Figure 8: Pressing Petrissage upon Brachialis
Figure 9: Midline Knuckles on Brachium
Three basic steps: 1. Place PIP (proximal interphalangeal joints) of both hands together at the center of the biceps brachii muscle (See Figure 9). Press with firm to medium pressure into the muscle. 2. The therapist slowly ulnar deviates (abducts) his/her wrist with both hands, creating a slow, gliding force in opposing directions. 3. The therapist continues this slow, gliding force in straight lines toward the table with both hands. Continue this stroke until both sets of knuckles strike the table. Freeing the medial epicondyle Therapist uses distal interphalangeal (DIP) joints of index and middle digits to create a scooping motion away from the medial epicondyle landmark (See Figure 11). Each scooping motion may be one to two inches. Moving in a proximal direction from this landmark addresses the triceps brachii muscle. Moving in a distal direction from this landmark addresses the common “flexors tendon” at which many anterior antebrachial muscles converge. Repeat the scooping motion several times, creating space around this key landmark. Figure 11: Knuckle Scooping Inferiorly The therapist uses the radial side of the thumb to accomplish the same goal of creating space as the prior technique, knuckle scooping (See Figure 12). Each scooping motion may be one to two inches. First, the therapist will guide the olecranon process at the distal end of client’s medial epicondyle with client’s arm upon the table with the palm forward and the hand near client’s head (See Figure 13). A small towel bolster may help a client achieve this position if there is any discomfort. Second, the therapist will begin this sequence of movement: Freeing the flexors The therapist grasps the client’s forearm to have his/her palm facing the therapist, hand near the client’s head. Therapist has thumbs parallel upon the flexor (anterior) side, fingers grasping firmly on the extensor (posterior) side. The therapist creates an alternating pressure movement – first on the radial side of forearm, then on the ulnar side. Repeat alternating motion several times to create space in the interosseous membrane.
The therapist uses straight fingers to begin the stroke at the superior aspects of the olecranon process, then scoops tissue in a proximal direction (See Figure 10). Repeat several times. Figure 10: Peeling at Olecranon
The therapist glides the elbow approximately a half inch distally upon forearm as he/she elevates their hand, then presses deeply with pressure when therapist lowers his/her hand toward the client’s forearm. Repeat this motion several times until the therapist has glided distally enough to contact flexor tendons (thereby being off muscle belly). Figure 12: Thumb Friction
Figure 13: Elbow Scooping Inferiorly
This technique can also be accomplished in a comparable manner with the client’s arm resting palm down on the table. The therapist creates alternating pressure movement, first on the radial side of forearm, then on the ulnar side. Repeat this alternating motion several times to create space in the interosseous membrane.
Figure 14: Compressions
Page 25
Book Code: MTX1323
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