0:04 This is Brent of the Brookbush Institute, and 0:06 in this video we're bringing you another 0:07 manual technique. Now if you're watching 0:09 this video I'm assuming you're watching 0:10 it for educational purposes, and that you 0:12 are a licensed manual therapists 0:14 following the laws regarding scope of 0:16 practice in your state or region. That 0:18 means athletic trainers, chiropractors, 0:20 physical therapists, osteopaths, licensed 0:23 massage therapists, you are likely in the 0:25 clear to do these techniques. Personal 0:28 trainers this probably does not fall 0:29 within your scope of practice, although 0:31 you might be able to use the palpation 0:32 portion of this video, to aid in learning 0:35 your functional anatomy in an 0:38 educational setting supervised by a 0:40 licensed manual therapists. Now before we 0:42 place our hands on a patient or client 0:44 it is important that we assess, and have 0:47 a good rationale for doing so. And of 0:50 course if we're going to assess, then we 0:52 should be reassessing to ensure that the 0:54 manual technique we're using is 0:56 effective, and we have a good rationale 0:58 for continuing to use that technique. In 1:00 this we're going to go over static 1:01 manual release of the splenii muscles, 1:03 that's the splenius cervicis and the 1:05 splenius capitis. I'm going to have my 1:06 friend Melissa come out she's going to 1:07 help me demonstrate. Now we're going to 1:09 use the same four step process we've 1:11 done in other static manual release 1:13 videos. We're going to talk about how to 1:14 palpate and differentiate the splenii 1:16 from the other structures proximal 1:18 to it on the posterior lateral neck. 1:20 We're going to talk about any structures 1:22 that might be proximal to the splenii 1:24 muscles that we could insult or abrade 1:27 with compression. We need to talk about 1:29 trigger points a little bit because that 1:30 will help the efficacy and accuracy of 1:33 this technique, and we're going to talk 1:35 about client and practitioner 1:38 positioning, so that I am in a position that I 1:40 can comfortably hold this technique. and 1:42 my client can relax in the position 1:45 they're in so that we can actually get a 1:46 release. Now step number one of this 1:48 technique is by far the hardest, it helps 1:51 to know a little bit of functional 1:52 Anatomy. We have to figure out how we're 1:55 going to differentiate the splenii 1:57 from the upper trapezius and the levator 2:00 scapulae which it lies in between. Now it 2:05 is important to be able to differentiate 2:07 this structure because the upper trap, 2:10 splenii, and levator scapulae don't all 2:14 rotate the head in the same direction. 2:16 So for example if I assessed Melissa she 2:19 came in with some cervical dysfunction, 2:20 maybe even some cervicogenic headache, 2:22 and I noticed that she could not rotate 2:25 her head completely in this direction, I 2:27 need to know which of those muscles I 2:30 should release on this side, and which I 2:32 should release on this side. So let's 2:34 talk about functional Anatomy a little 2:36 bit. My splenii and this is splenius 2:38 cervicis and splenius capitis together, 2:40 originate from the spinous process 2:42 of T6 up through the ligamentum nuchae to 2:46 the spinous process of C3, and then they 2:49 kind of run off in this direction, 2:52 so from inferior medial to 2:54 superior lateral, towards the mastoid 2:57 process of the temporal bone, and you 2:59 guys can feel that little bump that's 3:01 behind your ear, that little point right 3:04 that's where these fibers are 3:06 heading to. You can imagine if I'm on 3:07 this diagonal that when these muscles 3:09 shorten, they'll create ipsilateral 3:13 rotation. So the rotation the splenii 3:16 muscles create matches the levator 3:20 scapulae, but opposes the upper trapezius 3:24 which rotates this way. So for example, if 3:30 I had Melissa here and she had great 3:33 rotation this way, we couldn't rotate 3:36 this way very well, lets say she's stuck 3:39 right there. What I would probably want 3:42 to do is release levator scapulae and 3:46 splenii on this side, but upper trapezius 3:50 and deep extensors of the neck on this 3:54 side. The more accurate I can be the 3:57 better chance I have of getting good 3:59 outcomes. So how do I get to this 4:01 structure. Well we need to skip to step 4:04 three real quick. Knowing where the 4:06 common trigger points are, where we're 4:08 likely to find those increases in tissue 4:10 density is going to help. So trigger 4:13 points are commonly just in line with 4:16 the C7 spinous process, which is usually 4:20 that most prominent spinous process of 4:23 the base of the neck. So you guys can 4:24 look for that and think 4:25 ok, I got one trigger point that's going 4:27 to be in here somewhere, and then the 4:29 other one just happens to be in line 4:30 with C2 which is the first spinous 4:33 process I can feel underneath the head, It's 4:36 nice and convenient so at least we have 4:38 two nice landmarks we can kind of line 4:41 up with. Now although I said that this 4:45 this trigger point here which happens to 4:48 be the trigger point for the splenius 4:49 cervicis, is in line with the spinous 4:53 process of C7 I can't just go ergh 4:56 that's not going to work. It might leave a 4:58 nice bruise but I'm probably not going 5:00 to get to the splenii muscles, I 5:02 actually need to get deep to the upper 5:04 trapezius, and the only way I can do that is 5:07 by finding the anterior border of the 5:09 upper trapezius and falling off this way. So I 5:12 don't know if you guys can kind of see 5:13 my finger there fall off in front of the 5:17 trapezius. Now we have to take another step 5:20 here and get a little bit more technical 5:21 and find the lamina trough, which is the 5:24 trough between the transverse process and 5:26 the spinous process here. So 5:29 between the spinous process and the 5:30 transverse process of a vertebra you 5:32 have this little little divot, you guys 5:34 can even kind of feel that if you 5:36 kind of palpate in the neck here. The only 5:38 difference is we need to find this 5:40 trough while anterior to the trapezius, and 5:43 heading down towards C7 spinous process. 5:48 You guys got that, 5:50 anterior to the trapezius, into the lamina 5:53 trough, towards C7 spinous process 5:56 and then we hit the levator scapulae, 6:00 darn it, okay we're almost there. So 6:03 what we're going to do is we're going to 6:05 laterally flex, that's going to help 6:06 soften up the upper trapezius a little bit, 6:08 and then we're going to 6:09 ipsilaterally rotate. And although this is 6:11 going to shorten our tissues a little 6:14 bit, for the splenius cervicis here it's 6:17 going to allow me to get my thumb in 6:19 between the upper trapezius and the levator 6:22 scapulae which is just anterior, into 6:25 that trough so that I can start doing my 6:28 short stroke strumming perpendicular to 6:31 the splenii fibers,which remember 6:34 these fibers go up this way. So I'm 6:35 actually going to be kind of doing 6:37 these tiny little strums out this way in 6:43 the trough with her head in this 6:46 position, until I find the most dense 6:47 fascicles. I'm going to look for a nice 6:50 nodule once I find those fascicles and 6:53 it's right there. All right and then I 6:57 can use her head if I need to 7:02 add a little tension to kind of 7:04 stabilize that nodule, so I'm not playing 7:06 the finger on top of the marble game, I 7:08 can do that here. Now the other trigger 7:12 point which is going to be our splenius 7:14 capitis trigger point, all I need to do 7:18 is start searching in through here and 7:21 look for fibers that are heading from 7:24 the spinous process out towards this 7:28 mastoid process. The splenii 7:32 muscles have a unique fiber direction which 7:34 is kind of what I mentioned before, is 7:36 why we need to be able to differentiate 7:37 these tissues. They rotate differently 7:40 than the deep extensors of the cervical 7:44 spine underneath them. So i can have 7:47 Melissa to do all sorts of things to 7:48 help with my palpation, right like I can 7:50 kind of get my fingers in the right 7:51 place and I can go, hey do you mind 7:53 rotating towards me against my thumb, 7:54 right and then extend your head and turn 7:57 lateraly towards me, and then if I 7:59 do my my short strokes here, right so I'm 8:02 going to come down this way, I can kind 8:06 of see alright so I got her contracting 8:08 the right muscle; can I get them, can I 8:12 feel the ones that are going in the 8:13 right direction heading in the right 8:14 direction, and I can actually right here. 8:17 And then once I find those tight 8:19 fascicles is there any nodule or point 8:22 of acute density that i can press on. Now 8:27 a couple little things here guys; take 8:30 your time, this isn't a race, nobody's 8:34 expecting you to just put your finger 8:37 right down on a trigger point in a 8:38 muscle that's fairly deep and hard to 8:40 palpate. That doesn't show 8:42 proficiency to just kind of go aah, it 8:45 shows maybe carelessness more than 8:47 anything else. Your patient doesn't know 8:50 whether this should take you 15 seconds 8:52 to find, or three minutes to find. So if 8:54 you know your functional Anatomy you can 8:56 think of those fiber directions, you need 8:59 your client you need to move your 9:00 clients head around a little bit, you 9:02 need to have them contract the muscle, 9:03 that's all fine, that's all fine. Take 9:05 your time. I'd rather you took three 9:08 minutes to find the right point than to 9:12 spend 15 seconds and be totally wrong, 9:14 and not get any outcomes whatsoever. Now 9:17 although we don't have too much issue 9:19 here with sensitive structures, as long 9:21 as you don't jab your finger up in 9:23 towards the occiput that you kind of 9:26 stay going posterior to anterior, you 9:29 shouldn't run into any structures that 9:30 are particularly sensitive to 9:32 compression. You do have to be a little 9:34 careful with the splenius cervicis point, 9:37 because if you press down real hard, real 9:40 fast, and you're not real careful, you 9:43 could stretch the brachial plexus. So if 9:45 you get any burning, searing, tingling 9:48 they get that little jolt, right if they 9:51 get any numbness, or funky pins and 9:53 needles and their fingers, guys move, take 9:56 your time, move your fingers around get 9:59 off the brachial plexus. See if you can 10:01 mess around with some 10:03 ipsilateral flexion to get that brachial 10:05 plexus out of the way, and still get to 10:07 the muscle you're looking for. Now last 10:09 we do need to talk a little bit about 10:11 patient and client position. This is not 10:13 a good idea all right, this is kind of 10:15 weird, but I'm not I'm not just like 10:17 palming people's foreheads and 10:19 jabbing my thumbs in places where I 10:22 can't see, especially because I can't see 10:24 this trigger point here. This 10:25 is all for you guys to be able to see a 10:28 little bit of the anatomy, and how my 10:31 hands are placed relative to some other 10:33 structures. If I was going to do this in 10:35 a seated position which you can, I would 10:39 have Melissa swing her legs 10:40 over the end of the table here and I 10:43 would come sideways,and then I would 10:45 probably use that that kind of quasi 10:48 headlock position. I'll drop the table 10:50 down here a little bit, but we talked 10:52 about putting the forehead and the 10:54 crease of your elbow on another one of 10:56 our manual release techniques for the 10:57 neck. If I do this, I can now move 11:01 her head comfortably and she feels nice 11:03 and stable. I can use my body against her 11:06 shoulder, right like my rib cage and my 11:08 torso here a little bit, and then I can 11:11 take this thumb and get right where I 11:14 need to get. This particular technique 11:16 doesn't take a whole lot of pressure so 11:19 you might be okay. It's not ideal body 11:21 mechanics I can't really get my forearm 11:24 perpendicular to, or parallel to the 11:27 direction of force, but we're close to a 11:30 good position here. I personally prefer 11:33 to do this in supine, so i'm going to have Melissa 11:36 swing all the way around here. I think 11:40 supine is much more comfortable for both 11:41 the patient and the client, and I think 11:44 you guys will agree if I just slip this 11:48 hand underneath the occiput, I now have 11:52 total control of her head, and Melissa 11:55 is very relaxed right now because we've 11:56 done a lot of these videos and she 11:58 trusts me, poor thing. She has had 12:02 her neck worked on with me before. 12:04 It might take a second to get your 12:06 patients to completely relax, but you do 12:08 have really nice control this way, and 12:10 then I can take this hand and I'm going 12:12 to use kind of this technique of 12:15 reaching underneath her neck, and I can 12:17 see her trap right here drop my hand ,and 12:20 right anterior to it I'm going towards 12:23 that laminar trough, and since I can feel 12:27 C7 with these fingers, I can drop 12:30 my thumb right down in that direction. 12:32 Move her head however I need to, I can 12:35 start doing my strumming out 12:37 perpendicular to those fibers. Find the 12:41 tightest fascicles, find my tight nodule, add 12:45 a little tension so 12:49 that I have that nodule pinned, and then 12:51 wait for a release. 12:52 And believe it or not the splenius 12:55 capitis trigger point is even easier 12:57 because all i have to do is move my 13:00 fingers like this, right so i leave these 13:02 digits kind of facing up, and i'm just 13:06 going to use the weight of her head. 13:08 I'm going tofind C2 which is 13:10 that first by the spinous process I feel 13:12 underneath her occiput. I'm 13:16 going to look for the fibers that go in 13:18 the right direction and I might have her 13:19 like, okay can you rotate into this side 13:22 here. I might have her rotate a little 13:25 bit and then try to strum those fibers, 13:29 find the most dense fibers, find the most 13:34 dense nodule, and then once again just 13:37 have her totally relax. The nice thing 13:39 here is like my hand is curled, and then 13:42 I just have the weight of her head hold 13:45 for me until we get a release. Stay tuned for 13:48 the close-up recap. So now for a close-up 13:50 recap of the splenii static manual 13:54 release. We're starting here with the 13:55 splenius cervicis manual release. You can 13:58 see my thumb is actually just anterior 14:01 to the anterior border of the upper trap 14:03 here, that my hand is wrapped underneath. 14:06 I'm going to fall off the anterior 14:09 border down into the lamina trough, 14:12 which is the space between the 14:15 transverse process and the spinous 14:17 process on the posterior aspect of the 14:19 cervical spine. I know that my common 14:21 trigger point is down near the C7 14:25 spinous process. So i can even palpate 14:28 the C7 spinous process with these two 14:30 fingers and give myself an idea of where 14:32 that is, and then kind of push my fingers 14:36 towards one another. But unfortunately 14:39 the first thing I run into actually is 14:41 my levator scapulae. So the way I get my 14:43 levator scapulae out of the way is I do a 14:45 little ipsilateral rotation, and 14:47 although this takes some tension off my 14:50 splenius cervicis, it's the only way 14:53 for me to sink my finger down between my 14:56 upper trap and levator scapulae. Once I've 14:59 sunk my finger down in there I can then 15:02 use my short strokes, 15:03 kind of this lateral to medial stroke, 15:07 and these are very short strokes 15:09 just a couple fascicles at a time, to 15:13 find anything to me that feels 15:16 overactive, feels tauter than it should be. 15:21 Once I find those taut 15:23 fascicles I can kind of move inferior to 15:26 superior, superior to inferior to try to 15:29 find the densest nodule, and then i can 15:33 actually once i've located that nodule 15:36 go back into a little contralateral 15:39 rotation, contralateral flexion to add 15:42 some tension back in those tissues and 15:43 help me pin that point of hyperactivity. 15:48 Once I get a release, of course I can 15:51 move on and of course this is the more 15:53 complicated of the two release techniques 15:57 for your splenii muscles. The 16:00 splenius capitis muscle has a trigger 16:03 point that's commonly at the level of 16:05 your C2 spinous process, which your C2 16:08 spinous process is the first spinous processs 16:10 you feel underneath the occiput. So 16:12 that's fairly simple, and we know 16:15 that the splenii have this kind of 16:18 unique fiber arrangement thats this way. 16:20 So all we have to do is kind of go just to the 16:24 side of C2 spinous process here, and look 16:29 for fiber direction this way. Find her 16:32 tightest fascicles by strumming this way, 16:36 kind of from in the same direction that 16:38 her shoulder to her ear would be. 16:41 So we're strumming perpendicular 16:42 to those fibers. Once we find them -find the 16:46 tightest fibers that is, we can kind of go 16:48 lateral to medial to see if there's a 16:50 nodule and point of hyperactivity. And 16:53 then I'm just using that kind of curved 16:55 hand position and the weight of her head 16:58 to do all the work, and once i get a 17:01 release we're good to go and I would 17:05 reassess. So there you have it knowing 17:08 your functional Anatomy will definitely 17:09 help your manual technique. It will help 17:12 you differentiate structure so that you 17:13 can place your hands where they need to 17:15 be. 17:15 As well as make you aware of these 17:17 sensitive structures around the tissue 17:19 that you're trying to target. Things like 17:21 nerves, and lymph nodes, and arteries. Make 17:24 sure that if you're going to place your 17:25 hands on a patient that you have done an 17:27 assessment, and have a good rationale for 17:29 placing your hands on that patient. And 17:31 if you're going to assess, make sure you 17:33 reassess to ensure that your technique 17:35 was effective and you have a good 17:37 rationale for using that technique again. 17:38 Now with manual therapy one-on-one live 17:42 education is incredibly important. Please 17:46 be looking for opportunities like 17:48 workshops, and mentorships, and maybe even 17:51 classes at your local university that 17:54 can get you some one on one individual 17:57 instruction. Or at least some live classroom 17:59 instruction so you've had a chance to be 18:03 critiqued and mentored, by somebody 18:06 senior to you with some experience in 18:08 manual therapy techniques. And before you 18:11 bring this stuff back to your rehab, 18:15 fitness, or performance setting, please 18:18 practice on colleagues. There is no 18:20 substitute for practice, and it is going 18:23 to take a while to get accustomed to some 18:27 of the techniques that we show in these 18:29 manual technique videos. Don't expect to 18:31 learn them in two, or three,. or even five 18:34 minutes. You want to have hours of 18:37 experience under your belt working on 18:39 various different body sizes and shapes. 18:41 So that when you do get that first 18:44 paying client, first paying customer, and 18:46 you're really trying to make a good 18:48 positive impact, really trying to promote 18:51 better outcomes, you feel comfortable 18:54 with that technique. I look forward to 18:56 hearing about your outcomes and hearing 18:58 your questions in the comments section 19:00 of this video, I'll talk with you soon. 19:11 you
