0:04 This is Brent of the Brookbush 0:05 Institute in this video we're bringing 0:07 you another manual technique. Now if 0:08 you're watching this video I'm assuming 0:09 you're watching it for educational 0:11 purposes and that you are a licensed 0:13 manual therapists following the laws 0:15 regarding scope of practice in your 0:17 state or region. That means athletic 0:19 trainers, chiropractors, physical 0:21 therapists, osteopaths, licensed massage 0:23 therapists you are likely in the clear 0:25 to do these techniques. Personal trainers 0:28 this probably does not fall within your 0:30 scope of practice, although you might be 0:31 able to use the palpation portion of 0:33 this video to aid in learning your 0:35 functional anatomy in an educational 0:38 setting, supervised by a licensed manual 0:41 therapist. Now before we place our hands 0:43 on a patient or client it is important 0:45 that we assess and have a good rationale 0:48 for doing so, and of course if we're 0:50 going to assess then we should be 0:52 reassessing to ensure that the manual 0:55 technique we're using is effective and 0:57 we have a good rationale for continuing 0:59 to use that technique. In this video 1:01 we're going to do static manual release 1:02 of the sternocleidomastoid. I'm going to 1:04 have my friend Melissa come out, she's 1:06 going to help me demonstrate. We're going 1:07 to use the same four step process we've 1:09 been using for all of our manual release 1:11 techniques. We're going to talk about how 1:13 to differentiate this structure from the 1:15 other structures around it, and it's 1:17 actually fairly simple. I think this is a 1:19 structure that most of you would be very 1:21 visually familiar with. If i just take 1:23 Melissa's head and turn it away, you can 1:27 see this line right here is her 1:29 sternocleidomastoid. There's actually two 1:31 heads which if I follow just behind this 1:34 head, I can feel the other one going into 1:36 the clavicle. This head that you can see 1:38 goes right into the sternocostal joint. 1:40 So second step is do we have 1:44 any structures around the 1:45 sternocleidomastoid that could be 1:48 offended, insulted or injured by 1:51 compression, and the answer to that one 1:53 is yeah we definitely do in this 1:56 case. So a lot of people are really 1:58 scared of this technique and it's 2:00 because of things like the carotid 2:02 artery is right behind the 2:03 sternocleidomastoid. There's a lot of 2:05 nerves obviously in the neck, and since 2:08 we're on the front of the neck we have 2:10 things like your trachea that like 2:12 people don't really like getting pressed 2:13 on. So we're probably not going to use 2:15 anterior 2:16 to posterior pressure to release the 2:18 sternocleidomastoid, but there is an 2:20 answer, there is a different way to 2:22 release this. So let's skip to step 2:24 number three, where are the common 2:26 trigger points. Well it ends up the 2:29 common trigger points are kind of 2:30 throughout the sternocleidomastoid, 2:31 ranging all the way from the mastoid 2:34 process up here, so I can go just 2:36 inferior the mastoid process and I can 2:39 start feeling some increase in tissue 2:41 density all the way down, and depending 2:45 on who you're working with and what 2:47 dysfunction they have, and what history 2:50 they have, you'll find varied trigger 2:53 points throughout. So it's going to be 2:55 important to kind of search the entire 2:57 muscle rather than finding a trigger 3:01 point, landing on the first trigger point 3:03 or increased tissue density nodule that 3:05 you feel and calling it a day. You 3:08 need to make sure you search the whole 3:10 thing, and then of course step number 3:12 four is how do i get myself and my 3:15 patient comfortable so that i can hold 3:18 the technique long enough, and my patient 3:21 can relax. Since we're talking about the 3:23 sternocleidomastoid you can 3:25 probably guess that sitting up is not a 3:27 great idea, the only way I'm going to get 3:29 the sternocleidomastoid to relax is with 3:33 her head supported; and I haven't 3:36 even had that much luck with that 3:38 forehead headlock position that we've 3:40 done another techniques. I've tried 3:42 because I have somebody in sitting and 3:44 I'm trying to do a bunch of techniques 3:45 all in a row, it just never really seems 3:48 to work out. My suggestion is going to be 3:50 to put them in supine, so go ahead and lay 3:52 down, 3:54 move the table up here a little bit. Now once 3:57 she lays down her sternocleidomastoid is 4:00 going to relax, which is a good thing. Now 4:03 we just have to solve the problem of I 4:06 can't put an anterior to posterior 4:09 force of this muscle, that would 4:11 look a little something like this, that's 4:14 probably going to get me fired. I don't 4:17 know about you, but I'd like to keep 4:19 doing what I'm doing so let's not use 4:20 anterior to posterior force. Now Travell 4:23 and Simons describes a very simple way 4:25 around this, which is a pincer grip. Now a 4:28 pincer grip is just taking your your 2nd 4:30 finger here, your index finger and 4:31 curling up like this and then having 4:33 your thumb and kind of pinching it in 4:36 between, and if you have the other hand 4:40 to kind of put behind the occiput and 4:42 you kind of mess with contralateral 4:44 rotation here and put her in a little 4:47 flexion, her sternocleidomastoid becomes 4:49 really laxed, I can start up at the 4:52 mastoid process where I might be able to 4:54 use a little bit more of like a lateral to 4:56 medial pressure with my fingertips. But 4:59 then as I can get a hold of the whole 5:01 muscle I'm just going to put the muscle 5:04 inside of that pincer grip, and I'm going 5:10 to kind of search the tissue by 5:12 strumming, I'm kind of strumming this 5:14 way so I need to go from like, since this muscle 5:17 is long this way, I would strum the 5:19 muscle medial to lateral and i'm 5:22 just kind of taking segments down at a 5:23 time in my little pincer grip. These 5:27 little short strokes, looking for 5:29 anything that seems to have an increase 5:33 in tissue density or something that 5:35 feels like a nodule. Now notice guys 5:37 I'm not pushing down far into her neck. I 5:40 started by palpating the muscle up here 5:43 really finding it, really knowing what 5:46 i'm going for which i just fell off 5:48 inferior and slightly anterior to the 5:51 mastoid process here, and then I went 5:54 into my pincer grip this way. I know 5:58 some of you guys are thinking oh man 5:59 he's going to kill her, he's just going to 6:02 pinch off her carotid artery and game 6:04 over. Well it's not 6:06 that easy, to have somebody pass out like 6:09 that she would probably had some 6:10 symptoms first like nystagmus, or 6:13 lightheadedness, or her speech would 6:16 start to slur or something weird. 6:19 More than that as long as I'm not going 6:22 in and pinching down real hard, 6:25 real fast, if I'm being gentle with these 6:28 tissues and I'm just slowly increasing 6:32 my pressure, I'll feel a pulse from her 6:36 carotid artery before I cut off 6:39 circulation. If it pulses I have the 6:42 chance to move and chances are if you 6:45 could do this technique and you're 6:46 working on this technique you will feel 6:49 a pulse at some point of time, and you 6:51 will have to move over a little bit and 6:53 that's okay, no damage done. I can 6:58 actually feel her pulse against my thumb 7:00 on this side, right at the tip 7:02 of my finger which means i'm not 7:04 actually squeezing her carotid 7:07 artery, i'm actually squeezing her SCM 7:10 more at my second knuckle and 7:12 my IP of my thumb. So i know where her 7:16 carotid artery is. I found my densest 7:21 fascicles here. I'm finding a little bit 7:24 of a nodule of increased density right 7:26 here about a centimetre, two centimeters 7:29 below her mastoid process there, and 7:33 I'm just going to hold it until it 7:35 releases, that's it. How bad is this? Not 7:40 bad at all. It's a little less 7:43 comfortable if somebody has a trigger 7:45 point down here, be warned but like I 7:49 said if you start up here at the mastoid 7:51 process, you fall off, you get a good idea 7:54 of where that muscle is and you slowly 7:57 take out little parts, not take out 8:00 but slowly strum little sections of that 8:02 muscle with your thumb and be careful 8:05 when you feel a pulse, I think you guys 8:09 will find this technique is not that 8:11 uncomfortable. 8:13 If you want you can even add a little 8:15 stretch to the tissue by going back into 8:17 contralateral flexion, or back into 8:21 ipsilateral lateral rotation. 8:27 This muscle is definitely very related to arthrokinematic 8:33 inhibition, and you will see an increase 8:35 in tonicity if somebody's sternal 8:38 clavicular joint it is really locked up 8:41 or really hypermobile, so be aware of 8:43 that as you get down here. It's always 8:45 worth kind of checking on the how 8:48 stiff that joint is, kind of in 8:51 conjunction with this technique. Stay 8:53 tuned for the close up recap. All right 8:55 so here we go with our close-up recap of 8:57 the sternocleidomastoid static manual 9:00 release. I'll show you guys a real easy way to 9:03 find the sternocleidomastoid, if I 9:04 contralaterally rotate Melissa's head 9:06 here and then have her try to lift her 9:08 head off the table, you can see that 9:10 sternocleidomastoid just pops right 9:12 out and then I can place my pincer grip 9:16 right over the top of her 9:18 sternocleidomastoid at her mastoid 9:19 process, tilt her head back and now 9:23 we're in a nice relaxed position. I'll 9:25 keep her in a little contralateral 9:26 rotation just to keep some slack off 9:29 this muscle, and then I'm just going to 9:31 do my little medial to lateral strokes, 9:33 looking for those densest fascicles, 9:38 and then once I find an area of 9:40 increased activity I can move a little bit 9:43 proximal or a little superior and 9:47 inferior. Keep in mind you want to 9:50 be pretty close to where you 9:52 think that nodule is before you start 9:54 just kind of rubbing up and down the 9:56 muscle, because you don't want to take a 9:57 bunch of skin with you that's going to 9:58 be really uncomfortable. if I go right 10:01 here and then I just moved a little superior 10:03 there and I found a little point of 10:05 hyperactivity, and I'm just going to keep 10:07 my pincer grip right where it is until I 10:09 feel a release. Note I am not laying my hand 10:13 on top of Melissa's neck, there's no weight 10:16 from anterior to posterior on her 10:19 neck that would make her feel like she's 10:20 being choked, or like I'm putting 10:22 pressure on her trachea. I can feel the 10:25 pulse of her carotid artery a little bit 10:29 on just medial to my thumb, 10:32 and so for the most part the carotid 10:35 artery is medial to the 10:36 sternocleidomastoid. That doesn't mean 10:38 I'm compressing the carotid artery, it 10:41 doesn't mean that she's going to pass 10:42 out. It doesn't mean I'm doing any damage, 10:44 like I said I can just kind of feel the 10:45 pulse which is probably a good sign that 10:48 i shouldn't press any further 10:50 medialy, I shouldn't press any 10:52 further anterior to posterior but I'm 10:54 okay. I can just check the rest of 10:57 the muscle here, you're 10:58 sternocleidomastoid does get trigger 11:00 points throughout its entire length. It's 11:01 a little hard to identify where the most 11:04 common point would be, I do find that 11:09 near the mastoid process some trigger 11:12 points often get hidden and they are a 11:16 little easier to get to up here, you 11:19 have less chance of compressing the 11:21 carotid artery and the muscles a little 11:24 easier to grab up here so that helps. If 11:28 I wanted to I could add a little bit of 11:29 tension by going back into 11:31 ipsilateral rotation and contralateral 11:33 flexion just like so if I thought that 11:35 would help pin down tissues, or add 11:37 enough tension to to maybe stimulate a 11:40 stretch, an autogenic inhibition. So 11:43 there you have it knowing your 11:44 functional Anatomy will definitely help 11:46 your manual technique. It'll help you 11:48 differentiate structures so that you can 11:50 place your hands where they need to be, 11:51 as well as make you aware of these 11:53 sensitive structures around the tissue 11:56 that you're trying to target; things like 11:58 nerves and lymph nodes, and arteries. Make 12:00 sure that if you're going to place your 12:02 hands on a patient that you have done an 12:03 assessment and have a good rationale for 12:05 placing your hands on that patient, and 12:07 if you're going to assess make sure you 12:09 reassess to ensure that your technique 12:11 was effective and you have a good 12:13 rationale for using that technique again. 12:15 Now with manual therapy one-on-one live 12:19 education is incredibly important, please 12:22 be looking for opportunities like 12:24 workshops and mentorships and maybe even 12:27 classes at your local university that 12:30 can get you some one on one individual 12:33 instruction, or at least some live 12:35 classroom instruction so you've had a 12:38 chance to be critiqued and mentored by 12:42 somebody senior to you with some 12:44 experience in manual 12:45 therapy techniques; and before you bring 12:48 this stuff back to your rehab, fitness or 12:52 performance setting please practice on 12:55 colleagues. There is no substitute for 12:58 practice and it is going to take a while 13:01 to get accustomed to some of the 13:04 techniques that we show in these manual 13:06 technique videos. Don't expect to learn 13:08 them in two or three or even five 13:11 minutes, you want to have hours of 13:13 experience under your belt working on 13:15 various different body sizes and shapes, 13:18 so that when you do get that first 13:20 paying client, first paying customer and 13:23 you're really trying to make a good 13:24 positive impact, really trying to promote 13:28 better outcomes, you feel comfortable 13:31 with that technique. I look forward to 13:33 hearing about your outcomes and hearing 13:35 your questions in the comments section 13:37 of this video. I'll talk with you soon.
