SMM Manual Sample2.Pdf

Contents

Section One: Foundations of Haase Myotherapy®...... 6 Haase Myotherapy® Philosophy...... 6 Treating Cancer Patients...... 10

Section Two: Technique...... 12 Body Mechanics – Ensuring Your Professional Future...... 13 Golfer’s Elbow...... 20 Tennis Elbow...... 21 Carpal Tunnel Treatment...... 22 de Quervain’s Tenosynovitis/Tendonitis (Insertion Syndrome)...... 25 Triceps Tendonitis...... 26 Deltoid Tendonitis...... 27 Subacromial Bursitis...... 28 Supraspinatus Tendonitis (aka Painful Arc Syndrome)...... 29 Bicipital Tendonitis...... 31 Subscapularis & Frozen Shoulder...... 32 Head, Neck, & Whiplash Treatment...... 34 Military Neck (Cervical Hypokyphosis)...... 34 Head, Neck, & Whiplash Treatment...... 35 Seated Head & Neck...... 36 Supine Head, Neck, & Whiplash Treatment...... 40 Migraine Headaches...... 42 Thoracic Outlet Syndrome...... 43 Augmentation Exacerbation of Thoracic Outlet Syndrome...... 46 Treatment of Temporomandibular Joint Dysfunction (TMJD)...... 50 Erector Spinae Release...... 51 Rectus Abdominis Treatment...... 52 Intercostals & Diaphragm Release: Increasing Oxygen Capacity...... 54 Low Back/Psoas Release...... 56 Piriformis Syndrome / False Sciatica...... 59 Gluteus Medius & Minimus...... 61 Pelvic Decompression...... 63 Upper Leg & Knee Treatments...... 66 Lower Leg & Foot Treatments...... 73 Working with Scar Tissue...... 78 Self-Stretching Techniques...... 80 Recommended Resources...... 87 Treating Cancer Patients • Bones weaken from treatment • Bones REALLY weaken if cancer is in them • Inquire about blood clots What is it? Cancer consists of a collection of related diseases. In all cancer types, a number of the body’s cells begin to divide without stopping and spread, entering surrounding tissues. Cancer can get its start in nearly anywhere in the human body’s systems or tissues. Human cells nor- mally grow and divide, forming new cells. As cells age or become damaged, they die off and are replaced by new cells. When the orderly process breaks down and the abnormal, damaged cells don’t die but replicate at a rapid pace, the growths are called tumors. When those tumors spread into or invade nearby tissues, the cancer is considered malignant.

How Does Cancer Massage Differ

From Regular Massage? • Avoid tattoo / radiation sites • Techniques tailored to frailty of tissues, including • No creams or oils muscle, skin, and bone • Be prepared with adequate bolsters • Part of a medical health care team • Be prepared with moisture barriers • Adaptive / ever-changing treatment plan • Caution around colostomy bags • Environment is unusual and hostile • Pulmonary embolism is contraindicated • Profound impact of massage on patients • Bowel obstructions: stay clear! • Expect the unexpected • Deep leg thrombosis: no legs / feet Massaging Cancer Patients: • Stay clear of weeping lesions What You Need To Know… • Do not dabble in lymphatic work unless you are trained in this area • Low platelet count (<50K) = bruising – do not massage • DO NOT suggest medication/dietary changes • Low white blood cell count (<1k) = weakened im- • Realize that bone degradation lasts years mune system: ask doctor • Lymph vessels DO NOT regenerate • Don’t massage directly on/over a tumor • Elevate edema when bolstering • Avoid metastatic sites (e.g.: axillary) • Do not recommend herbs • Don’t treat if you are sick Research shows some herbs can interfere with • Wear mask / gloves if needed ÂÂ liver function • Be aware that patients will miss appointments • Be aware of wide mood swings • Avoid deep tissue (even if requested) • Be clear before treatment starts as to how long the massage / treatment will last • Avoid biopsy sites for a week or so • Resist pleads for deep tissue • Allow even more time for bone marrow aspirations • Pain medications block normal feedback • No work in surgery sites for 4-6 weeks

What Is It? main tendon, the common flexor tendon, attaching to the medial epicondyle of the humerus. Overuse puts strain on the ten- Golfer’s elbow is actually medial epicondylitis, or inflamma- don causing inflammation and/or scar tissue. tion of the medial epicondyle and surrounding tissues. The muscles involved in Symptoms medial epicondylitis primar- ily include the pronator teres Stiffness and/or sharp pain in the elbow and wrist. Dimin- and the flexor carpi radialis. ished strength of hands and wrists. Tingling of the fingers. Golfer’s Elbow usually results from repetitive use. Indications Swinging a golf club or a Weak shoulder and wrist muscles, pain under active resis- baseball bat can often be the tive movement during elbow flexion. cause of originating pain. It can also originate from chop- Contraindications ping wood with an ax, chain Tendon ruptures and muscle tears require extra precau- saw work, carrying a heavy tion. If severe or persistent joint pain occurs accompanied by suitcase, throwing a javelin redness, swelling or loss of joint function, do not treat without and hand tool use. further medical attention. Beware of inflammation disorders Most of the wrist flexors join together and attach to one like Rheumatoid Arthritis and Gout.

Golfer’s Elbow Technique Sequence Position: Your patient’s torso should be upright, standing or sitting on the massage table, facing you directly. Have your patient hold their left upper arm directly out in front of themselves, parallel to the floor, with elbow flexed to 90º 1 and their hand pointed directly upwards. Do not hold your patient’s arm up for them.

1. Using Reinforced Thumbs or Hooked Fingertips, press into tender area, dis- tal to and slightly medial to the medial epicondyle of the humerus. »»Deeply and aggressively Cross-Fiber Friction for 30-seconds. 2. Lay your right thumb laterally, across the forearm muscles about 1-2” above 2 the medial epicondyle as your fingers cradle their elbow. »»Place your left thumb vertically over your right thumb and press firmly while dragging the tissue into tension toward their olecranon process.

3. Hold the tissues taught with firm pressure and instruct your patient to extend their arm into a straightened position (extension). 3 a. To enhance the stretch, have your patient externally rotate their forearm into internal rotation with simultaneous extension. b. Repeat the Pin & Stretch several times.

4. Finish with either Ice Massage (Ice & Wipe), or wrap the area with an ice- pack, making sure to buffer the cold enough to avoid ice burns. 4 »»Be sure to ice until the treatment site remains cold to the touch using the back of your hand to evaluate. Treatment site should remain cold to the touch for a full (60) seconds after icing.

20 ©2018 Haase & Associates, Inc., Haase Myotherapy® Seminars - www.haasemyotherapy.com ©2018 Haase & Associates, Inc., Haase Myotherapy® Seminars - www.haasemyotherapy.com 21 Deltoid Tendonitis 6. As you stand behind your seated patient, use your left hand to help hold their left arm out parallel to the floor in abduction (active abduction of the arm to 90º) resulting in a shortened deltoid muscle. 6 a. Rest the heel of your right hand on top their left AC joint. b. Using your Fingertips, draw the deltoid muscle fibers back toward the AC joint, keeping the tissue taught. 7. Drop their arm back to their side as you hold the tissues taught for a Pin & Stretch. a. Repeat several times. 7 b. Repeat the same technique with your patient performing the movement actively.

8. Follow with Ice & Wipe or wrap in an ice pack. ÂÂTreatment site should remain cold to the touch, using the back of 8 your hand to evaluate, for a full 60-seconds after icing.

Subacromial Bursitis What Is It? Contraindications Often referred to as the generalized terms, shoulder bur- Bulge or lump formation requires further medical advisory. sitis or subdeltoids bursitis. This condition occurs when the subacromial bursa becomes inflamed and the coracoacromial tendon and subacromial bursa thicken creating more friction Corocoacromial during shoulder articulation. Activities of exacerbation include Ligament throwing a ball, lifting heavy objects overhead, washing hair, reaching high, forceful pulling or trauma such as falling on Acromion shoulder. When bursitis becomes advanced, passive ROM oc- Bursa curs categorizing the condition as adhesive capsulitis, or frozen Supraspinatus shoulder. Tendon Symptoms Shoulder stiffness, pain. Swelling and redness. Pain is felt at 60-90 degrees of when moving the arm into flexion with exter- Humerus nal rotation (moving up and outward).

Indications Gradual onset, Impingement Syndrome may already be present. Wakeful sleep due to pain. Anterior shoulder or top lateral top-third of the upper arm may be sore to touch. (Anterior View)

28 ©2018 Haase & Associates, Inc., Haase Myotherapy® Seminars - www.haasemyotherapy.com ©2018 Haase & Associates, Inc., Haase Myotherapy® Seminars - www.haasemyotherapy.com 29 Bicipital Tendonitis What Is It? Symptoms It is an inflammation of the long head of Dull, achy or sudden acute pain on front the biceps brachii. It is commonly referred to of shoulder. Swelling, bruising, weakness or as the fifth shoulder muscle. The long bicipital snapping/clicking sensation during shoulder tendon head passes through humeral bicipi- articulation. tal grove and attaches on the superior aspect of the labrum of the glenoid fossa. Both the Indications anteriorly exposed tendon and tendon sheath Radiating pain in the shoulder, especially may thicken as a result. Exacerbating factors when laying down in bed at night. Flexion of include lifting, elevated pushing or pulling. the elbow against resistance can be painful. It Pain with overhead activity, throwing a ball can also be tender to resist supination while or lifting heavy objects. the elbow is flexed and the arm is in adduc- Although the short head of the biceps tion. It always hurts with direct palpation brachii performs the vast majority of the (cross-fiber) on the tendon or musculotendi- work, the exposure of the long head is results nous junction. in a higher frequency of injury. Contraindications Infection or lump on affected area requires medical advisory.

Bicipital Tendonitis Technique Sequence Position: Patient may be seated, standing, or supine. 1. Locate the musculotendinous junction of the biceps brachii short head by hooking your index finger upward at the anterior edge of the patient’s armpit fold. 1 2. With Locked Thumb or Reinforced Fingertips, use firm pressure to friction the medial head of the bicipital tendon. a. Grind cross-fiber for at least 30-seconds, but no more than one minute. ÂÂExplain to your patient that the technique will be uncomfortable during the 30-second friction and get verbal consent prior to treating. 2 3. Bring your patient’s arm into anterior flexion.Rest your wrist on their shoulder and place your Hooked Fingertips on the short head of the biceps head with firm pressure. »»Allow their arm to drop back down to their side as your fingertip pressure provides friction as it drags the length of the biceps brachii short head tendon and superior muscle fibers. 3

4. Follow the treatment with ice massage in a with-fiber direction using Ice & Wipe. ÂÂTreatment site should remain cold to the touch, using the back of your hand to evaluate, for a full 60-seconds after icing. ÂÂIf an ice cup is unavailable, wrapping in an ice pack will suffice with 4 nearly the same effectiveness.

30 ©2018 Haase & Associates, Inc., Haase Myotherapy® Seminars - www.haasemyotherapy.com ©2018 Haase & Associates, Inc., Haase Myotherapy® Seminars - www.haasemyotherapy.com 31 Subscapularis & Frozen Shoulder What Is It? bursitis can occur but generally subacromial bursitis is more common. Other terms used are pericapsulitis, periarthritis, There are essentially two types offrozen shoulder. This se- adherent bursitis, obliterative bursitis. It is identified as an id- quence will be treating the type which is a muscular contracture iopathic restriction of shoulder mobilization that is generally of the muscle belly which usually initiates as a response to trau- painful during onset, originating from an adherence of a bursa ma and has a rather sudden onset. to the humeral head. Additional causes can include structural The other type of frozen shoulder is known as adhesive cap- changes around the shoulder, autoimmune, endocrine or other sulitis, which is based on scar tissue and adhesions. This type systemic diseases. has a gradual onset with increasing restriction to the shoulder’s range of motion. Symptoms The best way to determine the difference is the shoulder’s mobility when the patient is under general anesthesia. Frozen Frozen shoulder originating from muscular contracture shoulder originating from a contracture will relax under anes- will usually have a sudden onset, with significant initial pain, thesia, whereas adhesive capsulitis will not. especially when attempts are made to move the shoulder joint, Adhesive Capsulitis is a generalized term used to describe both passively and actively. The splinting effect of the contrac- advanced bursitis. There are six capsules in the shoulder where ture will usually relax over a period of time. Frozen shoulder originating from adhesive capsulitis usual- Subscapularis Insertion at ly begins with a generalized ache which is difficult to pinpoint. Lesser Tubercal The pain is present with movement and can increase at night of Humerus or when resting. As the pain subsides, the restriction increases. The scar tissue and fibrous adhesions can eventually soften, but not completely, necessitating a surgical intervention.

Indications Both forms of frozen shoulder can be helped by the proprio- ceptive neuromuscular facilitation (PNF) technique in steps five through seven of this sequence. Muscular based will respond with increased range of motion in a single visit, whereas the adhesive capsulitis form will only find limited relief.

Contraindications Aggressive stretching and joint mobilization during acute phase for adhesive capsulitis, as well as deep friction when the patient is taking anti-inflammatory medications. PNF if mus- (Anterior View) cle tears are present. Subscapularis & Frozen Shoulder Technique Sequence Position: Stand in a Forward Lunge table side. Patient lies prone to decrease likelihood of patient’s desire to assist, engaging their muscles instead of relaxing. 1 1. Use an excessive amount of oil or lotion to smooth the entire axilla/armpit. Smooth in circular movements until the surfaces are completely lubricated, allowing uninhibited glide of your fingers.

2. Drag your fingertips along the table-top and then up and into the axilla as your outside hand slides along the side of your patient’s ribcage. 2

32 ©2018 Haase & Associates, Inc., Haase Myotherapy® Seminars - www.haasemyotherapy.com ©2018 Haase & Associates, Inc., Haase Myotherapy® Seminars - www.haasemyotherapy.com 33 Head, Neck, & Whiplash Treatment Whiplash Indications • Muscle spasms, muscle weakness, whiplash, nerve What Is It? impingement injuries, tendinitis, arthritis, headaches and migraines. A hyperextension and flexion injury to the cervical spine resulting from whipping of the neck. Usually from a sudden Contraindications whip-like movement from acceleration-based events, such as a motor vehicle accident. • No testing of the neck which involves pressure or 60-70% of those with Thoracic Outlet Syndrome (TOS) force. had injury to neck or shoulder girdle, and whiplash is the main • Avoid extreme stretches in the acute and sub acute cause of neurogenic TOS. stages. • Avoid extreme stretches to cervical muscles in acute Symptoms and sub-acute stages. • Do not mobilize hyper-mobile cervical vertebra. • Neck pain and stiffness in the neck • Pain worsens with neck movement Endangerments • Reduced or loss of range of motion in the neck • Headaches, most often stemming from the occiput Carotid sinus mechanism: • Pain and soreness in upper back, shoulders, and arms • Do not directly compress the carotid artery. • Tingling or numbness in the arms • Do not massage the SCM muscles simultane- • Fatigue ously. • Dizziness • Do not apply pressure to the thyroid gland. Scalenes Additional symptoms may include: • Blurred vision • Ringing in the ears (tinnitus) • Sleep disturbances • Mood swings and irritability • Difficulty trying to concentrate • Memory issues • Anger, erratic behavior • Reduction sexuality and libido • Anxiety, depression The scalene muscles are accessed via the posterior triangle • Dysfunctions resolve when pain resolves which is defined by its borders, including the posterior border of the SCM, the anterior border of the trapezius muscle, and the middle one third of the clavicle.

Important Caution When Treating the Anterior Throat and Neck When working the anterior neck, it is normal to Should any technique result in a sharp pain, do not feel a pulse in this area. Pinching or compressing continue the procedure and immediately refer your patient that pulse is not a good idea, however. to a medical doctor or chiropractor. You should also re- There is a mechanism in the carotid artery fer your patients to a chiropractor or medical doctor if the called the carotid sinus. This mechanism is designed to patient experiences any dizziness, numbness or tingling monitor the body’s blood pressure and sudden pressure on sensations. the carotid artery, or near it, can sometimes lead the Carot- id Sinus to believe the body’s blood pressure has suddenly ÂÂIf you have a patient that suffers from a severe increased. The mechanism reacts by dropping the blood headache that has no relief (non-stop, constant) for pressure systemically, causing your patient to likely pass 3-days or more, do NOT massage the patient but out. To prevent this, simply ensure any pulse remains next immediately recommend the patient go to the ER to to your fingers, never between them. exclude potential tumor or aneurysm as the source. Massage only when this is excluded as a possibility.

34 ©2018 Haase & Associates, Inc., Haase Myotherapy® Seminars - www.haasemyotherapy.com ©2018 Haase & Associates, Inc., Haase Myotherapy® Seminars - www.haasemyotherapy.com 35 Seated Head & Neck When working with patients dealing with issues in their have more control of their movement while inhibiting your pa- head and neck region, it is important to have a variety of meth- tient’s ability to assist in the movement. This allows for optimal ods to address the complex structures of their anterior and stretching and overall better mobilization. posterior neck. The seated position allows you as a therapist to

Seated Head & Neck Technique Sequence Position: Stand behind your patient as they are seated on a stool.

1 1. Place the heel and thenar pad of your RIGHT hand on the RIGHT side of your patient’s neck and glide downward along the upper trapezius toward the shoulder as they drop their LEFT ear toward their LEFT shoulder. a. Have your patient maintain position as you place the heel and thenar pad of your LEFT hand on along the LEFT side of your patient’s neck and glide downward along the upper trapezius toward the shoulder as they drop their RIGHT ear toward their RIGHT shoulder. Repeat. 2 ÂÂThe purpose is to slide down along the superior aspect of the trapezius muscle, but to stop before you reach their AC joint. 2. PNF of cervical spine for increased ROM: »»Hold the patient’s shoulders still and have them turn both LEFT and RIGHT to determine their current range of motion 3. With the patient looking directly FORWARD, place the flat of your LEFT 3 hand on the LEFT side of their face and hold steady as you have them take a deep breath and attempt to turn LEFT against your resistance for two to four seconds. a. Release your resistance as they exhale, and then move their head a few degrees farther to the LEFT and repeat the same restricted movement as they take a deep breath. Then release the restriction as the patient exhales and relaxes. 4 b. Move the patient’s head a few more degrees to the LEFT, reposition your hands as necessary for support and ask the patient to turn toward the RIGHT this time. You will resist the movement as the patient takes a deep breath, and then release the restriction as the patient exhales and relaxes. Cervical PNF TIPS: c. Again, move their head a few degrees further to the LEFT and repeat the ÂÂYou will find it helpful to use your same restricted movement as the patient takes a deep breath and attempts elbow to brace against your pa- to turn their head to the RIGHT. Release the restriction as the patient tient’s anterior shoulder. exhales and relaxes. ÂÂTo simplify, you are attempting to 4. Continue this same pattern of two resisted movements to the LEFT, followed increase ROM toward the LEFT by two resisted movements to the RIGHT, each time incrementally continu- with several resisted movements. ing the head’s movement to the LEFT until you reach their maximum end feel. Once at the end feel, you will re- a. Bring the patient’s head back to the center so they are looking forward peat resisted movement toward and repeat the same sequence as they move incrementally toward the the RIGHT. RIGHT shoulder. ÂÂThe pattern is: Two resisted LEFT, b. Once you have completed the technique to the RIGHT cervical end feel, two resisted RIGHT, two resisted reevaluate by returning the patient’s head back to the mid-line, hold their LEFT, two resisted RIGHT, until shoulders in place, and ask them to turn as far as they are able to the you reach the end feel. LEFT and then to the RIGHT to determine the increase in ROM.

36 ©2018 Haase & Associates, Inc., Haase Myotherapy® Seminars - www.haasemyotherapy.com ©2018 Haase & Associates, Inc., Haase Myotherapy® Seminars - www.haasemyotherapy.com 37 Seated Head & Neck 5. Using an Open Claw Hand, place your LEFT thumb at the base of the far LEFT side of your patient’s suboccipital ridge. Place your RIGHT hand along the RIGHT side of their head, slightly toward the forehead. a. Holding firm pressure into the occiput, passively roll their head forward 5 in an arc toward the floor. Don’tpush the head forward, but curve it like a swan’s neck movement. b. Bring the head back to the starting position, this time placing your LEFT thumb slightly to the RIGHT of the previous press-point and repeat until you reach the middle of their occiput. c. Alternate your hand positions and continue the sequence using your RIGHT thumb to work along the RIGHT side of the occiput.

6. As an option to using your thumb, you can instead stand in front of your patient and use your Hooked Fingertips at their occiput with the other hand bracing against their forehead. 6

7. Place both hands on top of your patient’s trapezius muscles with full palmar contact, resting your flat, inline fingers over their scalenes toward the clavi- cles. Your thumbs will rest on the posterior trapezius. 7 a. Have your patient laterally rotate their head to the RIGHT as you broadly squeeze the LEFT trapezius. Now squeeze RIGHT as they turn LEFT. ÂÂDo not bend your fingers or you will potentially injure their scalene muscles. 8. Perform Pin & Glide strokes around the entire circumference of the neck. Begin by using Hooked Fingertips, place broad pressure on the RIGHT side of your patient’s posterior cervical muscles and your other hand at the crown of their head. 8 »»Gently roll their neck forward as you glide downward, tugging their leva- tor scapula, splenius capitis, splenius cervicis, and other cervical muscles for a Pin & Glide. 9. This same Pin & Glide technique can be used all along the lateral and posterior cervical muscles using a combination of Hooked Fingertips, Locked Thumb, and Open Claw Hand. 9 ÂÂAlways move the head passively in the opposite direction from the placement of your pressure.

10. Continuing the Pin & Glide work around the anterior neck, use relaxed, soft finger prints with moderate to gentle pressure. 10

36 ©2018 Haase & Associates, Inc., Haase Myotherapy® Seminars - www.haasemyotherapy.com ©2018 Haase & Associates, Inc., Haase Myotherapy® Seminars - www.haasemyotherapy.com 37 Gluteus Medius & Minimus What Is It? tes, and down the upper leg. Gluteus medius and gluteus minimus lay one on top of the Indications other, with the minimus being the inferior of the two. Orig- inating below the iliac crest and inserting on the greater tro- Patient has a history of hip pain for much of their adult life chanter, these muscles work together to abduct the hip as well with pain referring into the posterior and lateral hips, buttocks as offer both internal/external rotation and flexion/ extension and down the leg. of the hip. Specifically, gluteus medius problems are often the result of Contraindications Morton’s Toe/Morton’s Foot Structure, where the first metatarsal Hypermobility of the hip joint would preclude steps six bone of the foot is shorter than the second metatarsal. This ana- through nine. tomical anomaly results in the big toe, or first toe, being shorter than the second toe.

Morton's Toe, also known as Morton's Foot Structure

If Morton’s Toe is present, a podiatrist can fit a quality or- thotic to help compensate for the problem. Morton’s Toe not only leads to problems with the gluteus medius, but eventually will affect the vastus medialis, and peroneus muscles.

Symptoms Pain on the lateral side of the hip, painful trigger point re- ferral patterns will cause radiating pain into the low back, glu-

Gluteus Medius & Minimus Treatment Sequence Position: Standing with your hip against the foot of the table with, instruct your patient move to the end of the table until their buttocks is flush with the edge. Have them bring their knees to their chest in a fetal position. 1. Outline the space between the lateral iliac crest and greater trochanter. 1

2. Use a Reinforced Thumb, Passive Thumb Reinforced with Fingertips, or your Heal of Hand, to work the bellies of the gluteus medius and minimus. Your force is downward. Work with Trigger Point, Static Pressure, and Cross-Fiber Friction. 2 ÂÂ Cross-Fiber is from an anterior to posterior direction.

60 ©2018 Haase & Associates, Inc., Haase Myotherapy® Seminars - www.haasemyotherapy.com ©2018 Haase & Associates, Inc., Haase Myotherapy® Seminars - www.haasemyotherapy.com 61 Self-Stretching Techniques

Fundamentals of Self-Stretching risk to injury, improves circulation, breathing and increase joint range of motion.

What Is It? Indications It is the deliberate flexion or elongating of tendons and Everyone should stretch. The physiological benefits are muscles with the objective of improving the elasticity and endless as muscles directly affect and work collaboratively with healthy muscle tone. With frequent stretching, patients will the vast majority of our other bodily systems. When muscle gain flexibility and increased range of motion. There are two constriction occurs, damage to our joints, bones, respiratory main types of stretching which include dynamic (movement system, digestive system and neurological system may prevail. based) stretching and static (no movement) stretching. With- in these two types are many different sub types of stretching Contraindications which include: ballistic, passive stretching, active stretching, Bone fractures near surrounding tissues, torn muscles and active isolated stretching, active resistive stretching, isometric tendon ruptures. Seek medical clearance before performing stretching and PNF stretching. these exercises. Proceed with caution when working with geri- atric patients. Purpose Stretching is designed to improve flexibility of the muscles, Endangerments muscle systems and fascia. The intention is to lengthen the co- Note that prenatal women have a hormone called relaxin in hesive systems so that they can further improve our neurology, their system that increases laxity of joints. Make sure your pa- postural alignment, muscle function and enhance our kinetic tient knows their natural end feel so that over-stretching does energy. not occur. Expected Outcome ÂÂScope of Practice: Prescribing stretches is not within the scope of practice for all medical pro- Flexibility, mobility and improved interconnectedness be- fessionals so be aware of your state’s laws. Sug- tween muscles and the brain. Stretching reduces muscle pain, gesting is usually acceptable, however. Self-Stretching Techniques Pelvic Rocking Lay supine with your knees close to your chest. Place your hands together under your knees. Rock gently forward and back 6-12 times. You may also can rock side-to-side 6-12 times.

Hip Hike To stretch the glutes, lay supine, with feet flat on the ground. Hike your hip by moving the right hip toward the ribs slowly and evenly followed by the left side. Alternate sides 12-15 times each. Concentrate on using your low back muscles for these movements. This meth- od also works.

Side-Position With knees at 90º, extend the top knee out Hike and then back 12-15 times. Repeat on other side.

80 ©2018 Haase & Associates, Inc., Haase Myotherapy® Seminars - www.haasemyotherapy.com ©2018 Haase & Associates, Inc., Haase Myotherapy® Seminars - www.haasemyotherapy.com 81 Self-Stretching Techniques

To stretch the back extensors and abdominals, Cat Stretch get onto your hands and knees, arch your back and inhale with your head and eyes up.

Hip Circles

On your hands and knees, work your hips like a gyro with to larger circles. Stop fully and then work the motion in the maximum ROM in mind. Start with small circles and increase other direction.

Thoracic Mobility Stretch

Laying on your back with knees together, roll your upper that you twist at your waist to. To increase the stretch, curl the body one direction while your legs drop the other direction so arms over head toward the direction of the upper body.

Laying on your back, position your left foot Piriformis on floor with your knee up. Cross the right Stretch ankle over the left/up knee.

Push right knee toward your head with right fingers. Now, push away from your head.

12-15 times on each leg.

To stretch the obliques, lay on your back, Side-to-Side place your feet on floor and spread them Knee Drop spread apart. Lower one knee inward toward the other as far as is comfortable while keeping the other knee up and stable.

12-15 times each on each side.