0:04 This is Brent of the Brookbush Institute and 0:06 in this video we're going over a static 0:08 manual release of the biceps femoris, or 0:10 the lateral hamstring group. Now, if 0:11 you're watching this video, I'm assuming 0:13 you're watching it for educational 0:14 purposes and that you're a licensed 0:16 manual therapist following the laws of 0:18 your scope of practice in your state. 0:20 That means athletic trainers, physical 0:23 therapists, massage therapists, 0:24 chiropractors, osteopaths, you're probably 0:26 all in the clear. Personal trainers, this 0:28 video probably doesn't fall within your 0:29 scope, although, you could use the 0:31 palpation portion of this video as part 0:33 of a learning experience, especially 0:36 learning your anatomy. I'm going to have my 0:38 friend, Sonya, come out. She's going to 0:39 help me demonstrate this technique. Now, 0:41 of course, before I do any manual 0:43 technique, I'm pretty much eighty percent 0:45 sure that the muscle I'm going to target 0:48 is involved in the dysfunction, and the 0:50 only way I can get there is through 0:52 assessment. So, with Sonya, we're going to 0:54 make up a little case. We'll say she came 0:56 in complaining of a little knee pain. 0:58 When I did her overhead squat, maybe she 1:00 had some knees bow in. When I did gniometric 1:03 assessment, she was missing a 1:04 little hamstring length. It's that 1:07 test where we're at 90 degrees of hip 1:09 flexion and then we see how much knee 1:11 extension is left over. So, I have a 1:13 pretty good idea that biceps femoris 1:17 overactivity is part of her dysfunction. 1:19 Now, all of these static manual release 1:22 techniques follow a very similar 1:24 protocol. We need to be able to palpate 1:26 the muscle. We get bonus points for 1:28 knowing where the trigger points are. We 1:30 should probably know if there's any 1:32 other structures around that muscle that 1:35 we could potentially insult, something 1:39 like a nerve or an artery that we want 1:41 to stay away from. And then, 1:44 once we get all of that figured out, we 1:47 want to know what position should the 1:49 patient be in for their comfort, our 1:51 comfort, and so that we have some control 1:53 over the amount of tension within the 1:56 muscle so that we can help localize or 1:59 stabilize those tight fascicles and 2:01 trigger points. In this case, the biceps 2:04 femoris is on the lateral side of 2:07 the posterior thigh, so this is the outer 2:10 hamstring group. You can see I've marked 2:13 off the trigger points. We have a long 2:15 head in a short head of our biceps 2:16 femoris. 2:17 The long head trigger point is right about 2:19 here and the short head is right about here. 2:20 You guys will see that a little closer 2:22 when we do the close-up recap. 2:24 Generally speaking, these trigger 2:26 points are right in the middle of these 2:28 muscle bellies. So if you know that the 2:30 biceps femoris goes from ischial 2:32 tuberosity to fibular head, then 2:36 that's about center. And then the short 2:39 head of the biceps femoris comes off 2:40 that linea aspera at about halfway down, 2:42 so if I go half the distance of her 2:45 femur to fibular head, that's pretty 2:47 close to center. Now for the short head, 2:50 we can go in prone and still have some 2:54 control over how much tension we have in 2:57 this muscle. Remember, your short head 2:58 doesn't cross your hip, so all I have to 3:00 do is be able to 3:02 control how much knee flexion and 3:04 extension I have. I'm then going to use 3:06 my palpations this way, my 3:10 strumming palpations from medial to 3:13 lateral to try to figure out where are 3:17 these tight fascicles. Alright, so I'm 3:20 just going from medial to lateral, and I 3:23 notice that this fascicle is pretty 3:26 tight. You'll notice I put my 3:29 hands down pretty close to where those 3:31 trigger points are, but if I start moving 3:33 from proximal to distal now, I want to 3:36 see if those tight fascicles are 3:38 attached to maybe a tight nodule, maybe a 3:42 local point of hyperactivity. Then I can 3:46 really pin down. I'm going to add 3:48 just a little bit more attention to this 3:50 muscle here, because as I've explained in 3:53 some of these other manual release 3:54 technique videos, if you don't put a 3:56 little tension within the muscle you 3:58 start playing that game of trying 4:00 to put your finger on top of a marble. 4:01 Every time you push down, it slips 4:04 out. So, I want enough tension this way 4:06 that I stabilize that point. 4:09 I think right about there I got Sonya 4:16 making a little face, that's a good point. 4:18 I'm just going to use pressure from my 4:20 thumb. Now, if I wanted to, if I felt 4:24 like I needed both hands, if I was a 4:26 smaller therapist let's say and Sonya 4:28 was a huge individual, which obviously 4:30 she is not, I could use a dowel or maybe 4:35 my knee to keep her in this position, and 4:38 then use my thumb over thumb technique 4:41 here so that I don't have to to wear out 4:43 my hand. Notice that my elbow is locked, 4:46 like I'm trying to get my body 4:49 weight up and over the pressure I'm 4:51 using. I'm not using my grip 4:53 strength. You don't want to wear yourself 4:55 out. And, of course, after about 30 to 120 4:58 seconds, I actually start to feel the 5:02 increase in tissue density that I 5:04 identified disappear. It'll actually 5:07 start to melt or release, which is where 5:11 the name these techniques come from. 5:13 Sometimes you can actually feel a 5:14 release happen. If you ask your patient, 5:17 "How does this feel compared to when I 5:19 put for first put my fingers down? Is it 5:22 as tender?" No. She said it's not as tender. 5:26 Usually it'll be really tender when you 5:28 put your fingers down and over like 30 5:29 seconds it starts to calm down, a lot of 5:32 it calms down within the first 10 5:33 seconds. Alright, so that's short head, 5:37 guys. And, once again, I'm going to do a 5:38 close-up recap. So if you didn't see 5:40 exactly what was going on, don't worry 5:41 about it just keep watching. Go ahead and 5:44 flip over for me, Sonya. 5:47 Now, for the long head of the biceps 5:49 femoris, the long head actually crosses 5:51 the hip, so I have to be able to control 5:53 both her knee and her hip. In this case, 5:57 all I'm going to do is take Sonya's leg 6:00 and put it on my shoulder. 6:02 I'm then going to use my same palpation 6:06 skill of medial to lateral, kind of 6:09 strumming to find the 6:11 tightest fascicles. In this case, I'm 6:15 going to start a little a little distal 6:17 of where that trigger point is. Once I 6:20 find the tightest fascicles, I can then 6:23 start moving a little bit more proximally. 6:24 Once I find the tightest 6:29 point- and that's a little trickier with the 6:31 with the biceps femoris and some of the 6:33 other muscles we've gone over. They're long 6:35 stringy muscles, so you might have to 6:37 search just a little bit. There we go. 6:41 Make sure I have enough tension in her 6:44 biceps femoris to stabilize that point, so 6:46 it's not flopping all over the place 6:48 underneath my thumbs. And then you guys 6:49 notice, I've actually gone thumb over 6:52 thumb here. I'm obviously not going to be 6:55 able to get my arms straight in this 6:57 position, but at least I can use both 6:59 hands to apply that pressure. I am 7:03 using, or trying to use my body weight here 7:05 to lean forward with my hands. How does 7:10 that feel? It feels good. Sonya's a little 7:14 masochistic, she likes pain. This 7:19 is one of those techniques where if 7:20 somebody does enjoy massages though, 7:22 they'll like it because they'll feel 7:24 that release happen. And it's usually pretty 7:26 quick, usually 30 seconds and you'll start to 7:29 get a good release. You could be here up 7:31 to two minutes if you have somebody 7:32 who's really really overactive. So, once 7:34 again, guys, make sure that you are 7:37 careful with your own body position. 7:40 Everybody is all about patient comfort. I 7:43 don't I don't see a lot of patients in 7:46 super uncomfortable positions. I do see a 7:48 lot of therapists 7:49 put themselves in uncomfortable 7:50 positions, which is going to affect your 7:53 longevity. If you plan on doing this 7:55 for a long time, you need to really watch 7:57 your own mechanics. I'm lucky in this 7:59 office that I have so many mirrors, but 8:01 I'll even catch my own bad posture on 8:04 these techniques. Next, we're going to go 8:07 to the close-up recap, guys. We 8:08 have Sonya in position to do the long 8:11 head of her biceps femoris. Remember, when 8:13 we're releasing the long head of the 8:14 biceps femoris, we want control over hip 8:17 flexion so that we can place a little 8:19 bit more tension in those tissues, so 8:22 that we can pin down those overactive 8:24 fascicles as well as the trigger point 8:27 we're going to go after. I'm going to 8:28 start with my medial to lateral or 8:31 lateral to medial strokes pretty close 8:33 to the center of the belly of that 8:36 muscle, which is where that trigger point 8:38 tends to be. I'll go medial to lateral and 8:40 lateral to medial here, looking for the 8:44 most overactive or the densest fascicles. 8:48 You guys can notice that I'm between 8:49 this mass here, which is her vastus 8:51 lateralis and this mass here, which is 8:54 actually her medial hamstrings. I 8:56 actually notice a nice tight fascicle 8:58 right there. I then can move from 9:01 distal to proximal 9:04 or proximal to distal to try 9:08 to see if that overactive fascicle is 9:12 associated with a trigger point. I have a 9:16 nice little, a little tense nodule right 9:20 there. Once I find that trigger point, I'm 9:24 going to go ahead and press just enough 9:26 to start getting a little bit of tension 9:28 back from the tissue. Alright, so as I'm 9:31 pressing, you'll notice tension kind of 9:33 increases on an exponential curve there. 9:35 I want to be right in the trough of that 9:37 exponential curve. I don't want to press 9:38 it all the way down. I'm not trying to 9:41 put a hole in her leg. I don't want 9:42 to see how far or how much tension I 9:45 could place in those tissues. Just apply a 9:48 moderate amount of tension, and then I'm 9:51 going to hold. Notice that my arms are at 9:53 about 90 degrees here, guys. So all I have 9:55 to do to increase tension is lean 9:57 forward a little bit. 9:58 I don't need to use my grip strength. I 10:00 can also use my body here. I can lean 10:04 forward a little bit to add a little bit 10:06 more hip flexion and increase the 10:07 tension in the long head of her biceps 10:10 femoris if I need to to pin down these 10:11 tissues. Once I get a release, I get a 10:16 reduction in discomfort from my patient, 10:18 I can go ahead and move on to the next 10:21 muscle or the next trigger point. In this 10:23 case, we're going to move on to the short 10:24 head of the biceps femoris. I'm going 10:26 to have Sonya flip over for us. You 10:31 guys can see here that I have this trigger 10:32 point marked off, too, but we'll pretend 10:34 that this X isn't here for a second. We 10:38 know that the short head of the biceps 10:39 femoris attaches to the linea aspera and 10:42 the fibular head, and right between it, in 10:44 the middle of the belly of the muscle, 10:45 tends to be where the trigger point is. 10:48 So, I'm going to go ahead and use those 10:50 same medial to lateral and lateral to 10:55 medial strokes to find the the tensest 10:58 fascicles. And once I do, I can start 11:01 moving either proximal to distal or 11:05 distal to proximal to try to find any 11:10 nodule that may be associated with those 11:12 overactive fascicles. Once I find it, I 11:15 can use my thumb over thumb technique. Of 11:18 course, if you guys wanted to play with 11:19 the amount of tension within that muscle, 11:23 I can control the knee with one 11:25 hand and use one hand to do the release 11:28 technique. Once again, we'll hold 30 to 120 11:35 seconds or until we feel a reduction in 11:38 the density of the tissue. Make sure 11:41 you're not pressing too hard. It does 11:43 take a little bit of practice to know 11:44 how much pressure to apply with these 11:47 techniques. So, there you guys have it, the static 11:49 manual release of the biceps femoris, or 11:52 lateral hamstring group. Make sure that 11:54 before you do these manual release 11:56 techniques, you have a good working 11:58 hypothesis of why that structure may be 12:00 overactive. Ideally, before you would try 12:03 any of these techniques on a patient or 12:06 client, you would also practice 12:08 them on a colleague or maybe a mentor 12:12 with great manual skills who you look up 12:14 to. There is no substitute for getting 12:18 feedback from another manual 12:20 practitioner. I hope you guys enjoyed 12:22 this video. I look forward to hearing 12:24 your comments. Please leave your comments 12:26 below. I'll talk with you soon. 12:36 you
