Scap-Off Load

Scap Off Load Remedial Massage SetUp

A Scap-Off Load is a special test or functional test that we use to evaluate the implication of Lev Scapular and Up. Trap in Cercival Rotation.

As previously mentioned, in cervical rotation, we got a fair bit of muscle working towards this action.Scap off load

As many clients come in with cervical pain, it’s time to explain in more detail what’s going on there.

Cervical Rotation. How does it happen?

So, when we rotate our head, either right or left, the muscle on the same side of the rotation movement is contracting.

If a muscle along those is weak, we may reproduce pain in rotation along the same side.

To thin down which muscle is responsible for the limited ROM, we have to safely deactivate some of them to see if the left behind one can deliver the expected movement.

Here is an example of how scap offload works.

If a client comes in with 30° Cervical rotation on the R and pain on top of the scapula, that could be an indication that its levator scapulae is the muscle to target.

To confirm this hypothesis, I would ask the client to shrug their shoulders and flex their elbow (the client is sitting on a stool).

After that, I will make my way behind the client, and I will support their shoulder weight with my forearm and hands.

As the client relieves the shoulder tension, that lev scapulae and up. Traps. are now deactivated.

The next thing would be to ask the client to perform the cervical rotation.

Ideally, I would like to see the client have a full range of motion (80° to 90°).

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Cervical Scap Off Load

That would tell me that the only muscles that are limiting the cervical rotation are the lev scap. and up trap.

On the other hand, what could happen, is that the cervical rotation is, yes improved, but still limited, compared to the ROM expected.

In this case, the muscles involved in the stiff range of motions are not only lev scap. and or upper trap.

In fact, what is causing the limitation is the cervical occipital muscles.

And yes, spending long hours at the computer or looking at the phone doesn’t help.

After this test, to narrow down even more which other muscles are involved in the stiffness of the cervical area, I do run another series of tests.

Those tests would look into joint areas like C0-C1, which would refer to Obliquus Capitis Superior muscle, and the C1-C2 test, which would look at tension for Obliquus Capitis Inferior.

Furthermore, for the other facet joints that make up the lower cervical region (C3 to C8), I would analyze each facet joint individually.

These series of tests are indeed part of my Myotherapy training.

Last would be then the usage of the joint mobilisation technique. In this case, we would look into what joint has lost mobility or which one has an excess of it.

Strengthening the cervical.

In order to improve the presentation, massage on its own is not enough.

As per any condition so far, the strengthening of the muscle, in this case, the cervical and upper thoracic one, would allow to prevent further pain and discomfort.

The work that the cervical muscle has to do daily is considerably high, giving the natural weight of the skull. So exercising a chin tag in a supine position can help.

Ideally, we would do these exercises in the supine position (lying down face up) so that we have gravity to fight back as we train our deep flexors.

To further improve the strengthening, once the chin tag is not enough, we can start using a soft rubber band to create resistance.

Said so, be mindful that the cervical area is a delicate area to work on too, and those exercises are best practice under the supervision of an expert trainer or massage therapist.


Giovanni La Rocca

Giovanni moved to Melbourne, Australia, from Italy in 2008 and became a citizen in 2017. He started studying massage therapy in 2016, then completed a Bachelor of Health Science in Clinical Myotherapy in August 2024. During those years, he also specialised in Thai Massage and Manual Lymphatic Drainage for presentations like Lipedema and Lymphoedema. Nowadays, he runs his clinic in Fitzroy North, Melbourne, where he integrates movement therapy into his practice to enhance overall well-being. He also values meditation, having completed several Vipassana courses. Committed to continuous learning, he aims to share his expertise in integrated therapies to help others achieve balance and resilience.

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Arm Lymphoedema Quiz

Based on the original document - Piller,NB (2006) Lymphoedema Research unit Department of surgery, Flinders Medical Centre, Bedford Park, South Australia,  5042 (Adapted and reprinted with permission). This guide is designed as an educational aid-based primary on experience, no evidence in literature.

(Optional)
1. More than 10 nodes removed from armpit
2. Radiotherapy to armpit area
3. More than 2 infections (redness) in the limb per year
4. Whole of Breast Removed (Mastectomy)
5. More than 2 but less than 10 nodes removed from armpit
6. Radiotherapy to chest/breast area
7. Fluids drained from wound more than 1 week
8. Infection at the wound site
9. One infection (redness) in the limb per year
10. Heaviness, tightness or tension in the limb at times
11. Frequent cuts/scratches to the limb
12. Dry skin
13. Part of Breast removed
14. 1 or 2 nodes removed from armpit
15. Limb feels different as the day progresses

OTHER PROBLEMS WHICH MAY ADD TO RISK

16. Body weight is very high (obese)
17. Surgery was on side of dominant hand
18. Generally experience high stress levels
19. Generally have high non-controlled blood pressure
20. Body weight is a little high (overweight)
21. Frequent long distance air traveler
22. Previous or current other injuries to limb/shoulder
23. Thyroid gland activity is not normal and not medicated
24. “At risk” limb is used for repetitive actions
25. Often carry heavy loads for long periods using “at risk” arm
26 Smoking is currently part of my life
27. Swelling was present in limb prior to surgery

What to do now?

    • If you are at LOW RISK, then you will benefit from a range of appropriate educational literature that may be able to even further reduce the risk of developing lymphoedema.

    • If you are at MODERATE or HIGH RISK, then the educational materials will also benefit you. Ideally, if you are in these categories, you should have a non-invasive assessment (Bio-impedance spectroscopy or Tissue Dielectric Constants) to determine if there are already some fluid accumulations in your "risk" limb.

Independently of your level of risk, Giovanni offers 15-minute Online Consultation to better guide you on how to manage this presentation, or prevent any degeneration.

Book your free 15-minutes online consultation now.

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Lipedema Questionnaire

This is not a diagnostic tool but only a guide.
To learn more about the Lipedema presentation, contact Giovanni by sending the result, or booking a free 15-minute online consultation. Be sure to include your full name and email address in the form below (At the end of the quiz).

If you prefer to contact Giovanni anonymously, call with a private number at 0449790781.

Texture of fatty tissue may feel granular and/orfibrotic
Symmetrical, disproportionate accumulation of fatty tissue (refer to picture on the Lipedema page)
The waist may be small in proportion to thighs, buttocks, and legs
Cuffs or bulges may develop around joints (e.g. ankles, knees, elbows, wrists). Feet remainunaffected unless lymphoedema is a comorbidity
Legs are often hypersensitive to touch and pressureand may feel cold
Affected areas may bruise easily with minimaltrauma
Patients describe affected areas as sore, painful, heavy, swollen and tired
Symptoms can worsen in hot weather, during orafter exercise, standing or sitting for long periods
Fat pads, which can be tender or painful, accumulate on the upper outer thighs, inner thighs, and around the knee area, can cause abnormal gait,and contribute to joint pain
Filling of the retromalleolar sulcus
Hypermobility
Soft, thin skin with loss of elasticity. Skin can havea lumpy appearance.
Non-pitting oedema and negative Stemmer’s sign on feet and hands in the absence of coexisting lymphoedemaPitting oedema is when by appling pressure to the area with a finger, for more than 60 seconds, you get left an indentation in the skin.
Difficulty losing weight from affected areas despite exercise, modified diet or bariatric surgery. If well-directed, these measures may help reduceinflammation and co-existing obesity if present
Abnormal nerve sensations
Pain on blood pressure check (larger cuff may berequired)
Relatives with similar body shape or fat distribution

Out of 17 questions, the number above, tells you how many symptoms applies to you. The more symptoms, the more luckily you are suffering from a Lipedema presentation. Get in touch with Giovanni now, via the form below, for further understanding on how to manage Lipedema presentation.

Reference list

This quiz is a reproduction of a flyer from the association Lipoedema Australia.
The reference list is Adapted from 1, 4, 5, 6, 7, 8, 9, 12, 13,14[1] , 16, 18 and available here (PDF).

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Leg Lymphoedema Quiz

Based on the original document - Piller,NB (2006) Lymphoedema Research unit Department of surgery, Flinders Medical Centre, Bedford Park, South Australia,  5042 (Adapted and reprinted with permission). This guide is designed as an educational aid-based primary on experience, no evidence in literature.

(optional)
1. More than 10 nodes removed from the groin
2. Radiotherapy to the groin/pelvic area
3. Average of more than 2 infections (cellulitis) in the limb per year
4. Dry or scaly skin on lower legs/feet
5. More than 2 but less than 10 nodes removed from groin
6. Fluids drained from wound more than 1 week
7. Infection at the wound site after surgery
8. Average of one infection (cellulitis) in the limb per year
9. Frequent cuts/scratches to the limb
10. 1 or 2 nodes removed from the groin
11. Heaviness, tightness or tension in the limb at times
12. Limb feels worse as the day progresses

OTHER PROBLEMS WHICH MAY ADD TO RISK

13. Family history of leg swelling
14. Frequent long distance air/bus/car traveler
15. Previous or current other injuries to legs, ankles or feet
16. Limb is most often in a dependant position (standing)
17. Generally experience high stress levels
18. Generally have high blood pressure
19. Thyroid gland activity is not normal and not medicated
20. Diabetic but controlled by diet or medication
21. Diabetic uncontrolled
22. Some varicose veins or spider veins
23. Many varicose veins or spider veins
24. Prior varicose vein stripping and scars
25. Smoking is currently part of my life
26. Body weight is a little high (overweight)
27. Body weight is very high (obese)
28. Diet is rich in animal (omega 6) fats
29. Swelling was present in limb prior to surgery/radiotherapy

What to do now?

    • If you are at LOW RISK, then you will benefit from a range of appropriate educational literature that may be able to even further reduce the risk of developing lymphoedema.

    • If you are at MODERATE or HIGH RISK, then the educational materials will also benefit you. Ideally, if you are in these categories, you should have a non-invasive assessment (Bio-impedance spectroscopy or Tissue Dielectric Constants) to determine if there are already some fluid accumulations in your "risk" limb.

Independently of your level of risk, Giovanni offers 15-minute Online Consultation to better guide you on how to manage this presentation, or prevent any degeneration.

Book your free 15-minutes online consultation now.

Save as Draft

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