0:04 This is Brent of the Brookbush Institute. 0:06 In this video we're going to go over 0:07 manual static release of the rectus 0:10 femoris and vastus intermedius, those 0:12 middle quadriceps muscles. If you're 0:14 watching this video, I'm going to assume 0:15 you're watching it for educational 0:17 purposes and are a licensed manual 0:19 therapist. That's physical therapists, 0:21 ATC's, chiropractors, massage therapists... 0:25 and you are following the laws dictating 0:28 your scope in your state. If you're not 0:30 sure what those laws are, or whether 0:32 you're allowed to perform manual release 0:33 techniques, please look those up before 0:36 trying these out on patients or clients. 0:37 I'm going to have my friend Melissa come 0:39 out, she's going to help me demonstrate 0:39 this technique. The only rough little 0:44 thing you need to know about rectus 0:47 femoris or vastus intermedius static 0:50 release technique, is the position to put 0:53 your patient or client in. If you try to 0:56 pin down trigger points, pin down 1:00 hypertonic nodules, or pin down adhesions in 1:03 this position you're going to have a 1:05 hard time. The muscles are going to feel like 1:07 mush. You're going to play that 'finger 1:11 tip on top of a marble' game, where it just 1:13 keeps shooting out. What you need to 1:15 do, is have your client or patient go 1:19 crooked on the table. Hang their lower 1:24 leg off the table, and you're going 1:27 to use your thigh, just like 1:31 you used your thigh to control plantar 1:33 flexion or dorsiflexion on some of those 1:35 lower leg release techniques that we did. 1:38 Once we get here, you will see that 1:41 I've marked off the rectus femoris 1:43 trigger point here, and the vastus 1:46 intermedius trigger point. Those are 1:48 the common trigger points. Once again, 1:49 trigger points are very related to 1:52 motor points, or where the nerve 1:55 innervates the muscle. We think this 1:59 is where the the most dysfunction 2:03 happens, especially in those overactive 2:05 muscles. Once I know kind-of where these 2:08 trigger points are, what I'm going to do 2:11 is use a thumb. A nice, broad 2:15 surface, 2:16 to track over these fascicles, 2:19 perpendicular to them, because what I 2:21 want to do is find the densest 2:24 fascicles in this muscle. Once I find 2:27 some dense fascicles, I'm then going to 2:29 move proximal and distal, remember that 2:32 the rectus femoris originates in 2:35 the AIIS, so that's up pretty 2:38 high. I want to make sure that when I do 2:43 my tracking here, my searching for a 2:47 tight nodule, I go from origin, down. 2:53 I find my tight nodule right 2:57 there, and then what I'm going to do is, 2:58 once again, I'm going to use a broad 3:01 surface here to block that that trigger 3:04 point, make sure I pin it down with a 3:07 little distal to proximal force, and 3:10 anterior to posterior force. Then I 3:13 can even help to center and 3:16 stabilize that trigger point by pulling 3:19 these fascicles taut, by giving just a 3:21 little pressure into knee flexion. 3:24 Again, broad surface over that 3:27 nodule, little distal proximal force, 3:32 and anterior to posterior force, as I 3:35 push a little bit in the knee flexion. 3:36 I'm then going to use this groove right 3:39 here in my hand over my thumb to apply 3:43 pressure. Once I apply some pressure, I'm 3:48 going to go right into where I feel a 3:50 little give back in that tissue density. 3:52 I don't need to go too far. I don't need 3:55 to try to kill Melissa with pain. Just 3:58 right up to where the tissue starts 4:00 giving back a little bit, and then I'm 4:02 going to hold patiently while it lets go. 4:07 Usually this takes 15 to 30 seconds. 4:11 I think Melissa can start feeling it right 4:13 about now, I can actually start to feel 4:15 the tissue melt underneath my thumb. 4:17 Melissa will probably feel a little 4:19 reduction in the discomfort. Once I'm 4:23 done with that trigger point, 4:24 let's go a little lower. Let's look 4:27 for these trigger points, and maybe 4:29 vastus intermedius. Notice I take 4:31 some of the pressure off the leg, and I 4:33 started doing these perpendicular kind 4:37 of strokes with my thumb, strumming over 4:39 those fascicles, looking for the tightest 4:41 fascicles. I found one here. Now, it's 4:44 about finding the knot that's pulling 4:46 those fascicles tight. With the 4:52 quads, it's going to take a fair amount 4:53 of searching. This is a lot of muscle, 4:57 these fascicles are very long, and there are a 5:00 ton of them, so be patient with yourself. 5:02 This isn't a race. It's not a game to see 5:05 who can get the quickest release. 5:08 Accuracy is far more important, so take 5:11 your time finding the most dense 5:13 fascicles. I found that 5:17 nodule right there, I'm going to use that 5:19 nice, broad, thumb stroke to create 5:22 distal to proximal, and anterior to 5:24 posterior force, as I stabilize that 5:28 trigger point a little bit 5:30 underneath my finger, by placing her knee 5:33 a little bit more into flexion. Then, 5:35 this will be my dummy hand. No 5:38 pressure on this hand, I'll use this hand 5:39 with my shoulders over my hands, to 5:43 create the pressure. Just one quick note, 5:47 before we go into our close-up 5:49 review... Notice that my hands are 5:53 palpation hand on the outside, dummy hand 5:58 on the inside, and if I flip my hands 6:02 around, 6:05 and I go after that rectus femoris 6:07 trigger point, I think you're going 6:09 to see where this hand is going to end 6:11 up, and that's just not necessary or 6:14 appropriate. Don't get yourself into 6:16 trouble. This is your 6:18 close-up recap. Notice that I have the 6:20 rectus femoris and vastus intermedius 6:22 trigger points marked. Try to memorize 6:24 where those positions are. Notice 6:27 the rectus femoris is fairly high. This 6:30 is the anterior inferior iliac spine 6:32 behind this soft tissue. The rectus 6:35 femoris, goes all the way down to the 6:37 knee, but this trigger point is really 6:39 high. I'm going to use the same technique 6:41 I always do of palpating across those 6:44 fascicles, until I find the fascicles 6:47 that have an increase in tissue density or an increase in tension. Once 6:54 I find them, I'm going to go ahead 6:56 and track that fascicle approximately 7:00 all the way up to the AIIS in this case, 7:03 and down until I find that little 7:07 nodule or knot that I think is pulling 7:09 the whole thing tight. Notice that I have 7:12 Melissa kind of hanging this leg off, and 7:14 I have her whole body crooked on the 7:17 table so that she's aligned with this 7:19 leg. The reason I have this is so that I 7:22 can once again center that trigger point, 7:25 make sure it's stable for me to press 7:29 into by just adding a little tension, 7:32 pushing her into knee flexion, so now I 7:34 can use my nice broad thumb stroke here 7:38 do a little distal to proximal force, and 7:41 then use this hand again right over my 7:44 thumb, right there in between my 7:46 fenar eminences, press until I get a 7:50 little pushback from that tissue density, 7:52 and hold it 5, 10, 15 seconds. It'll start 7:57 to melt away, and it'll probably 8:00 completely disappear in 30 to 60 seconds. 8:03 It does take a little practice, learning 8:06 how much tension you should put into the 8:08 system, because if you push too hard and 8:10 constant pain, the muscle will kick 8:13 back against you and you'll never get 8:14 release. If you don't put enough, you 8:16 probably don't stimulate enough receptor 8:19 activity to get autogenic inhibition. 8:21 Once I get a release here, of course, I 8:25 can move on to vastus intermedius which, 8:27 notice, vastus intermedius is much more 8:29 in the center of the length of the leg. 8:32 Again, I'm going to palpate across, find 8:36 those dense fascicles, find the knot 8:39 that's contributing to that density, and 8:44 once I've got it, a little pressure 8:48 into knee flexion with my thigh. 8:51 That will help tense this line, center 8:55 that trigger point, and then I can put 8:59 some pressure over it. Like I 9:02 said before, you're going right up 9:04 against that tissue density, where it 9:07 starts to really increase on you, 9:11 and then you're just going to hold that 9:13 spot. Please pay careful attention. 9:15 Notice that my dummy thumb is on my 9:18 outside hand, not my inside hand. You 9:21 can imagine that if I started tracking 9:24 proximally, I'm going to get my hands in 9:26 a position that is not appropriate. 9:29 Once again, dummy thumb on me on the 9:32 outside hand, and then you're going to 9:34 put pressure with your inside hand. So there 9:37 you go. Vastus intermedius and 9:39 rectus femoris static manual release 9:42 techniques. Keep in mind if you're doing 9:44 palpation and manual release, you should 9:47 be 75-80% sure you 9:50 have a solid hypothesis that's 9:52 based on assessment, you believe those 9:54 muscles are overactive. If we were 9:58 talking about me, and I was going after 10:00 the rectus femoris specifically, I 10:01 probably saw something like an anterior 10:04 pelvic tilt, or an excessive forward lean. 10:06 Maybe the knees bow out on an overhead squat 10:09 assessment. In goniometry, the rectus 10:11 femoris can restrict both internal and 10:13 external rotation of the hip. Maybe we 10:18 did that muscle length test, the Ely's 10:20 test, which is specific to rectus 10:23 femoris extensibility. 10:24 Once you guys have a good hypothesis, 10:27 definitely don't be afraid to try rectus 10:30 femoris and vastus intermedius release. I 10:32 think you'll get great results if these 10:35 muscles are involved in the dysfunction 10:37 or pathology that you're working with. 10:38 Make sure to try these techniques on 10:42 colleagues and friends so that you get 10:46 good practice and good confidence 10:49 skills before you start placing your 10:52 hands on patients and clients where a 10:55 mistake could cost you not only outcomes, 10:59 but maybe a client or patient. I look 11:03 forward to hearing how this technique 11:05 added to your repertoire improves your 11:07 outcomes and improves the performance of 11:09 your clients. Please feel free to write 11:11 questions down in the comments boxes 11:13 below, I always love to hear from you.
