0:05 This is Brent of the Brookbush Institute, and in this video we're going to go over a joint 0:07 based manual therapy technique. If you're watching this video I'm assuming you're 0:11 watching it for educational purposes, and that you are a licensed professional 0:14 with joint based techniques within your scope; that means osteopath's, chiropractors, 0:20 physical therapists, you're probably all in the clear. Physical therapy assistants, 0:24 athletic trainers, massage therapist you need to check with your governing body 0:28 in your state or region to see whether this is within your scope of practice. 0:32 Personal trainers this is definitely not within your scope of practice. Of course 0:36 all professions could use this video for purely educational purposes to help with 0:41 learning biomechanics, anatomy and of course palpation. In this video we're 0:46 going to do our superior to inferior, or cranial to caudal clavicle on sternum 0:52 mobilization. So this are our caudal sternoclavicular mobilization, I'm going to 0:56 have my friend Melissa come out and help me demonstrate. Now this is an 1:00 interesting technique that I want you guys to keep in your back pocket, I find 1:04 it very very helpful for those stubborn stiff shoulders where you can't quite 1:10 figure out how to get that last five degrees of shoulder flexion, or five 1:15 degrees of shoulder external rotation; and I know some of you guys are thinking 1:18 well wait a second, how does the sternoclavicular joint contribute to 1:22 shoulder range of motion? And this, this gets a little deep into biomechanics but 1:27 we do have some research to suggest that those with shoulder impingement or 1:32 shoulder dysfunction, do not get enough elevation and posterior rotation of the 1:38 clavicle during elevation of the arm. So if we're not getting enough motion of 1:45 the clavicle, we might want to start thinking towards well could we have 1:48 stiffness in the SC and AC joint. Now in this video we're going to focus on an SC 1:53 joint mobilization, so why would I go superior to inferior, well if I'm 1:58 thinking about trying to get more elevation of the clavicle based on the 2:03 way the clavicle is shaped being a saddle joint, we can presume that it 2:09 follows concave on convex rules in the frontal plane right. So this joint wants 2:17 to as the clavicle elevates, roll superiorly, 2:21 which means we also need the glide inferiorly; hence why we come back to 2:29 this superior to inferior glide that I want you guys to keep in the back of 2:34 your brain, to try to help elevation of the clavicle, which just may help you get 2:40 those extra few degrees with that stubborn stiff shoulder. So from here we 2:46 kind of need to know how do we place our hands, how are we going to make this 2:51 technique work, and that all starts with your knowledge of anatomy and and being 2:55 able to palpate, and I would start with just palpate the clavicle, try to try to 2:59 outline the clavicle. If you've never done that before, I mean we all know 3:02 where our collarbones are that's fine, but start visualizing the shape of the 3:08 clavicle and try to find the rounded end of the clavicle. One rounded end, the 3:13 distal end would be the AC joint, but that proximal end is right where the 3:18 sternoclavicular joint is, and if you keep exploring the border of that 3:24 rounded proximal end you can actually feel like a depression, like a line 3:30 between the flat sternum, in this case actually the manubrium which is the top 3:35 of the sternum, and the rounded edge of the clavicle. And what I'm going to have 3:41 you guys do is once you find that, without jabbing somebody in the neck 3:45 which I know I jus jabbed Melissa in the neck there, 3:47 but without jabbing her in the neck I want you guys just to take two fingers 3:50 and put them right right over the joint line, we're going to use these as our 3:56 feelers of joint glide. Once again it's one of those things 4:00 where I just don't see taught often enough in joint mobilizations is if you have a 4:05 free hand, if you have the opportunity to use your fingertips to feel a joint line, 4:10 it's always a good idea to do so. It's going to help you determine when your 4:14 first motion happened at the joint, and of course when the end of arthrokinematic 4:19 motion or the end of glide happened as well. Now the way I'm going to mobilize 4:23 this joint is a little different than this technique which I've seen 4:28 traditionally in texts and and in some videos. 4:32 This is pokey like you guys could just see Melissa's face kind of like uhh, and I think 4:38 some clinicians are ok with with a little pokeyness sometimes if they have 4:43 to, and and not that I want to say that there's a problem with that, but there is 4:47 an alternative way to do this technique where you just don't need to be poking 4:50 at somebody's bony sternoclavicular joint. Use these two fingers to feel the 4:55 joint line, and then just use your your thenar eminence close to the joint line 5:01 on the clavicle; and so if I do this you guys can see now notice I have my 5:06 fingers pointed up here right ,like we don't want roaming fingers over 5:09 somebody's chest no need to get yourself into trouble, but 5:13 if I just put my thenar eminence nice and close to the joint line and I 5:17 press in an inferior direction, I can immediately feel the clavicle move 5:23 against my fingertips. No need to do this, nice broad surface area not pokey, and 5:31 providing I don't let my hands slide down over the top of Melissa's neck like 5:36 I'm going to choke, her like we definitely don't want anything like that. 5:39 And if I just kind of keep right on top of the clavicle and I push that way, how 5:44 does that feel? A lot better than this right. Okay yeah pokey, not pokey. A couple 5:54 precautions before we get started with our protocol here guys, watch 5:59 their sternocleidomastoid, keep in mind that your sternocleidomastoid like 6:03 goes right over the top of your sternoclavicular joint. So if somebody 6:08 starts tensing up and starts really guarding on you, you're not going to get 6:13 a good mobilization. It's also going to make them feel a lot more uncomfortable 6:17 because it's going to put a lot more tense muscle in your way which, we don't 6:24 want anything bearing down on the neck. So fingertips here, thenar eminence here. 6:31 I'm watching to make sure that her sternocleidomastoid aren't getting 6:35 geared up, and then I'm just going to go okay where's my first resistance barrier, 6:40 and it's right there, and then where is the end, is right there. 6:46 I'm going to back off to 50%, and then I can either do my grade 3's by coming all 6:52 the way back to the first resistance barrier, and doing like a larger 6:56 amplitude mobilization here. Or I could do my grade 4, going all the way down 7:02 arthrokinematic end range, back off 50% and stay right there at 50%, being a 7:07 little bit more intense than our grade 3. Now one thing I do want you guys to 7:12 notice is how straight this arm is, like I'm basically locked out here, and I'm 7:18 using my my core muscles to push. So don't think because you're seated you're going 7:26 to get away with like muscling this technique. You don't want to turn this 7:31 into like a chest press, like this is not a good thing, notice all like I'm just like 7:35 rocking her whole body anyway. What I really want to do is have my arms pretty 7:41 much straight out, be straight on to the table with my feet, and then like I'm 7:47 just using the weight of my trunk to push into Melissa's clavicle, Stay tuned 7:55 for your close-up recap. To give you guys a different view of our superior to 7:59 inferior sternoclavicular mobilization, the first thing we're going to do is 8:04 palpate the clavicle right. So hopefully you guys can kind of see how I'm 8:07 outlining the clavicular bone, and I actually want to follow the clavicular 8:11 bone medially until I fall off the clavicular bone. I can feel this nice 8:17 round bump here, and it approximates the rather flat manubrium which is the top 8:24 of my sternum. So you guys can see here my fingers are on this flat sternum, and 8:29 then if you watch me kind of go like this medial to lateral, you guys can see 8:35 my fingers kind of bump up over the rounded edge of the clavicle. Now what I 8:41 want to do is actually use my other hand to palpate the joint line. I'm going to 8:48 palpate my joint line, and that's going to help me determine 8:51 when my arthrokinematic motion starts with this mobilization, when I've had hit 8:55 end range arthrokinematic motion, and I mentioned before I'm just going to use 9:00 my thenar eminence here close to the joint, without being on top of Melissa's 9:06 throat, and without having to be on top of my fingers because that's not going 9:11 to be verycomfortable for me. So right here is probably good, and I can feel as 9:17 soon as I push down, I can actually feel with these fingers that joints start to 9:22 move. So there's my first resistance barrier just that easy, and then I can 9:28 feel the end of arthrokinematic motion and then back off to 50%; and I can do 9:35 either my grade 3s by starting at first resistance barrier and going to 50% in a 9:40 larger amplitude, or I can stay at 50% in small amplitude and do my grade fours. 9:47 Notice this is fairly comfortable for both Melissa and myself since I have my 9:53 arms straight, and I'm just using my torso, my core muscles essentially to 9:59 create the oscillatory motion. I'm not using my hand strength, I'm not using my 10:05 arm strength, it's really just the weight of my torso leaning forward and a little 10:11 core strength to create that oscillatory motion. Once I finish one to two 10:18 oscillations per second and start to feel a decrease in arthrokinematic 10:24 stiffness, I'll then go ahead and reassess. So there you have it assess, 10:29 address, reassess. Make sure that every time you choose a joint based manual 10:34 therapy technique it is based on an assessment, and that you return to that 10:39 assessment after you've finished the intervention to see if it was effective 10:43 for the individual, the patient or client that you had in front of you. Ensure that 10:47 you continue to learn your Anatomy because your Anatomy is going to help 10:52 you with your hand placement, with understanding what a joint can do, with 10:57 understanding what you may gain from this particular technique. And of course 11:03 practice, you have to practice these techniques hopefully not for the first 11:08 time on a patient or client who just walked in the door. If you can, find a 11:13 more senior instructor or a mentor to give you some really good hands-on 11:17 instruction. Use your peers for some good feedback, and of course always look for 11:25 live education to help with your manual therapy techniques. I know these videos 11:31 make education very convenient, but there is no substitute for learning manual 11:37 therapy in a live setting. I look forward to talking to you guys again 11:40 soon.
