0:04 This is Brent of the Brookbush 0:05 Institute and in this video we're bringing 0:07 you another manual technique. Now, if 0:08 you're watching this video, I'm assuming 0:09 you're watching it for educational 0:11 purposes and that you are a licensed 0:13 manual therapist following the laws 0:15 regarding scope of practice in your 0:17 state or region. That means athletic 0:19 trainers, chiropractors, physical 0:20 therapists, osteopaths, licensed massage 0:23 therapists, you are likely in the clear 0:25 to do these techniques. Personal trainers, 0:28 this probably does not fall within your 0:30 scope of practice, although you might be 0:31 able to use the palpation portion of 0:33 this video to aid in learning your 0:35 functional anatomy in an educational 0:38 setting supervised by a licensed manual 0:41 therapist. Now before we place our hands 0:43 on a patient or client, it is important 0:45 that we assess and have a good rationale 0:48 for doing so. And of course if we're 0:50 going to assess, then we should be 0:53 reassessing to ensure that the manual 0:55 technique we're using is effective and 0:57 we have a good rationale for continuing 0:59 to use that technique. In this video, 1:01 we're going to go over static manual 1:02 release of the infraspinatus and teres 1:03 minor. I'm going to have my friend 1:04 Melissa come out, she's going to help me 1:06 demonstrate. Now in this video we're 1:07 going to use the same "palpate and 1:09 compress" protocol we've used for all of 1:11 our static manual release techniques, 1:13 paying attention to how to differentiate 1:16 these tissues from other tissues in the 1:17 area, where our common trigger points are, 1:19 what tissues may be in the area we 1:22 shouldn't compress and of course, patient 1:24 and client position and our position to 1:26 ensure that we have good technique. 1:29 Knowing where infraspinatus and teres 1:30 minor are is the first challenge and to 1:34 find out where they are we really kind 1:35 of need to know where the scapula is, 1:37 specifically where is the vertebral 1:39 border of the scapula, which I can feel 1:41 right here. I'm going to 1:43 leave my thumb right there so you 1:45 can see that border and then the other 1:46 border I need to find is actually the 1:48 spine of my scapula, which is this bony 1:51 ridge right here. 1:55 That's just like that and this area in 1:57 here is your infraspinous fossa, which is 2:01 the origin of your infraspinatus so all 2:04 this right here is your infraspinatus. 2:07 You're teres minor, if I put my 2:11 finger down just like this, just to where 2:14 her armpit starts to crease right there, 2:16 sorry I didn't mean to tickle you there 2:18 Melissa, right just where her arm creases 2:21 right there and I press down in towards 2:24 her shoulder, I can actually feel a 2:26 little tube shaped muscle right 2:30 underneath the convergence of the fibers 2:33 of my infraspinatus. They 2:37 almost blend up in here, but if you 2:40 kind of play around with okay palpating 2:44 the tissues in this area I think you'll 2:45 find that your infraspinatus 2:47 is a fairly lumpy muscle. You can really 2:50 feel the different fascicles and 2:51 groupings of fascicles in your 2:54 infraspinatus as they converge onto this 2:56 tendon that goes into the back of 2:59 your shoulder and then just underneath 3:00 that, you can feel this little tube 3:03 shaped muscle, that is your teres minor. 3:07 Common trigger points generally fall 3:12 right in the corner where the spine of your 3:16 scapula meets the vertebral border of 3:19 your scapula, which that would be the 3:20 root of my spine of my scapula here, but 3:22 generally in this area you get some 3:25 pretty tender spots. How does that feel 3:26 Melissa? I'm going to show you 3:29 where those are marked off in the 3:31 close-up recap but we'll definitely look 3:35 to palpate those. And then as the teres 3:39 minor trigger point ends up right in 3:41 the middle of the muscle, which is going 3:42 to be between the axillary border of the 3:45 scapula and then the posterior portion 3:48 of your shoulder, so you're going to be 3:50 able to find a teres minor trigger point 3:52 in here. I guess you could fall off 3:55 the posterior delt almost right into 3:57 that trigger point. The big question 4:00 becomes with this one is we do have 4:02 something called your quadrangular space, 4:04 where your axillary nerve runs through 4:07 so if we're not careful how we palpate 4:10 these tissues you can get somebody's 4:12 4th and 5th finger to go numb or 4:15 them to start feeling numbness in this 4:17 area in general because you'll pinch off 4:20 the axillary nerve and that's a little 4:24 problematic. It's not it's not very 4:25 comfortable, it's not something we want 4:27 to do often. If you do manage to do it, 4:30 try to remember 4:30 that nerves are fairly thin so chances 4:34 are if you change the angle that you're 4:37 going at that trigger point in, you're 4:40 going to release pressure from that 4:43 nerve or get off that nerve all together. 4:46 The infraspinatus, we don't really 4:48 have any contraindicated tissues that we 4:52 need to to worry about missing or not 4:55 compressing but when we get to the teres 4:57 minor, we do have to be a little careful 4:59 as we could end up compressing down on 5:02 that quadrangular space, compressing down 5:04 on the axillary nerve and getting 5:06 somebody some uncomfortable nerve 5:08 symptoms including numbness of the 5:09 4th and 5th finger. 5:12 Patient position, your position. 5:16 On this technique, I wouldn't reach cross 5:18 body, I would stay on the same side. Since 5:22 these are our external rotators of our 5:24 shoulder, to lengthen the tissue out so 5:27 that I can anchor down these points of 5:30 hypertonicity- these trigger points- I'm 5:32 going to have Melissa do the hand's 5:34 underneath the ASIS thing, there you go. 5:38 And then what I find it easiest to do is 5:41 rather than to be here at shoulder 5:44 height, I'm actually going to go this way. 5:47 These fibers run horizontal, kind 5:53 of from vertebral border to the back of 5:56 your shoulder, so I want to be able to 5:59 strum this way and then I also find it 6:02 easier to lock down trigger points this 6:05 way. This is just what I found personally. 6:07 If you find it easier to go this 6:09 way, that's fine. I think if I was this 6:11 way I would probably want the table a 6:13 little higher and I would make sure that 6:14 I'm back a little farther so that I 6:18 can just lean. Try to get into a position 6:21 where you're not using your hand 6:23 strength. Just as with all techniques, 6:27 I'm going to do my perpendicular to the 6:30 fiber strokes. Fibers go this way, 6:33 I'm going to run my fingers across the 6:34 fibers this way and look for dense 6:36 fascicles and in the infraspinatus 6:37 it's a little challenging because 6:39 they're all kind of dense. 6:42 You really need to do a good survey 6:43 and maybe think about looking for the 6:45 densest fascicles. There's a good one 6:48 right there and these tend to be really, 6:52 really sensitive and somebody who needs 6:53 this technique, so you need to go in 6:56 gently. Only push until you get a little 7:00 pushback from the tissue. Once you feel 7:02 that tension start to increase, that's 7:05 all the pressure you need. With this 7:07 technique, I generally use my thumb over 7:10 thumb technique, get my arms straight and 7:13 lean or I'm using my perpendicular 7:17 stroke with one hand and then the hand 7:19 that's doing the perpendicular strokes, 7:21 the feeling, once I found it, that 7:23 becomes my dummy thumb, I relax that 7:25 hand and I use this hand to apply some 7:28 pressure. I'm going to hold for 30 7:32 seconds 2 minutes until I get a good 7:34 release and then I can go on to the next 7:36 point in that muscle or the next muscle. 7:39 In the case of the axilla or the 7:44 teres minor, I'm sorry, which is more in 7:46 the axilla, we're trying to get in here, 7:48 this technique, we're going to find that 7:53 muscle. If it needs it, the whole muscle 7:56 might feel pretty dense, so we're going 7:59 to look for the tightest nodule, the 8:02 tightest point within that muscle which 8:06 is going to be between again axillary 8:09 border and posterior deltoid, we're talking 8:10 about a space about yay wide. Once I 8:15 find that dense point, I'm going to hold 8:17 on. I know you can't see this 8:19 particularly well. I'm more interested in 8:21 this view for you seeing- notice my 8:23 body mechanics are set up in such a way 8:25 that I can apply pressure this way and 8:27 down by essentially leaning in. My arms 8:31 are nice and fairly straight, I can get 8:33 into my thumb over thumb technique or my 8:35 thumb and thenar groove here 8:38 technique without having to use my 8:42 hands. The last thing I want to do is 8:43 fall back on my hand strength 8:45 because if she is very athletic 8:48 like Melissa is here and she needs a lot 8:51 of work and I am going to 8:52 have to hold these points for 30 8:53 seconds to 2 minutes, I'm going to 8:55 wear out my hands. I want to get into a 8:57 position where I can find tight 9:01 fascicles, go along the tight 9:05 fascicle to find the tightest nodule, 9:07 once I find it, I can just add my hand 9:10 technique, get into a good position where 9:12 my arms are straight and I can just lean 9:14 as much as I need to which in this case 9:16 is not very much, to get the pressure I 9:19 need. And then I'm just going to wait for 9:20 a release to happen. Stay tuned for a 9:24 close-up recap. Now for the close-up 9:25 recap of infraspinatus and teres minor 9:28 static manual release the first thing we 9:30 need to do is really identify where the 9:32 borders of our scapula are. We want to 9:34 find the vertebral border of our scapula. 9:36 You can palpate there. I'm going to 9:39 go ahead and lay my index finger down 9:41 right along the vertebral border of her 9:43 scapula so you can see that. 9:45 Then I'm going to wrap the webspace of my 9:46 thumb around the inferior angle of her 9:49 scapula and then my thumb itself along 9:52 the axillary border. Now you can 9:54 kind of see I'm pinching her scapula so 9:57 you know where that is. The only other 9:59 thing what I need to find now is the 10:01 spine of the scapula. The spine of the 10:04 scapula is right here so if I lay my 10:07 thumb down there for you, you 10:09 should have a good little visual image 10:11 of where my infraspinous fossa is, which 10:15 is kind of where my infraspinatus lies. 10:18 Once I found that 10:20 infraspinatus fossa, I can go ahead and 10:24 start doing my perpendicular strokes 10:27 because I know all of these fibers 10:30 converge towards her posterior shoulder. 10:34 I'm going to gently go through here. 10:36 As I mentioned before, if 10:38 somebody needs this technique, these 10:41 fascicles tend to get really, really 10:43 tender. I'm looking for that densest 10:46 tissue and not surprisingly I'm finding 10:51 my densest tissue right around these X's 10:55 which happen to be my common trigger 10:59 point sites 11:00 for the infraspinatus and teres minor 11:03 respectively. Let's say this, 11:08 we'll start with this one, let's say this 11:10 is the first dense fascicles, I feel I'll 11:12 then go along the length of the fiber 11:16 and see if I can find a tight nodule, 11:18 making sure I don't go further than the 11:20 vertebral border of my scapula. Once I 11:23 found that, I'm just going to do my thumb 11:26 over thumb technique and lean my body in 11:28 there to anchor down, apply some pressure 11:33 and try to get a release from these 11:36 tissues. Remember, I'm only pushing hard 11:39 enough to get a little tension back from 11:42 the muscle. Once I feel tension back from 11:46 the muscle, I don't need to go any further. I 11:49 don't need to try to press through 11:51 her scapula. Once I get a release, I 11:55 can move on to the next set of dense 12:00 fascicles and I see some right there, oh 12:02 yeah, that's a nice dense set of fasicles. 12:06 I'm going to once again kind of go 12:07 along the length of those fascicles to 12:09 see if I can find a tight nodule, an 12:11 acute point of hyperactivity. And again 12:16 there's another common trigger point 12:17 site, make sure I can get this set 12:23 of fibers in this particular nodule 12:26 anchored down and then once I do I can 12:28 use my thumb over thumb technique or I 12:29 can use my thenar groove over thumb 12:34 technique again holding for 12:38 30 seconds to 2 minutes until 12:40 I get a release. Now the only one that's 12:43 a little tricky is I have to kind of 12:45 fall off my axillary border way up close 12:49 to where my humerus meets my scapula, 12:52 being your shoulder. But right up in 12:56 there between these two points is my 13:01 teres minor. Here is my axillary 13:04 border of my scapula, here's my posterior 13:06 shoulder, you see where this X is, 13:08 that's actually the center of my teres 13:12 minor, which feels like 13:14 a band of tissue kind of underneath the 13:18 converging fibers of my infraspinatus. If 13:21 I've already done a really good job of 13:22 exploring the infraspinatus and I felt 13:26 those fibers going into the tendon, I can 13:28 usually move just below 13:30 that string of muscle fiber and 13:33 tendon and find this tube shaped muscle 13:37 really high in the armpit and then I 13:40 just kind of have to search along the 13:44 length of it to find the densest point, 13:46 the nodule again and then I'm going to 13:49 push up into the axilla there to anchor 13:53 that tight nodule or trigger point until 13:56 I get a release. So there you have it, 13:59 knowing your functional anatomy will 14:01 definitely help your manual technique. 14:03 It'll help you differentiate structures 14:05 so that you can place your hands where 14:06 they need to be as well as make you 14:08 aware of these sensitive structures 14:10 around the tissue that you're trying to 14:12 target- things like nerves and lymph 14:14 nodes and arteries. Make sure that if 14:16 you're going to place your hands on a 14:18 patient, that you have done an assessment 14:19 and have a good rationale for placing 14:21 your hands on that patient and if you're 14:23 going to assess, make sure you reassess 14:25 to ensure that your technique was 14:27 effective and you have a good rationale 14:29 for using that technique again. Now, with 14:31 manual therapy, one-on-one live education 14:35 is incredibly important. Please be 14:38 looking for opportunities like workshops 14:40 and mentorships and maybe even classes 14:43 at your local university that can get 14:46 you some one-on-one, individual 14:48 instruction or at least some live 14:50 classroom instruction, so you've had a 14:53 chance to be critiqued and mentored by 14:57 somebody senior to you with some 14:59 experience in manual therapy techniques. 15:02 And before you bring this stuff back to 15:05 your rehab, fitness or performance 15:08 setting, please practice on colleagues. 15:11 There is no substitute for practice. And 15:15 it is going to take a while to get 15:17 accustomed to some of the techniques 15:20 that we show in these manual technique 15:22 videos. 15:22 Don't expect to learn them in two or 15:24 three or even five minutes, you want to 15:27 have hours of experience under your belt 15:30 working on various different body sizes 15:32 and shapes so that when you do get that 15:35 first paying client, first paying 15:37 customer and you're really trying to 15:39 make a good positive impact, really 15:42 trying to promote better outcomes, you 15:45 feel comfortable with that technique. I 15:47 look forward to hearing about your 15:49 outcomes and hearing your questions in 15:52 the comments section of this video. I'll 15:54 talk with you soon.
