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Infraspinatus and Teres Minor Static Manual Release (Soft Tissue Mobilization)

This video will show you how to use static manual release techniques to mobilize the muscles of the infraspinatus and teres minor, improving shoulder discomfort and restoring functional movement.

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00:04 - 00:05This is Brent of the Brookbush
00:05 - 00:07Institute and in this video we're bringing
00:07 - 00:08you another manual technique. Now, if
00:08 - 00:09you're watching this video, I'm assuming
00:09 - 00:11you're watching it for educational
00:11 - 00:13purposes and that you are a licensed
00:13 - 00:15manual therapist following the laws
00:15 - 00:17regarding scope of practice in your
00:17 - 00:19state or region. That means athletic
00:19 - 00:20trainers, chiropractors, physical
00:20 - 00:23therapists, osteopaths, licensed massage
00:23 - 00:25therapists, you are likely in the clear
00:25 - 00:28to do these techniques. Personal trainers,
00:28 - 00:30this probably does not fall within your
00:30 - 00:31scope of practice, although you might be
00:31 - 00:33able to use the palpation portion of
00:33 - 00:35this video to aid in learning your
00:35 - 00:38functional anatomy in an educational
00:38 - 00:41setting supervised by a licensed manual
00:41 - 00:43therapist. Now before we place our hands
00:43 - 00:45on a patient or client, it is important
00:45 - 00:48that we assess and have a good rationale
00:48 - 00:50for doing so. And of course if we're
00:50 - 00:53going to assess, then we should be
00:53 - 00:55reassessing to ensure that the manual
00:55 - 00:57technique we're using is effective and
00:57 - 00:59we have a good rationale for continuing
00:59 - 01:01to use that technique. In this video,
01:01 - 01:02we're going to go over static manual
01:02 - 01:03release of the infraspinatus and teres
01:03 - 01:04minor. I'm going to have my friend
01:04 - 01:06Melissa come out, she's going to help me
01:06 - 01:07demonstrate. Now in this video we're
01:07 - 01:09going to use the same "palpate and
01:09 - 01:11compress" protocol we've used for all of
01:11 - 01:13our static manual release techniques,
01:13 - 01:16paying attention to how to differentiate
01:16 - 01:17these tissues from other tissues in the
01:17 - 01:19area, where our common trigger points are,
01:19 - 01:22what tissues may be in the area we
01:22 - 01:24shouldn't compress and of course, patient
01:24 - 01:26and client position and our position to
01:26 - 01:29ensure that we have good technique.
01:29 - 01:30Knowing where infraspinatus and teres
01:30 - 01:34minor are is the first challenge and to
01:34 - 01:35find out where they are we really kind
01:35 - 01:37of need to know where the scapula is,
01:37 - 01:39specifically where is the vertebral
01:39 - 01:41border of the scapula, which I can feel
01:41 - 01:43right here. I'm going to
01:43 - 01:45leave my thumb right there so you
01:45 - 01:46can see that border and then the other
01:46 - 01:48border I need to find is actually the
01:48 - 01:51spine of my scapula, which is this bony
01:51 - 01:55ridge right here.
01:55 - 01:57That's just like that and this area in
01:57 - 02:01here is your infraspinous fossa, which is
02:01 - 02:04the origin of your infraspinatus so all
02:04 - 02:07this right here is your infraspinatus.
02:07 - 02:11You're teres minor, if I put my
02:11 - 02:14finger down just like this, just to where
02:14 - 02:16her armpit starts to crease right there,
02:16 - 02:18sorry I didn't mean to tickle you there
02:18 - 02:21Melissa, right just where her arm creases
02:21 - 02:24right there and I press down in towards
02:24 - 02:26her shoulder, I can actually feel a
02:26 - 02:30little tube shaped muscle right
02:30 - 02:33underneath the convergence of the fibers
02:33 - 02:37of my infraspinatus. They
02:37 - 02:40almost blend up in here, but if you
02:40 - 02:44kind of play around with okay palpating
02:44 - 02:45the tissues in this area I think you'll
02:45 - 02:47find that your infraspinatus
02:47 - 02:50is a fairly lumpy muscle. You can really
02:50 - 02:51feel the different fascicles and
02:51 - 02:54groupings of fascicles in your
02:54 - 02:56infraspinatus as they converge onto this
02:56 - 02:59tendon that goes into the back of
02:59 - 03:00your shoulder and then just underneath
03:00 - 03:03that, you can feel this little tube
03:03 - 03:07shaped muscle, that is your teres minor.
03:07 - 03:12Common trigger points generally fall
03:12 - 03:16right in the corner where the spine of your
03:16 - 03:19scapula meets the vertebral border of
03:19 - 03:20your scapula, which that would be the
03:20 - 03:22root of my spine of my scapula here, but
03:22 - 03:25generally in this area you get some
03:25 - 03:26pretty tender spots. How does that feel
03:26 - 03:29Melissa? I'm going to show you
03:29 - 03:31where those are marked off in the
03:31 - 03:35close-up recap but we'll definitely look
03:35 - 03:39to palpate those. And then as the teres
03:39 - 03:41minor trigger point ends up right in
03:41 - 03:42the middle of the muscle, which is going
03:42 - 03:45to be between the axillary border of the
03:45 - 03:48scapula and then the posterior portion
03:48 - 03:50of your shoulder, so you're going to be
03:50 - 03:52able to find a teres minor trigger point
03:52 - 03:55in here. I guess you could fall off
03:55 - 03:57the posterior delt almost right into
03:57 - 04:00that trigger point. The big question
04:00 - 04:02becomes with this one is we do have
04:02 - 04:04something called your quadrangular space,
04:04 - 04:07where your axillary nerve runs through
04:07 - 04:10so if we're not careful how we palpate
04:10 - 04:12these tissues you can get somebody's
04:12 - 04:154th and 5th finger to go numb or
04:15 - 04:17them to start feeling numbness in this
04:17 - 04:20area in general because you'll pinch off
04:20 - 04:24the axillary nerve and that's a little
04:24 - 04:25problematic. It's not it's not very
04:25 - 04:27comfortable, it's not something we want
04:27 - 04:30to do often. If you do manage to do it,
04:30 - 04:30try to remember
04:30 - 04:34that nerves are fairly thin so chances
04:34 - 04:37are if you change the angle that you're
04:37 - 04:40going at that trigger point in, you're
04:40 - 04:43going to release pressure from that
04:43 - 04:46nerve or get off that nerve all together.
04:46 - 04:48The infraspinatus, we don't really
04:48 - 04:52have any contraindicated tissues that we
04:52 - 04:55need to to worry about missing or not
04:55 - 04:57compressing but when we get to the teres
04:57 - 04:59minor, we do have to be a little careful
04:59 - 05:02as we could end up compressing down on
05:02 - 05:04that quadrangular space, compressing down
05:04 - 05:06on the axillary nerve and getting
05:06 - 05:08somebody some uncomfortable nerve
05:08 - 05:09symptoms including numbness of the
05:09 - 05:124th and 5th finger.
05:12 - 05:16Patient position, your position.
05:16 - 05:18On this technique, I wouldn't reach cross
05:18 - 05:22body, I would stay on the same side. Since
05:22 - 05:24these are our external rotators of our
05:24 - 05:27shoulder, to lengthen the tissue out so
05:27 - 05:30that I can anchor down these points of
05:30 - 05:32hypertonicity- these trigger points- I'm
05:32 - 05:34going to have Melissa do the hand's
05:34 - 05:38underneath the ASIS thing, there you go.
05:38 - 05:41And then what I find it easiest to do is
05:41 - 05:44rather than to be here at shoulder
05:44 - 05:47height, I'm actually going to go this way.
05:47 - 05:53These fibers run horizontal, kind
05:53 - 05:56of from vertebral border to the back of
05:56 - 05:59your shoulder, so I want to be able to
05:59 - 06:02strum this way and then I also find it
06:02 - 06:05easier to lock down trigger points this
06:05 - 06:07way. This is just what I found personally.
06:07 - 06:09If you find it easier to go this
06:09 - 06:11way, that's fine. I think if I was this
06:11 - 06:13way I would probably want the table a
06:13 - 06:14little higher and I would make sure that
06:14 - 06:18I'm back a little farther so that I
06:18 - 06:21can just lean. Try to get into a position
06:21 - 06:23where you're not using your hand
06:23 - 06:27strength. Just as with all techniques,
06:27 - 06:30I'm going to do my perpendicular to the
06:30 - 06:33fiber strokes. Fibers go this way,
06:33 - 06:34I'm going to run my fingers across the
06:34 - 06:36fibers this way and look for dense
06:36 - 06:37fascicles and in the infraspinatus
06:37 - 06:39it's a little challenging because
06:39 - 06:42they're all kind of dense.
06:42 - 06:43You really need to do a good survey
06:43 - 06:45and maybe think about looking for the
06:45 - 06:48densest fascicles. There's a good one
06:48 - 06:52right there and these tend to be really,
06:52 - 06:53really sensitive and somebody who needs
06:53 - 06:56this technique, so you need to go in
06:56 - 07:00gently. Only push until you get a little
07:00 - 07:02pushback from the tissue. Once you feel
07:02 - 07:05that tension start to increase, that's
07:05 - 07:07all the pressure you need. With this
07:07 - 07:10technique, I generally use my thumb over
07:10 - 07:13thumb technique, get my arms straight and
07:13 - 07:17lean or I'm using my perpendicular
07:17 - 07:19stroke with one hand and then the hand
07:19 - 07:21that's doing the perpendicular strokes,
07:21 - 07:23the feeling, once I found it, that
07:23 - 07:25becomes my dummy thumb, I relax that
07:25 - 07:28hand and I use this hand to apply some
07:28 - 07:32pressure. I'm going to hold for 30
07:32 - 07:34seconds 2 minutes until I get a good
07:34 - 07:36release and then I can go on to the next
07:36 - 07:39point in that muscle or the next muscle.
07:39 - 07:44In the case of the axilla or the
07:44 - 07:46teres minor, I'm sorry, which is more in
07:46 - 07:48the axilla, we're trying to get in here,
07:48 - 07:53this technique, we're going to find that
07:53 - 07:56muscle. If it needs it, the whole muscle
07:56 - 07:59might feel pretty dense, so we're going
07:59 - 08:02to look for the tightest nodule, the
08:02 - 08:06tightest point within that muscle which
08:06 - 08:09is going to be between again axillary
08:09 - 08:10border and posterior deltoid, we're talking
08:10 - 08:15about a space about yay wide. Once I
08:15 - 08:17find that dense point, I'm going to hold
08:17 - 08:19on. I know you can't see this
08:19 - 08:21particularly well. I'm more interested in
08:21 - 08:23this view for you seeing- notice my
08:23 - 08:25body mechanics are set up in such a way
08:25 - 08:27that I can apply pressure this way and
08:27 - 08:31down by essentially leaning in. My arms
08:31 - 08:33are nice and fairly straight, I can get
08:33 - 08:35into my thumb over thumb technique or my
08:35 - 08:38thumb and thenar groove here
08:38 - 08:42technique without having to use my
08:42 - 08:43hands. The last thing I want to do is
08:43 - 08:45fall back on my hand strength
08:45 - 08:48because if she is very athletic
08:48 - 08:51like Melissa is here and she needs a lot
08:51 - 08:52of work and I am going to
08:52 - 08:53have to hold these points for 30
08:53 - 08:55seconds to 2 minutes, I'm going to
08:55 - 08:57wear out my hands. I want to get into a
08:57 - 09:01position where I can find tight
09:01 - 09:05fascicles, go along the tight
09:05 - 09:07fascicle to find the tightest nodule,
09:07 - 09:10once I find it, I can just add my hand
09:10 - 09:12technique, get into a good position where
09:12 - 09:14my arms are straight and I can just lean
09:14 - 09:16as much as I need to which in this case
09:16 - 09:19is not very much, to get the pressure I
09:19 - 09:20need. And then I'm just going to wait for
09:20 - 09:24a release to happen. Stay tuned for a
09:24 - 09:25close-up recap. Now for the close-up
09:25 - 09:28recap of infraspinatus and teres minor
09:28 - 09:30static manual release the first thing we
09:30 - 09:32need to do is really identify where the
09:32 - 09:34borders of our scapula are. We want to
09:34 - 09:36find the vertebral border of our scapula.
09:36 - 09:39You can palpate there. I'm going to
09:39 - 09:41go ahead and lay my index finger down
09:41 - 09:43right along the vertebral border of her
09:43 - 09:45scapula so you can see that.
09:45 - 09:46Then I'm going to wrap the webspace of my
09:46 - 09:49thumb around the inferior angle of her
09:49 - 09:52scapula and then my thumb itself along
09:52 - 09:54the axillary border. Now you can
09:54 - 09:57kind of see I'm pinching her scapula so
09:57 - 09:59you know where that is. The only other
09:59 - 10:01thing what I need to find now is the
10:01 - 10:04spine of the scapula. The spine of the
10:04 - 10:07scapula is right here so if I lay my
10:07 - 10:09thumb down there for you, you
10:09 - 10:11should have a good little visual image
10:11 - 10:15of where my infraspinous fossa is, which
10:15 - 10:18is kind of where my infraspinatus lies.
10:18 - 10:20Once I found that
10:20 - 10:24infraspinatus fossa, I can go ahead and
10:24 - 10:27start doing my perpendicular strokes
10:27 - 10:30because I know all of these fibers
10:30 - 10:34converge towards her posterior shoulder.
10:34 - 10:36I'm going to gently go through here.
10:36 - 10:38As I mentioned before, if
10:38 - 10:41somebody needs this technique, these
10:41 - 10:43fascicles tend to get really, really
10:43 - 10:46tender. I'm looking for that densest
10:46 - 10:51tissue and not surprisingly I'm finding
10:51 - 10:55my densest tissue right around these X's
10:55 - 10:59which happen to be my common trigger
10:59 - 11:00point sites
11:00 - 11:03for the infraspinatus and teres minor
11:03 - 11:08respectively. Let's say this,
11:08 - 11:10we'll start with this one, let's say this
11:10 - 11:12is the first dense fascicles, I feel I'll
11:12 - 11:16then go along the length of the fiber
11:16 - 11:18and see if I can find a tight nodule,
11:18 - 11:20making sure I don't go further than the
11:20 - 11:23vertebral border of my scapula. Once I
11:23 - 11:26found that, I'm just going to do my thumb
11:26 - 11:28over thumb technique and lean my body in
11:28 - 11:33there to anchor down, apply some pressure
11:33 - 11:36and try to get a release from these
11:36 - 11:39tissues. Remember, I'm only pushing hard
11:39 - 11:42enough to get a little tension back from
11:42 - 11:46the muscle. Once I feel tension back from
11:46 - 11:49the muscle, I don't need to go any further. I
11:49 - 11:51don't need to try to press through
11:51 - 11:55her scapula. Once I get a release, I
11:55 - 12:00can move on to the next set of dense
12:00 - 12:02fascicles and I see some right there, oh
12:02 - 12:06yeah, that's a nice dense set of fasicles.
12:06 - 12:07I'm going to once again kind of go
12:07 - 12:09along the length of those fascicles to
12:09 - 12:11see if I can find a tight nodule, an
12:11 - 12:16acute point of hyperactivity. And again
12:16 - 12:17there's another common trigger point
12:17 - 12:23site, make sure I can get this set
12:23 - 12:26of fibers in this particular nodule
12:26 - 12:28anchored down and then once I do I can
12:28 - 12:29use my thumb over thumb technique or I
12:29 - 12:34can use my thenar groove over thumb
12:34 - 12:38technique again holding for
12:38 - 12:4030 seconds to 2 minutes until
12:40 - 12:43I get a release. Now the only one that's
12:43 - 12:45a little tricky is I have to kind of
12:45 - 12:49fall off my axillary border way up close
12:49 - 12:52to where my humerus meets my scapula,
12:52 - 12:56being your shoulder. But right up in
12:56 - 13:01there between these two points is my
13:01 - 13:04teres minor. Here is my axillary
13:04 - 13:06border of my scapula, here's my posterior
13:06 - 13:08shoulder, you see where this X is,
13:08 - 13:12that's actually the center of my teres
13:12 - 13:14minor, which feels like
13:14 - 13:18a band of tissue kind of underneath the
13:18 - 13:21converging fibers of my infraspinatus. If
13:21 - 13:22I've already done a really good job of
13:22 - 13:26exploring the infraspinatus and I felt
13:26 - 13:28those fibers going into the tendon, I can
13:28 - 13:30usually move just below
13:30 - 13:33that string of muscle fiber and
13:33 - 13:37tendon and find this tube shaped muscle
13:37 - 13:40really high in the armpit and then I
13:40 - 13:44just kind of have to search along the
13:44 - 13:46length of it to find the densest point,
13:46 - 13:49the nodule again and then I'm going to
13:49 - 13:53push up into the axilla there to anchor
13:53 - 13:56that tight nodule or trigger point until
13:56 - 13:59I get a release. So there you have it,
13:59 - 14:01knowing your functional anatomy will
14:01 - 14:03definitely help your manual technique.
14:03 - 14:05It'll help you differentiate structures
14:05 - 14:06so that you can place your hands where
14:06 - 14:08they need to be as well as make you
14:08 - 14:10aware of these sensitive structures
14:10 - 14:12around the tissue that you're trying to
14:12 - 14:14target- things like nerves and lymph
14:14 - 14:16nodes and arteries. Make sure that if
14:16 - 14:18you're going to place your hands on a
14:18 - 14:19patient, that you have done an assessment
14:19 - 14:21and have a good rationale for placing
14:21 - 14:23your hands on that patient and if you're
14:23 - 14:25going to assess, make sure you reassess
14:25 - 14:27to ensure that your technique was
14:27 - 14:29effective and you have a good rationale
14:29 - 14:31for using that technique again. Now, with
14:31 - 14:35manual therapy, one-on-one live education
14:35 - 14:38is incredibly important. Please be
14:38 - 14:40looking for opportunities like workshops
14:40 - 14:43and mentorships and maybe even classes
14:43 - 14:46at your local university that can get
14:46 - 14:48you some one-on-one, individual
14:48 - 14:50instruction or at least some live
14:50 - 14:53classroom instruction, so you've had a
14:53 - 14:57chance to be critiqued and mentored by
14:57 - 14:59somebody senior to you with some
14:59 - 15:02experience in manual therapy techniques.
15:02 - 15:05And before you bring this stuff back to
15:05 - 15:08your rehab, fitness or performance
15:08 - 15:11setting, please practice on colleagues.
15:11 - 15:15There is no substitute for practice. And
15:15 - 15:17it is going to take a while to get
15:17 - 15:20accustomed to some of the techniques
15:20 - 15:22that we show in these manual technique
15:22 - 15:22videos.
15:22 - 15:24Don't expect to learn them in two or
15:24 - 15:27three or even five minutes, you want to
15:27 - 15:30have hours of experience under your belt
15:30 - 15:32working on various different body sizes
15:32 - 15:35and shapes so that when you do get that
15:35 - 15:37first paying client, first paying
15:37 - 15:39customer and you're really trying to
15:39 - 15:42make a good positive impact, really
15:42 - 15:45trying to promote better outcomes, you
15:45 - 15:47feel comfortable with that technique. I
15:47 - 15:49look forward to hearing about your
15:49 - 15:52outcomes and hearing your questions in
15:52 - 15:54the comments section of this video. I'll
15:54 - 15:56talk with you soon.

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