0:04 This is Brent of the Brookbush Institute, and in this video we're going over 0:07 static manual release of the tensor fasciae latae and gluteus minimus. I'm 0:11 assuming that if you're watching this video you're watching it for educational 0:14 purposes, and that you are a licensed manual therapist or student on your way 0:18 to becoming a licensed manual therapist. Personal trainers this technique 0:23 probably doesn't fall within your scope, although you could use the palpation 0:27 portion of this video in an educational setting to help you learn your Anatomy. 0:31 I'm going to have my friend Melissa come out, she's going to help me demonstrate 0:35 this technique. Now all of these techniques follow a very similar 0:39 protocol, over simplified that protocol would look something like palpate and 0:45 compress. We're going to break it down a little further than that. We want to be 0:49 able to palpate and differentiate these tissues from other muscles in the area. 0:54 We do get bonus points for knowing our trigger points, so if you know where the 1:00 common trigger points in the tensor fasciae latae are, the common trigger 1:02 points in the gluteus minimus are, you will narrow your search field a bit and 1:07 you won't have to search around quite so much to find those local points of 1:11 overactivity. We do have to keep in the back of our head is there any tissues in 1:16 this area that compression or abrasion might insult. So are there any nerves, 1:22 lymph nodes, arteries. There are some nerves in this area but usually they're 1:27 fairly small nerves, and if you happen to give somebody a tingling sensation or a 1:31 burning sensation, it's pretty easy to get out of the way of those nerves by 1:35 moving backward or forward. Last we have to figure out what position can we put 1:41 Melissa in that will add some tension to this muscle. So we've pinned down those 1:46 nodules, those trigger points, those locally overactive muscle fibers right. 1:53 We also have to make sure she's comfortable and possibly most 1:57 importantly, that we're comfortable that we're using our own body mechanics to 2:03 apply pressure, so that we don't wear ourselves out over the course of one 2:07 session or one day, one week or even one career. We don't want to be using so much 2:13 of our hands that we only get a couple of these 2:16 techniques before we're tired. Now let's start with our palpation and the anatomy 2:21 involved in the tensor fasciae latae and gluteus minimus here. The first thing 2:25 you're going to want to find is the top of the iliac crest here right. So the top 2:32 of her pelvis, because I'm going to want to follow that to her ASIS, I'm going 2:38 to go ahead and put the top of her pants over the top of her ASIS, so I know where 2:41 that's located. I'm then going to go ahead and find her greater trochanter. 2:47 We've actually put a little dot here on Melissa's pants right, so that we can 2:52 mark the greater trochanter so that you guys can see it, if not in this view in 2:56 the close-up recap. If I go from ASIS to greater trochanter, and then back up the 3:03 mid-axillary line to the to the iliac crest here, in that triangle is my TFL, 3:13 and right in the middle of that triangle is where the TFL trigger point usually 3:19 is and we have that marked off. Now the gluteus minimus is just behind the TFL 3:27 right, so the trigger point is also in the middle of that muscle, 3:31 generally speaking falls just behind the mid-axillary line above the greater 3:38 trochanter. So we're dealing in this little triangle right here below her 3:44 pelvis and above her greater trochanter. Now to add some tension to this muscle 3:50 I'm going to kind of use a modified Obers test right. I'm going to go ahead 3:55 and bring her leg back, and if you watched the vastus lateralis video I 4:00 talked about how we should put the vastus medialis on top of the calf, 4:04 because what you don't want to end up with is kneecap on top of ankle because 4:09 that hurts. When you start pressing, so we're going to take the meaty part of 4:13 her of her quad here put it on the meaty part of her lower leg, so that when I 4:20 start pressing, we're just compressing soft tissues we don't 4:24 have any problems there. Now I'm going to palpate across these faacicles. This is 4:31 a fan-shaped muscle right, a fan-shaped muscle whose fascicles run this way. So 4:36 I'm going to palpate from anterior to posterior to find the tightest fascicles, 4:44 and then I can start. Once I find some tight fascicles I can start moving a 4:50 little bit more distal, or a little bit more proximal to find the tightest point 4:57 within those fascicles, and then of course I'm just going to apply my 5:02 pressure. I can use a thumb over thumb technique. I can use my pisiform over 5:07 thumb technique. I can use my inner thenar groove over thumb technique here, 5:13 and then you'll notice I have the table pretty low here with Melissa, so that I 5:17 can just lean in until I get a little increase in tissue density here. I 5:25 don't want to go further than that. I don't want pain. I don't want the tissues 5:29 to all of a sudden guard on me because I'm pushing in so hard just right 5:33 up until I hit some tissue resistance, how does that feel Melissa? Yeah that's, 5:40 that's tender. This muscle definitely tends to get tender. A lot of people talk 5:44 about IT band tightness and iliotibial band syndrome, and runners knee, guys your 5:50 IT band is connective tissue it's not muscular tissue. Your IT band doesn't get 5:55 tight, but your TFL will get over active and short and pull your IT band tight. so 6:03 on a lot of these individuals what you'll find is they have very sensitive 6:07 trigger points in their TFL, and releasing them usually does them some 6:13 good. Sometimes you have to be a little gentler, so sometimes the 30 seconds to 6:18 120 seconds static hold doesn't work out as well as maybe the five seconds on 6:24 five seconds off, an increasing pressure a little bit each time. 6:29 Trying to desensitize that area a little bit. Be gentle with people, you crush 6:35 somebody right off the bat they might not come back, and if they don't come 6:38 back you're not going to have a chance to fix their problem. Now after I get a 6:42 release in the tensor fasciae latae I can just keep moving my thumb back, keep 6:47 using that same anterior to posterior strum of her fascicles to find other 6:54 tight fascicles. The gluteus minimus guys is basically the tensor fascia latae's 6:59 nasty cousin. Both muscles do the same joint actions, both muscles are 7:04 involved in the same dysfunctions. The only difference is the gluteus minimus, 7:08 it does not have an attachment to the iliotibial band. Once I find some tight 7:15 fascicles I'm going to narrow in by going proximal to distal, or distal to 7:20 proximal to find the the tightest point within those fascicles. 7:25 And again I'm going to apply my pressure, I could do the five-second holds on and 7:31 off, increasing pressure each time if she was really sensitive. Or I could go in so 7:37 I meet tissue resistance, hold for thirty seconds to a hundred and twenty seconds. 7:45 Alright guys in the next video you'll see or in the next section, you're going 7:48 to see us do a close up recap so you can see exactly where I'm putting my hands. 7:54 Alright guys for the close-up recap let's start with palpation. The top of 7:59 her iliac crest is right here alright. I'm going to put the front of her 8:03 pants over the top of her ASIS, and then we'll kind of adjust here. Make sure our 8:09 little markings there are over her greater trochanter. So we used this 8:13 little beige button to mark the greater trochanter, ASIS, greater trochanter, up 8:19 the mid-axillary line. In between this triangle right here is her tensor fasciaE 8:27 latae, that nice fan-shaped muscle. And you can see we've marked off that trigger 8:31 point which is basically in the middle of that muscle. You notice just posterior 8:37 to that trigger point is another trigger point, marking this one representing the 8:42 gluteus minimus which again falls behind the tensor fasciae latae, but doesn't 8:47 have an attachment to the iliotibial band. So as far as my palpation I'm going 8:53 to use those anterior to posterior kind of strumming, with a broad thumb 8:58 here. Find the the most overactive fascicles there, and then move. In this 9:05 case since I'm starting so proximal, I'm going to go ahead and keep moving distal 9:09 until I find the tightest point, maybe even a little nodule within those 9:16 fascicles that's where I'm going to apply my compression. I'm going to use my dummy 9:20 thumb and then either my inner thenar groove here, or my pisiform to go ahead 9:28 and apply pressure. I do find it helpful to add a little bit of a distal to 9:34 proximal angle to this to help pin down that trigger point. I'm just going to go 9:40 up to tissue resistance, and then hold it for 30 seconds to 120 9:45 seconds. I did mention that this area does get very tender on people. You guys 9:50 have heard of iliotibial band syndrome, runners knee, a lot of that comes from 9:55 the tensor fasciae latae being overactive in those individuals and pulling on the 9:59 iliotibial band, and it'll get it'll just get tender to the touch. So that five 10:04 seconds on, five seconds off, five seconds on a little harder, five seconds off to 10:09 help desensitize is sometimes a better way to start this technique. Then of 10:14 course after I finished releasing this trigger point I can just keep going with 10:19 my anterior to posterior strums, and I'll find my next trigger point in the 10:27 gluteus minimus, and again just use my my pisiform over thumb grip here, apply 10:34 pressure until I hit that first tissue resistance, and hold for 30 to 10:41 120 seconds. So there you guys have it, ASIS, iliac crest, greater trochanter, TFL, 10:50 gluteus minimus behind it, and trigger points right in the middle of those 10:54 muscles. So there you guys go that was static manual release of the tensor 10:58 fasciae latae and gluteus minimus. As I've said in all of our other manual 11:03 release videos, make sure that by the time you put your hands on somebody you 11:06 are 80% sure that those are muscles that need to be targeted with manual release 11:11 techniques, and you should know that from your movement assessments. Manual 11:16 release techniques by themselves make terrible assessments, be practising these 11:23 techniques often, and if you can with your fellow professionals. The ability to 11:30 practice with somebody who also does manual release techniques, to have these 11:35 techniques done on you is learning that you are not going to get from this video, 11:39 and no matter how well I speak, or how well we demonstrate this stuff on video, 11:47 you need to have that practical application before you try this on 11:52 our patients and clients. I hope you guys enjoyed this video. I hope you learned a 11:57 lot from our video and this technique. I look forward to hearing about your 12:01 outcomes. 12:09
