0:04 This is Brent of the Brookbush Institute, and in this video we're going to go over 0:07 manipulations or high-velocity thrust techniques. I assume that if you're 0:11 watching this video you're watching it for educational purposes, and that you 0:14 are a licensed professional with high- velocity thrust or manipulation 0:18 techniques in your scope of practice. If you are not sure check with your state 0:24 board. Most physical therapists, chiropractors and osteopaths you're in 0:28 the clear. I believe that ATC's you can't do manipulations in the United States, 0:33 although other countries again check your scope. Of course massage therapists 0:38 and personal trainers these are generally not within your scope. Of 0:41 course you could continue to watch these videos just for educational purposes, 0:47 learn a little Anatomy, learn a little biomechanics. If you're going to do these 0:51 techniques please make sure that you have a good rationale for putting your 0:56 hands on a patient. This should be based on assessment, and if you're going to 1:00 assess I'm hoping that you'll assess, use these interventions and reassess to 1:06 ensure that you're getting the result that you're looking for and have good 1:09 reason to continue using this technique. In this video we're going to go over 1:12 sacroiliac joint manipulation, the technique is commonly referred to as the 1:16 Chicago technique or the Chicago roll. I'm going to have my friend a Yvette come out, 1:20 she's going to help me demonstrate. Now this technique we could use for sacroiliac 1:24 joint stiffness. Obviously we want to base that on several assessments, not 1:28 just palpation skills. However, if you want to look up how to do a passive 1:33 accessory motion exam, which is basically a joint mobilization P-A check out 1:39 our sacroiliac joint mobilization posterior to anterior video, and you'll 1:43 get a good idea of all of the palpation and how to actually place your hands and 1:48 use that technique. Now the technique itself is one of those that is going to 1:53 look really easy when I do it, and then not feel so easy when you do it, so be 1:59 prepared. It is one of those deceptively hard techniques, but essentially what 2:04 we're going to do is we're going to set our patient up in supine, with the 2:08 involved side -the stiff side opposite us. So the way Yvette is set up now, we have 2:16 to assume that I am working on her left SI joint. Now I kind 2:21 of want to lock up that SI joint the best I can, and the way I'm going to do 2:25 that is I'm going to place this leg over the top of this leg, alright so maybe we 2:30 get a little bit of posterior tilting there, and then I'm going to go ahead and 2:35 side-bend that way. This is sometimes referred to as smile away 2:40 position, so you're making like a little smiley face. So she's all locked 2:46 up down there, now we have to rotate her torso to lock up all of the segments 2:52 above, right which would be all of her lumbar spine. So as you can imagine in a 2:58 way this is going to have some similarities to that lumbar manipulation 3:03 you saw in a previous video. Now what I'm going to have Yvette do is she's 3:07 going to go ahead and interlock her fingers behind her head, I'm going to use this hand 3:12 over the top of her ASIS to brace her pelvis. Now be careful, just because 3:19 you put the palm of your hand over there ASIS doesn't mean that I can't feel 3:22 very bony and very pokey to them. So adjust your hand so that you get nice 3:29 wide purchase, a lot of surface area right but you're nice and stable, so we 3:34 don't want any pinch there. I'm then going to try to lace my hand through her 3:39 arm. Now again I'm a lot bigger than Yvette is, 3:43 so I'm not going to be able to get all of my arm through her arm, but I can get the 3:49 back of my hand onto her sternum, and that's probably enough. I can feel her 3:54 chin on my hand, but I think that's okay. Now what we're going to do is keep this 3:59 down and rotate as far as we can into rotation, trying to make sure that Yette 4:06 keeps her hands nice and locked up; and when I start feeling a good amount of 4:10 force pressing in to my right hand here, I lock out and thrust, and that's 4:19 it. Again that's not particularly complicated, but it does take a little 4:25 bit of practice. Let me kind of go through one more time 4:30 and then give you a couple little pointers to try to get that feeling of a 4:35 lock, and to get all the force right here so that when you do that manipulation 4:40 you actually get a successful movement of the SI joint. So we said this leg goes 4:47 over this leg. This gets side -bent away. Now you could experiment with a little 4:54 side-bending of the upper-torso. All right so we get as much side bending as 4:58 you can and then again we'll put the hands back here. If you don't like this, 5:03 you could do this. All we need is rotation of the spine. So if I rotate 5:12 this way and maybe even like plant my fist into the table, and then I can kind 5:18 of straighten out my arm, right now I actually I feel a lot better in this 5:24 position. Especially me being unable to get my hand in between her her arms here 5:30 because her biceps are actually so huge that I can't get them in between her 5:35 forums, she works out a lot. But that being said, I get her rotated up, all 5:42 right so I got flexion, rotation, I got her locked out this way; 5:47 and actually I just, I lost it moving her around so much. All 5:53 right and this happens, like this is part 5:55 of the practice right. So let's try it again. We learned a couple things that 5:59 time. So we move this leg over this leg, smile away, we side-bent you this way when we 6:07 first did that, that actually helped, we locked you up really fast. Now, 6:12 we also learned in this last time for me personally that I don't like the arm 6:17 through. Now if you're a smaller person you might be able to get your arm all 6:21 the way through and hook your other arm on the other end of the table, I've seen 6:23 that right and then that kind of ends up looking, can you just hook your arm 6:26 around this arm, right like so that ends up looking something like this but with 6:31 her hands all the way hooked back, I've seen that. If she was doing this to me 6:36 that's what I would recommend. But for me on the other hand, 6:41 you can put your hands behind your head and be comfortable but we've 6:46 found that I get you all set up into side-bend, pull this way, use her forearms 6:55 a little bit to get me started, but then place my fist here. All right 7:01 rotate up by straightening my arm out, now that I have her all locked up, make 7:07 sure I get that force coming through this right hand, like I feel this coming 7:11 up like this and now I can, and thrust. How'd that feel? Better than the first 7:18 time? All right, big things to remember, leg far 7:25 away goes up, and you're going to side-bend, somehow I've seen this done where people 7:32 just side-bend from the bottom. I've seen it done where if people side-bend from 7:36 both sides. I think you need to experiment and try to figure out how 7:41 you're going to get locked position. You can go just hand through if you're a smaller 7:49 person, on a larger person you can go full arm through and hook through the 7:52 table, or you can start this way and then go behind and use your whole forearm 7:59 against their back to try to pull in as much rotation as you possibly can. 8:04 Now if you do that, keep in mind that you might have to continue to adjust so that 8:10 you don't lose all of your lateral flexion in the process. Your goal is to 8:14 get lock through here so that you start feeling pressure into this hand, so that 8:21 when you go down to press, you're pressing the innonimate through a 8:28 sacrum that's trying to rotate in the opposite direction. Boom. 8:37 Practice, a lot a lot of practice. Take some time to set this up with your 8:43 clients. Remember it's not a race, take as much time as you need. If you have 8:48 any questions about this technique please leave them at the bottom. A couple 8:51 of points to recap, knowing your anatomy and knowing your biomechanics will 8:55 certainly help you choose the right technique for the right patient. If 9:00 you're unsure whether manipulations are appropriate due to their higher 9:03 intensity it's okay to do mobilizations. Most research points to manipulations 9:09 being slightly more effective, but mobilizations being very effective, and 9:13 of course we have those videos for you if you want to start with those less- 9:17 intense techniques. Make sure that if you are doing any technique that is based on 9:23 assessment, and of course that you're reassessing ensuring that the technique 9:27 is effective for the patient that you're working on, and when it comes to all 9:30 manual techniques, manipulations maybe more than any other, look for 9:35 opportunities to get live education. Although I know videos are convenient 9:40 and I'm happy to have these up for you to watch, it would be so much more 9:45 helpful to use those videos as a recap of one-on-one attention with somebody 9:52 who's experienced with manipulation techniques. At the very least grab a 9:58 colleague, grab a friend and start practising these before you bring them 10:03 into clinic and start using them on patients and clients. I hope you enjoyed 10:07 this video, if you have any questions please leave them in the comments box 10:10 below.
