KATA KO RI
MINILESSONS 3

This treatment was published in the magazine MASAJE no 20. It was written by Yoichi Asaka, who was instructor of the Japanese Shiatsu School in Madrid. Nowadays, he is the manager of a manual therapies center in Tokyo (Japan).

Kata Ko Ri, could be translate as stiff shoulder or severe shoulder contracture. Most of the people have suffered once in their life (as low back pain), seem as these pains were part of the destiny of the human being.
"Quick Shiatsu = Chair Shiatsu", is popular nowadays, not only in Japan but in any part of the world and this shows that lot of people is having physical problems.
The causes of this disease are varied. There are "unexpected" symptoms that don't obey to any physical origin and on the other hand, there are secondary symptoms that came from physical problems. For that reason the variety of symptoms is infinite.

Attending to the most common causes it could be divide as follow:

1.- Bones muscle or tendon problem. Cervical spondylosis, arthritis, Intervertebral disk displacement, biceps tendinopathy, frozen shoulder, etcc
2.- Post traumatic problems. Whiplash, sport injuries, etc..
3.- Internal organs disease: Heart, stomach, liver, gallbladder. If these organs have problems, it would be reflect on the shoulders through the autonomic nervous system.
4.- Face and head disorders. Eye, teeth and ears problems.
For 1 to 4 points it would be necessary to treat the cause of distress, apart from the shoulder treatment.
5.- Structural problems. For example women with sloping shoulders.
6.- Physical discomfort . When no medical diagnosis is found in Rx and RMN, patient has pain but no specific cause is found. Could be related with menopause and autonomic nervous system imbalance.
7.- Muscular fatigue ( due to poor posture). If the same posture is maintained for a long time, blood circulation is affected and lactic acid begins to accumulate in a specific zone.
These toxins when mass produce pressure, pain and discomfort.
Number 6 & 7 are the more frequent causes of frozen shoulder.
To treat these causes we would use cataplasms, creams and muscle relaxants,
If these products don't have any effect, treatment with shiatsu would be most effective as don't have side effects, is most recommended and deserve a special mention.
To start with, lying face down shiatsu work will follow this sequence:

1.- Occipital region
2.- Posterior cervical region
3.- Lateral cervical region
4.- Suprascapular region
5.- Base of the neck
6.- Interscapular
7.- scapular region
After that we'll work around the back, working between C7 & D7
Though is out of the line of basic shiatsu, here we could notice some stringy contracture stuck in the spine. When we found this tension, first we would do a perpendicular pressure to deepen the pressure. Second, keeping the pressure strength we'll change the direction, as taking off the stringy.
I would work each point three or four times, following the same procedure. Paying attention not to exceeding the number of pressures to avoid inflammation or an over reaction.
To continue, we will place the patience arm bent behind his back, to notice the shape of the scapula.
If there is any problem with the shoulder joint, do not force the movement (frozen shoulder).
This time I would work around the superior corner of the scapula, between the insertions of the levator scapulae and rhomboid minor muscles.
Shiatsu therapy has three main rules: First one says that pressure must be always perpendicular to the surface we are pressure, most of the times we must respect this rule, but sometimes the direction of the pressure can be change. Changing the direction of the pressure you can get different sensations and effects. For instance on this occasion we could pressure in four different directions.

Most of the people that complain of shoulder pain have a knot or a "mass" in the zone.

After have worked this zone and with the patient in the same position, we would check the medial corner of the scapula. But on this occasion we won't pressure as we did when working the second line of the interscapular region. This time we pressure deeper the subscapular region.

The aim of the pressure is as taking off the scapula from the body. If you can't go through with the thumb, you could use the movement of the upper extremity of the patient to help. If the muscles that cover the scapula are to stiff is very difficult to find a place to deepen the pressure.

To exceed the limit of the joint movement cause discomfort on the shoulders, as the muscles are shortened by the tension. Baseball player, specially the pitcher, must take care of the flexibility of the scapulothoracic joint, as the lack of movement in this region means a short live for the player. I mean, that if player doesn't have enough scapular movement, couldn't pitch the ball quickly and will charge other joints (elbow and wrist) due to the lack of movement in the shoulder.

This affects not only to sportspersons but also to clerks who maintain the same posture for a long time.
These persons accumulate a lot of tension in the shoulders, the muscles of this region to treat are: rhomboid major and serratus anterior.


LYING FACE UP
We will start working: occipital, cervical posterior, lateral and anterior region and suprascapular and though it is possible to work these regions in other posture, this one allow the patient be more relaxed than in the other ones. Moreover, you can use the weight of the head of the patient when wavy pressure and cervical posterior require less effort when pressing the zone.

First important point is around mastoid process where the sternocleidomastoid muscle has the insertion and the second important point is along the occipital line. Here we also have the trapezius insertion. These two muscles are used a lot in almost any neck movement and to hold the weight of the head. For this reason, in these two muscles would be concentrate the tiredness for keeping the same posture for a long time.

The sternocleidomastoid not only accumulates fatigue but also reflexes of the autonomic nervous system as is related with parasympathetic nervous system. It is important to work in detail all the muscle not being enough just to press the origin and the insertion.

To avoid the tension in the shoulders we work distally from the occipital and mastoid process.

After have worked the occipital and cervical region, we will stop in the subclavicular region, this zone reflex the trapezius muscle tension and also the dorsal region cover by this muscle.
The pressure is done from the sternum manubrim to the anterior deltoid muscle.

We'll work along the inferior side of the clavicle. If the thumb penetrates well, you will feel a strong contracture by the deltopectoral zone where you can feel the coracoid process.
This zone reflexes the back and also the dysfunction of the respiratory organs.
People that suffer bronchitis, asthma c has inclination to close the chess to protect his weakest zone, but this produce tension in the back charging the shoulders.

For that reason, working deeply the subclavicular region not only helps respiration, but also eases the shoulder symptoms.

Usually shiatsu treatment is done with the patient lying face up and face down. These two postures are the most used and effective ones. But some people can't have this posture, as pregnant women or elderly people in these cases side lying position is most effective.

Although shiatsu points are localized as in the pictures, now we're working out of these points. First of all we are going to look at the lateral side of the scapula where serratus anterior muscle passes by.

The function of this muscle allows carrying the scapulas onwards, taking them away from the trunk and turning the scapula from his inferior angle.

Generally people are not aware of this nuisance but when they feel the shiatsu pressure they will feel the fatigue

accumulated. Also we press around the axillary fold. This area doesn't have a direct relation with frozen shoulder but keeping the shoulder in the same posture for a long time makes them to feel fatigue in that zone.

If there is accumulation of tension, they'll feel pain and a strange sensation when receiving the pressure. To ease this tension, you don't need to massage, just press with your thumbs, keeping the pressure for 10 seconds. To end with we'll add an exercise as the one in the next picture:


First hold the posterior part of the axillary fold with one hand, with the other one hold the patient wrist, at the same time spin the arm widely.

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