0:04 This is Brent of the Brookbush 0:05 Institute, and in this video we're doing 0:07 static manual release of the posterior 0:08 deltoid. If you're watching this video, 0:10 I'm assuming you're watching it for 0:11 educational purposes and that you are a 0:13 licensed manual therapist. That is, the 0:16 laws around the scope of practice in your 0:19 state allow you to do manual techniques. 0:20 If you're unsure what those laws are, 0:22 please look them up. I'm assuming 0:24 chiropractors, athletic trainers, physical 0:26 therapists, massage therapists, osteopaths, 0:28 you're all in the clear. Personal 0:30 trainers, this probably does not fall 0:32 within your scope, although you could use 0:34 the palpation portion of this video in 0:36 an educational setting to help you with 0:38 your anatomy. I'm going to have my friend, 0:40 Crystal, come out and she's going to help me 0:42 demonstrate the technique. Now, before I 0:45 put my hands on Crystal, I want to be 0:47 very certain that this, or at least 0:50 fairly certain that this technique is 0:52 going to either improve her symptoms or 0:55 improve her performance. The only way to 0:57 get there is with assessment. Posterior 0:59 delt is a little weird. We think 1:02 about most of the time people get too 1:04 internally rotated. We think of the 1:06 posterior delt as long, but due to some 1:10 more complex human movement science 1:12 issues, this muscle tends to become long 1:15 and overactive, synergistically dominant 1:18 for an underactive infraspinatus and 1:21 teres minor. So, we do have good reason to 1:24 do this technique if things like arms 1:27 fall on the overhead squat assessment or 1:29 a lack of internal rotation in goniometry 1:32 pop up during our assessment 1:34 and evaluation. Now, all of our manual 1:37 techniques follow a very similar and 1:40 fairly simple protocol, especially if you 1:43 know your anatomy. We're going to palpate 1:45 and compress. We get bonus points for 1:48 knowing where our trigger points are to 1:50 help us aim our hands, aim our fingers 1:53 to the tightest points within that 1:55 muscle. We want to know if there's any 1:57 other structures that could be insulted 2:00 or injured by compression in the same 2:03 area. In this case, not really. Potentially there's 2:06 the axillary nerve if we really, really 2:08 pressed hard with somebody with a little 2:10 bit of out of the ordinary anatomy. But, 2:15 again, 2:16 the axillary nerve at this point would be very, 2:17 very thin. You just move a millimeter or 2:19 two in either direction and you'd be off 2:21 that. And, of course, we want to think 2:23 about body position, which I'll get to 2:24 here in a second. So, you guys know where 2:27 your palpating. We're just literally 2:30 doing the posterior one-third of the 2:34 deltoid. That's going to be our 2:35 palpation area. So, on Crystal, here, 2:38 because she's got nice, defined, strong 2:40 deltoids, you can actually see the shape 2:42 of her deltoid, and you can think there's 2:44 the back third. Even on somebody who's a 2:47 little larger, a little less fit, has some 2:51 more adipose tissue, I'm pretty sure you 2:53 guys will be able to palpate through 2:55 that tissue and feel this upside down 2:58 triangle shaped muscle, and maybe even 3:01 feel this border where the the triceps 3:03 begins. This is usually a pretty good 3:05 border on most people. If you get a 3:08 chance, you might start by practicing on 3:11 somebody a little leaner- faculty, 3:13 professors, teachers out there. I 3:15 definitely suggest when you can finding 3:17 a nice, lean, fit person to start these 3:21 techniques with, because I think the 3:23 better visual model up here we can get, 3:26 the easier these techniques become on 3:29 those individuals who are a little less 3:31 fit or are a little larger. Alright, so 3:34 now that we're on the posterior third, 3:36 we know that the fiber direction is 3:38 this way, so what I'm going to do is 3:40 strum this way to find those denser 3:45 fascicles, those fascicles that are a 3:48 little more active than the rest. I 3:50 feel right here, these are some nice 3:52 dense fascicles. Now what I'm going to do 3:54 is I'm going to move from distal to 3:57 proximal to see if those fascicles are 4:00 related to an overactive point or nodule. I'm 4:04 going to find a nice nodule right there, 4:06 and then all I'm going to do is press 4:09 into the tissue until that first 4:12 resistance, not even first resistance, but 4:16 that that point where the the muscle 4:18 starts increasing in tension. Alright, so 4:22 I've talked about how if you press in, 4:24 you start getting a little 4:25 tissue tension, a little bit of tissue 4:27 tension, and all of a sudden it increases 4:29 pretty rapidly. I'm going to go right up 4:31 to that point. I don't really want to try 4:32 to push through the tissue tension. Once 4:36 I get there, I'm going to hold for 30 to 4:39 120 seconds. Any sort of nervy feeling 4:44 like burning, tingling? No, so chances are 4:47 we're not on a nerve. It just feels tender, 4:50 right? Is it starting to go away? It's 4:54 starting to go away. You guys will 4:55 notice, right where my thumb ended up you 4:58 see that little X. That is the common 5:01 point of the trigger point. If you can't 5:03 see it now, you'll see it in our close-up 5:04 recap. Now, the one thing I'm not doing 5:06 very well here, guys, is showing you what 5:08 my body position should be. My patient or 5:10 client's body position is lying on a 5:12 table, fairly comfortable, fairly 5:15 comfortable position. I do find that 5:16 most therapists I talk to, they're really 5:18 good with keeping their clients and 5:20 patients comfortable. They're definitely 5:22 caring people who want to make sure 5:24 that their patient is as relaxed as can 5:29 be and is going to stay with this 5:31 process. What they're terrible at is 5:33 watching their own posture, which has a 5:35 lot more to do with the longevity of 5:37 their career and is probably just as, if 5:39 not more, important. We want you to be 5:41 able to help a lot of people throughout 5:43 a long career. So how would I 5:45 particularly position myself? Number one, 5:48 I wouldn't release the posterior delt on 5:50 the opposite side of the body. I would 5:52 stand next to the side that I wanted to 5:55 release. What I'm going to do with 5:57 Crystal, here, is I'm going to use my 5:59 lumbrical grip, that kind of crab claw 6:02 grip, right over the top of her 6:04 elbow and forearm. This actually gives me 6:07 good control over her forearm with my 6:09 fingers, as well as control of internal 6:12 rotation, external rotation, adduction, 6:14 abduction, flexion, extension, like I have 6:16 total control over her shoulder. Alright, 6:20 so once I get this position here, I'm 6:22 going to take this hand and I'm going to use 6:24 that lumbrical grip again. I'm going to 6:28 use my four fingers to help keep her 6:30 scapula in a neutral 6:31 position, and then I'm going to 6:33 use my thumb straight down over the top 6:36 of the tissue. I know you guys can't 6:38 quite see that. You'll see it in the 6:39 close-up recap though. I'm going to use 6:42 my thumb straight down over the top of 6:43 the tissue so that I 6:45 can use this hand to pull a little bit 6:47 into adduction and internal rotation. 6:50 That'll tense up those tissues a little 6:54 bit. And then, I'm coming at an oblique 6:56 angle to pin down that tender nodule, 7:02 because what I don't want to do is start 7:04 playing that game of trying to put my 7:05 finger on top of a marble. You know, it's 7:08 like put your finger on top of the marble and it spits 7:10 out this way, and you put- right? So what 7:12 we're going to do is we're going to use 7:13 the fascicles themselves to kind of 7:15 pull long, so that will help center 7:19 that marble. And then, rather than come at 7:21 it like this, I'm going to kind of come 7:23 this way at the marble so that it stays 7:26 pinned down. And so, here, here, and I can do my 7:32 strumming from this position, and then 7:35 once I find those fascicles and I find 7:38 that nice tight point, I can straighten 7:40 my body out. I can add a little tension 7:43 here and I'm just going to wait for that 7:45 nodule either to melt away underneath my 7:47 finger, to notice that the tissue isn't 7:50 giving me much tension back anymore, or 7:54 what I might even notice, since I kind of 7:55 have her pulled into horizontal 7:57 adduction and internal rotation here, is 7:59 her arm starts to give way a little bit. 8:01 That would be a good indication that 8:04 those fibers have started to tone down 8:07 and relax. Next, we'll show you our 8:10 close-up recap. Now, for a close-up recap. 8:12 You guys can see I have that lumbrical 8:14 grip over Crystal's elbow here and a 8:17 little bit over her proximal forearm. I 8:20 can control her forearm with my fingers. 8:22 I can control internal and external 8:24 rotation or horizontal adduction 8:26 horizontal abduction, which is going 8:28 to come in handy for increasing or 8:31 decreasing the tension in her posterior 8:33 deltoid. You can see her posterior 8:35 deltoids here. You can see this line, right 8:39 here, where triceps come off. This, 8:42 right here, is our posterior delt. 8:44 I got that trigger point, that common 8:46 trigger point for the posterior deltoid 8:47 marked off. Now what I'm going to do is 8:49 I'm going to take my other hand, and it's 8:50 also going to be in a lumbrical grip, 8:52 because I'm going to use these four 8:54 fingers to control her scapula so she 8:57 doesn't get all up into elevation and 8:59 upward rotation. I can kind of pin 9:01 that down. But then, I'm also going to use 9:03 my thumb in this direction, because this 9:08 distal to proximal force along with a 9:12 little force from superficial to deep is 9:15 going to help me pin any trigger point 9:18 or nodule of overactivity. I'm going 9:22 to want to do my strumming this way, 9:25 since the posterior deltoid fibers run 9:28 this way. And again, I can just kind of 9:30 move my thumb back and forth looking for 9:32 the tightest fascicles. And I notice 9:36 right here, nice tight fascicles. And then, 9:39 I can move from distal to proximal over 9:43 that nice tight fascicle until I see if 9:47 there is a nodule or some little point 9:50 of increased density. I found it right 9:52 there, right about where I have that 9:54 trigger point marked off. Now I'm 9:57 going to go ahead and 9:58 add some compressive force right up to 10:00 the point where I get some good tissue 10:03 resistance, not past it. I think you guys 10:06 will find that you push into soft tissue 10:07 and it's pretty soft, and then all of a 10:09 sudden you get a big increase in tissue 10:12 resistance. You're just going up to that 10:14 point, not past it, and then I'm going to 10:17 go ahead and hold if I want. I can add 10:20 some tension this way by adding a little 10:22 horizontal adduction and internal 10:25 rotation to either help me pin the 10:29 tissue by kind of pulling these fibers 10:32 this way so that we don't get as much 10:35 play this way, or maybe I feel like I 10:38 don't have enough tissue 10:40 resistance, so I can pull this way. 10:43 I'll hold that until I either feel that 10:45 density melt underneath my fingers, 10:47 Crystal tells me that she's no longer 10:49 feeling anything 10:51 from that pressure, or all of a sudden 10:53 her shoulder starts giving way into 10:56 internal rotation or horizontal 10:58 adduction. So there you have it, static 11:01 manual release of the posterior deltoid. 11:03 Make sure before you attempt this 11:05 technique that you practice it on 11:07 friends, colleagues, with a mentor. Maybe 11:10 even take a live workshop on manual 11:13 release techniques and then come back to 11:15 this video for review. If you're going to 11:17 put your hands on somebody, ensure that 11:19 you have a good working hypothesis that 11:21 this technique is going to either reduce 11:23 symptoms or improve performance. The 11:26 only way to get there is assessment. I 11:29 hope you guys have enjoyed this video. I 11:31 look forward to seeing your questions. 11:33 Please leave them in the comments box 11:35 below. I'll talk with you soon. 11:44 you
