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Modified NISA:
Start of with patient sidelying on asymptomatic side. Have them raise their hand above their head. Starting from the last rib, progressively stretch the skin using thumbs by using medial stokes to opposite sides (ie. one thumb ant. and the other post.) until you reach the teres muscle belly (patient uncomfortable). Bring arm down to anatomical position and jam the thumb as deep as it can go into the belly of the subscap (patient feels pain). Very gently and slowly raise arm into forward flex position while sliding the thumb down to apex of the scapula (patient feels pain). Do this three times ensuring effective drag with the thumb. Skin roll from lat to spinous process (snake bite sensation) ensuring full coverage of the scapula. Skin roll biceps and teres. Insert thumb into muscle belly of biceps when passively contracted position and then extend elbow using the same techniques as the subscap (you must also include ALL tendons). ART teres, infra and lats. Skin roll delts.
Hope this helps
Adamo
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