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 0:10 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 0:26 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 go over static manual 1:02 release of our suboccipital muscles, 1:04 that's our rectus capitis posterior 1:07 major, rectus capitis posterior minor, our 1:09 obliquus capitis superior, or obliquus 1:11 capitis inferior. If that wasn't enough 1:14 of a mouthful I know a few of you are so 1:16 familiar with your suboccipital muscles, 1:17 you're wondering where the rectus 1:18 capitis anterior and rectus capitis 1:20 lateralis are, those muscles are too deep 1:22 to actually be palpated and probably 1:25 fall anterior to the axis of rotation 1:27 for the upper cervical spine, making them 1:31 deep cervical flexors. So our rectus 1:32 capitis anterior, rectus capitis 1:34 lateralis, we're going to go ahead and 1:36 say that they're included in deep 1:37 cervical flexor activation. What we're 1:40 going to work on this video is release 1:42 of the posterior suboccipital muscles. 1:45 I'm going to have my friend Melissa come 1:46 out, she's going to help me demonstrate 1:48 this technique. Now she's going to start 1:50 lying face down so I can kind of point 1:51 out some landmarks although, we'll do 1:54 this technique face up. I should mention 1:58 right off the bat that it's probably not 2:01 a reliable palpation, or it's not 2:03 possible to reliably differentiate 2:06 between the various suboccipital muscles. 2:09 Unfortunately these muscles are very 2:10 small they're kind of hidden away, and 2:12 they're deep to two larger 2:15 muscles of the neck, being the upper 2:17 trapezius and splenii muscles. But if I 2:20 think about my anatomy a little bit I 2:22 think that we can set up some borders, 2:25 especially with the obliquus muscles 2:27 that will give us an idea of where we 2:29 should put our thumbs to release these 2:30 muscles as a group. So my obliquus 2:33 capitis inferior goes from the spinous 2:36 process of c2 to the transverse 2:39 processes of C1. So C2 is the first 2:42 spinous process you can feel underneath 2:44 the skull. The transverse process of c1 2:46 is just inferior posterior to the 2:49 mastoid process, yes that that had point 2:54 that the skull comes down to right here, 2:56 right behind your ear, if you go just 2:58 inferior and posterior to that, you can 3:02 actually feel your transverse process 3:04 sticking out, it definitely feels like 3:06 bone and not soft tissue, you can't press 3:09 all the way through it, you press through 3:10 a little soft tissue where it is and all 3:12 of a sudden boom you hit it a hard 3:14 little point. So put your finger on that 3:18 transverse processs, put the other finger 3:20 on the spinous process of c2, that's 3:24 going to be the inferior border of our 3:28 suboccipital muscle. Now my obliquus 3:31 capitis superior goes from transverse 3:33 process of c1 to inferior nuchal line, 3:36 that's our outer border, so we can 3:39 honestly say just trans that transverse 3:41 process we just found, if we just go just 3:43 medial to that, that's going to be our 3:45 outer border. Our superior border is 3:48 going to be this inferior nuchal line, 3:49 and you guys can feel that by just going 3:52 just underneath the base of the skull 3:54 here into the end of the soft tissues. I 3:58 think you'll feel that ledge right where 4:01 all of a sudden you can't, you palpate 4:04 right into some pretty pretty dense 4:06 tissues, that's going to be our 4:08 suboccipitals. So we got our borders drawn 4:13 out here, that's that's how we're going 4:16 to palpate these muscles, before we go 4:18 any further with this technique though 4:20 I'm going to have Melissa flip over and 4:22 be face up, 4:25 because this isn't a very comfortable 4:28 way to get a release to happen, there's 4:30 an easier way to do this; which is, I can 4:33 go just like this, I can do that curling 4:36 of the fingers technique and let the 4:38 weight of Melissa's head do all of the 4:42 work. Not to mention I have a little bit 4:44 more control over lateral flexion, 4:48 flexion extension, which may help me when 4:52 I start trying to palpate for dense 4:55 fascicles. So I'm going to start with one 4:59 side at a time, once again I'm going to 5:01 find I'm going to find that transverse 5:03 process of C1, i'm going to find C2, i'm 5:06 going to let my fingers fall in, a little 5:09 trick here you can use guys is if i go 5:11 into a little bit of upper cervical 5:15 flexion, which is going to be like a chin 5:18 tuck, and it is probably helpful to think 5:21 of like a chin tuck while retracting, and 5:24 then i go into a little contralateral 5:28 flexion, I've now lengthen those tissues 5:31 quite a bit and then i can actually 5:34 experiment with either contralateral 5:38 rotation, or ipsilateral rotation to 5:44 try to further allow me to find dense 5:48 fascicles into an area that's actually 5:52 not going to allow me to strum. I know in 5:54 a lot of our other videos we've talked 5:55 about strumming the fascicles to find 5:57 the densest fascicle, and then moving 5:59 around on that fascicle to find a nodule. 6:01 In this case all we're going to do is 6:04 sink our fingers down into that area i 6:08 explained, which honestly is about a 6:10 finger tips width we don't have much 6:13 more room than that, and we're going to 6:15 use this upper cervical flexion, 6:20 contralateral flexion, and rotation to 6:26 see if we can further stretch these 6:29 fibers. Contralateral rotation making the 6:32 majority of these fibers longer, 6:34 everything except for the obliquus 6:36 capitus superior, and I can find my 6:40 fingers just sinking right into some 6:43 pretty dense tissue up there, and then 6:46 once I find the most dense or tender 6:49 spot, I'm again just going to hold for 30 6:51 to 60 seconds how's that feel? Good and 6:57 then I can do the other side. Once again 6:59 now this hand i'm using as a control, this 7:01 hand i'm going to do that little curved 7:03 position just laying Melissa's head right 7:06 back over my fingers. I'm going to use a 7:08 little upper cervical flexion, 7:11 contralateral flexion to get my fingers 7:13 in a little deeper, and then I can use 7:15 rotation a little bit. Either 7:20 contralateral rotation lengthen most of 7:23 the suboccipital muscles, or ipsilateral 7:26 rotation to lengthen the obliquus 7:32 capitus superior. Once I find a nice and 7:37 tender spot I'm going to hold that until 7:40 I get a release, and then of course 7:42 reassess. 7:47 Stay tuned for the close-up recap. In 7:49 our close-up recap of the suboccipital 7:51 muscles, first step is we need to know 7:53 where we're putting our fingers, which of 7:55 course is going to be between that 7:57 inferior nuchal line, and the line we 8:00 created between the transverse process 8:04 of C1, which is just underneath the 8:05 mastoid process here, and the spinous 8:10 process of C2. The lateral border we're 8:13 going to say, of this place we're putting 8:15 our fingers, we're going to say is the 8:17 outside or the lateral edge of the 8:20 transverse process, and then we're 8:22 slipping our fingers just underneath the 8:24 inferior nuchal line, which is 8:26 essentially the base of the skull here. 8:29 Now to get our fingers a little deeper 8:32 and put some stretch on these 8:34 suboccipital tissues, we can do a little 8:37 upper cervical flexion, which is going to 8:39 look a lot like retraction of the 8:41 cervical spine and lateral flexion. And 8:44 then from there we can even experiment 8:47 with rotation. So if i do contralateral 8:50 rotation that's going to lengthen the 8:53 majority of the suboccipital 8:55 muscles. If I need to shorten them a 8:56 little bit and get a little bit more 8:58 slack I can do ipsilateral rotation. The 9:01 only suboccipital muscle that doesn't 9:03 follow that rule of rotation is the 9:06 obliquus capitis superior. Now step 9:12 two, are there any tissues that could be 9:16 damaged, or insulted, or maybe don't like 9:20 compression. Well we do have to realize 9:22 that the floor of the suboccipital 9:24 muscles here, is the vertebral artery. So 9:28 I would keep your VBI signs in mind. If 9:30 you're in this position you can look 9:32 straight into somebody's eyes and watch 9:34 for things like nystagmus, if you have 9:36 them just continue to talk to you, you 9:38 can notice if there's any slurred speech, 9:40 and of course if they feel like nausea, 9:42 or any symptom that's just a little 9:45 outside of the norm, I'd certainly be 9:49 careful. I've never actually had those 9:52 symptoms occur it's just an anatomical 9:54 possibility. 9:56 Step number three, finding our densest 9:58 tissue guys, you're just going to go from 10:00 lateral to medial. I don't think you're 10:03 going to be able to feel fascicles like 10:07 we have on other techniques. As I said to 10:09 in the further shot it's probably not 10:12 possible to differentiate or reliably 10:15 differentiate the different suboccipital 10:17 muscles, but I think just moving from the 10:19 transverse process of C1 in towards the 10:22 spinous process of C,2 underneath the 10:25 inferior nuchal line looking for the 10:26 densest tissue, and holding it until you 10:29 get a release, is probably the most 10:31 reliable technique we're going to be 10:34 able to come up with, or the most reliable 10:35 protocol we're going to be able to come 10:37 up with. And of course patient position 10:40 once again is just supine, and you notice 10:42 like I get that nice natural curled hand 10:45 position, I'm holding her head so I can 10:47 control it real easy, and it's actually 10:50 the weight of her head that's doing all 10:51 the work i'm not like gripping her head, 10:53 I'm just kind of curling my fingers, and 10:56 letting my fingers sink in where I think 10:59 she has a point of hyperactivity, or 11:01 increased tissue density. So there you 11:04 have it knowing your functional Anatomy 11:05 will definitely help your manual 11:07 technique. It'll help you differentiate 11:09 structure so that you can place your 11:10 hands where they need to be, as well as 11:12 make you aware of these sensitive 11:14 structures around the tissue that you're 11:16 trying to target, things like nerves and 11:18 lymph nodes, and arteries. Make sure that if 11:21 you're going to place your hands on a 11:22 patient that you have done an assessment 11:24 and have a good rationale for placing 11:26 your hands on that patient. And if you're 11:28 going to assess, make sure you reassess 11:30 to ensure that your technique was 11:31 effective, and you have a good rationale 11:33 for using that technique again. Now with 11:36 manual therapy, one-on-one live education 11:40 is incredibly important, please be 11:42 looking for opportunities like workshops 11:45 and mentorships, and maybe even classes at 11:48 your local university that can get you 11:51 some one on one individual instruction, 11:54 or at least a live classroom instruction, 11:56 so you've had a chance to be critiqued 12:00 and mentored by somebody senior to you 12:03 with some experience in manual therapy 12:06 techniques. 12:07 And before you bring this stuff back to 12:10 your rehab fitness or performance 12:12 setting please practice on colleagues, 12:16 there is no substitute for practice, and 12:19 it is going to take a while to get accustomed 12:22 to some of the techniques that we 12:25 show in these manual technique videos. 12:27 Don't expect to learn them in two or 12:29 three or even five minutes, you want to 12:32 have hours of experience under your belt 12:35 working on various different body sizes 12:37 and shapes, so that when you do get that 12:40 first paying client, first paying 12:42 customer and you're really trying to 12:43 make a good positive impact, really 12:47 trying to promote better outcomes, you 12:50 feel comfortable with that technique. I 12:52 look forward to hearing about your 12:53 outcomes and hearing your questions in 12:56 the comments section of this video. I'll 12:58 talk with you soon.
