Name: Biceps Femoris Manual Static Release
Uploaded: 2023-04-26T01:02:18.000Z
Duration: 12 min 38 s

English captions

https://stream.mux.com/vLy4Ymsr166HZENV1Q5UuMj27vBEFPwhAYJRBhXDzQM.m3u8

Learn the best-practice techniques for biceps femoris manual static release (a.k.a. ischemic compression, soft tissue mobilization, pin-and-stretch) in this step-by-step instructional video from the Brookbush Institute. This evidence-based approach may improve hamstring muscle extensibility, reduce trigger points, increase hip and knee joint range of motion, and optimize lower extremity alignment. Perfect for clinicians and students seeking to enhance their manual therapy skills for hamstring rehabilitation and performance.

Introduction to Biceps Femoris Manual Release

Assessment Techniques for Identifying Dysfunction

Static Manual Release Protocol and Technique Overview

Applying Pressure and Monitoring Patient Response

Long Head Release Technique: Step-by-Step Guide

Short Head Release Technique: Specifics and Execution

Conclusion and Best Practices for Manual Release Techniques

Biceps Femoris Manual Static Release

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

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The biceps femoris is the two-headed, lateral hamstring muscle within the posterior compartment of the thigh. It is the prime mover of knee flexion and also contributes to hip extension. 

Biceps Femoris

 are superficial, tube-shaped muscles on the lateral aspect of the posterior thigh.

The hamstrings are the only muscles on the posterior thigh that will flex the 

 flexion can be used to aid in palpation by stimulating contraction and a sudden increase in tissue density.

Resisted tibial external rotation can be used to differentiate between the 

 flexion can be used to differentiate between these two muscles.

The sciatic nerve may be accessible while palpating the medial aspect of the 

 ; however, it is fairly unlikely. If tingling, numbness, or burning is felt, adjust your hand position, attempting to pin trigger points, taut bands, and dense nodules from a different angle.

Common trigger points for the long and short head of the 

 are in the middle of the muscle bellies. Note, the middle of the short head of the 

 is roughly halfway between the mid-point of the femur and the knee.

 may be released in two different positions. It is recommended that the technique is practiced with the patient in prone to start; however, experienced practitioners will likely find that the supine position is more effective.

Start with the patient in prone, standing on the affected side adjacent to the patient's knee

 on the lateral aspect of the posterior thigh.

Palpation can be confirmed with manual resistance of 

 on the lateral side, and tibial external rotation to differentiate between 

Using a thumb over thumb hand position to press into the muscle, and use lateral to medial strokes (perpendicular to the fiber direction) to identify taut bands in this tissue.

Once a taut band is located, the length of the band is explored for a dense nodule and consistent pressure is applied.

The practitioner may control the lower leg with the other hand to adjust the amount of 

 flexion, adjust the amount of tension in the muscle, and aid in pinning dense nodules.

Consistent pressure is held until the nodule softens under the practitioner's fingers, or tissue density/sensitivity is significantly reduced (generally 30 - 120 seconds).

Start with the patient in supine, standing on the affected side.

Place the foot or calf of the patient's affected side on your shoulder.

Use the palpation skills developed in the prone position to identify the long tube-shaped 

Using a thumb over thumb hand position to press into the muscle, use lateral to medial strokes, perpendicular to the fiber direction, to identify taut bands in this tissue.

The practitioner may adjust the amount of tension to aid in pinning dense nodules by leaning into the patient and increasing the amount of 

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