 131.