0:04 This is Brent of the Brookbush Institute, and in this video going over static manual 0:07 release for the vastus lateralis. Now if you're watching this video I'm assuming 0:11 you're watching it for educational purposes, and that you are a licensed 0:14 manual therapists, or your scope of practice in your state allows you to 0:19 perform static manual release techniques. Physical therapists, athletic trainers, 0:23 massage therapists, chiropractors, osteopaths you're likely all in the clear. 0:27 Personal trainers this probably does not fall within your scope. I'm going to have 0:32 my friend Brian come out, he's going to help me demonstrate this technique. Now 0:37 all of our manual release techniques they follow similar principles. We have 0:43 to know how to palpate the muscle, and in this case the vastus lateralis is huge 0:47 and fairly easy to palpate being on the side of our leg. We get bonus points for 0:52 knowing where our trigger points are because that will help direct our hands, 0:56 and I got the trigger points marked off here on Brian. I don't know if you can 0:59 see in this view, but when we go to a close-up you will be able to see those 1:02 trigger points marked out. You should be aware if there's any contraindications 1:08 to this technique, there's anything that could be damaged by compression. In the 1:12 case of the vastus lateralis we don't have any major concerns, and the last 1:17 thing is we need to know what the best position for release technique is, and 1:21 that's usually based on what's comfortable for the therapist, as well as 1:24 being able to put a little tension in that muscle. So as you go to press down 1:28 on these trigger points, these little balls of overactivity, you don't start 1:33 playing the trying to put your finger on a marble game. Now there's two positions 1:38 we use for vastus lateralis release, and one of them in particular makes very 1:45 little sense, that I think you guys will find in both techniques that moving the 1:50 hip actually contributes to increase in tension in the vastus lateralis, which 1:56 doesn't make a whole lot of sense if we think back to our basic anatomy courses. 2:00 But if we take things up a notch we learned that the vastus lateralis 2:05 actually does invest into the iliotibial band and putting tension in the 2:10 iliotibial band, whether we go into extension and the TFL pulls a 2:16 little tighter. Or we go into flexion and the glute max pulls a little tighter on 2:21 the iliotibial band, that's also going to have an effect on those vastus lateralis 2:25 fibers. The first position i'm going to show you guys is it's probably the one 2:30 that's most obvious, or makes the most sense. I'm going to go ahead and take him 2:35 into some knee flexion. I'm going to use my body to block knee flexion. I'm going 2:41 to be pushing down on his vastus lateralis so i'm going to go ahead and 2:44 take this leg, make them a little bit more comfortable and stable by bending 2:47 it, and then i'm going to be careful to actually put his medial gastroc 2:53 underneath his vastus medialis. So that when i press down i get meat on meat and 3:01 I don't do one of these like knee cap on ankle bone things, because if i press 3:05 down there it's going to hurt. So we go here. I'm going to do my palpation 3:12 posterior to anterior to feel for the most overactive or the densest fascicles, 3:19 and then once i found them i generally know that trigger points in the vastus 3:26 lateralis usually happen pretty close to the knee, or right dead center 3:31 between greater trochanter and me. So you guys notice even when I put my hand down, 3:36 I put my hand down pretty close to the center of his thigh, because i'm hoping 3:40 to get kind of lucky here and not only put my hand down on overactive fascicles, 3:47 but be pretty close to a nice tight nodule, a trigger point without having to 3:55 do too much searching moving from distal to proximal, or proximal to distal. 4:03 How's that feeling? That's a little more tender. Okay so now that I found this 4:09 nice hyperactive point, I'm going to go ahead and this is going to be my dummy 4:14 hand, I'm just going to let this totally relax. I'm going to take this hand 4:18 straighten it out, alright so I'm noW using this hand to apply force. I'm just 4:24 going to go ahead and lean over, and I'm going to wait for 30 seconds to 2 4:28 minutes until that tissue density starts to decrease. The over activity starts to 4:36 decrease, Brian tells me he just can't handle it anymore, which of course you 4:41 need to listen to your patients and back off a little bit. Or of course he tells 4:46 me that he's not feeling anything at all, the discomfort has subsided, that's 4:49 probably a good sign we can move on. Now we can move on to other points right, so 4:57 I can go back to, all right we did the one in the middle of his thigh, does he 5:00 have anything near his knee. I feel a point right there, go ahead and put down 5:08 some pressure. One thing that often gets mistaken with this technique, is once 5:15 again I said this is vastus lateralis static manual release. I think a lot of 5:19 people would look at me doing this and being like oh its IT band release. You 5:24 can't really release your IT band guys. Trigger points are muscular phenomenon. 5:29 There are some fascial techniques that might be able to help with gliding of 5:37 the iliotibial band over the vastus lateralis, but these static compression 5:42 techniques are muscular techniques for a muscular phenomenon, for the most part 5:48 being trigger points, and what we're really trying to do is decrease that 5:52 over activity. How's that feel? 5:58 Good, let's go ahead and have you on your back. 6:02 Now the other position that you can do for vastus lateralis manual release is 6:08 similar to what is called the Iron Cross stretch, right cross stretch. This 6:15 is the weird one where I have them in knee extension, I'm taking it further into 6:19 flexion, but somehow the increased tension in the iliotibial band allows me 6:26 to have enough tension in my vastus lateralis to still find hyperactive bands, 6:36 and of course tight nodules. Which I of course then want to release. Now be 6:43 careful with this technique. If you have somebody with low back pain this isn't a 6:48 great technique or a great position to put them in. Notice I have a whole lot of 6:53 hip adduction, his pelvis is rotated this way, I'm pulling them further into spinal 6:58 flexion. Hip or low back this could be a somewhat a compromised position. This 7:06 position does come in handy though if you're doing a lot of different 7:09 techniques, and you happen to be working on the biceps femoris and then you can 7:12 just go on to the vastus lateralis. I do find this an effective position. 7:18 Next a little close-up recap. Alright guys this is your close-up recap, just so 7:23 you can see my hands, the position of the leg, how I search for a trigger point. I'm 7:28 going to go ahead and pull him into knee flexion. I'm going to use my body to 7:32 block his leg, so now I'm not doing any work. I got both my hands-free. I'm going 7:37 to go ahead and I'm going to use, I mean since is this vastus lateralis and it's 7:42 very thick, very dense, chances are i'm going to use both thumbs to even search 7:47 for overactive fascicles. And then you can see here, I happen to know that the 7:52 trigger points are closer to the knee, or right in the middle of the muscles. So 7:55 i'm going to put my hands pretty close to where i think those are, and then i'm 7:59 going to search by finding the most overactive fascicles, and moving either 8:05 proximal or distal, there's a nice one right there. Alright once i found that, i'm 8:11 going to use my dummy thumb. I'm going to relax 8:13 this hand. I'm gonna use the other hand to apply pressure, and when I say use the 8:16 other hand to apply pressure i'm actually just pushing through my arm 8:19 into my palm, and then making sure that we're meat on meat here, vastus medialis 8:26 to gluteus, I'm sorry vastus medialis to medial gastroc. I'm going to go ahead 8:33 and push down until I get a nice release, make sure you guys don't do this thing, 8:40 because if i push down his kneecap into his ankle that's not going to feel 8:46 good at all. To show you guys the other position, go ahead and have Brian move 8:53 away from me a little bit, and then he's going to go into this kind of Iron Cross 8:57 stretch. Now the trigger points would be in the same places on this other leg 9:02 closer to the knee, or right in the middle of the muscle. And generally 9:05 speaking I'm moving my hands in this direction, with this one alright. So I am 9:09 applying a little bit of a distal to proximal force. I'm going to find those 9:13 tight fascicles, that's a nice tight fascicle there. Let's see if I can find a 9:17 nodule within that tight fascicle. A little marble, well there we go once i 9:24 find that, again just apply a little pressure and lean in, and i am leaning 9:29 this way guys, so I'm not pushing straight down per se. This position can 9:36 be a little problematic for those individuals with low back or hip pain. So 9:40 keep both these techniques in your repertoire, that first technique is 9:45 probably your go-to. I think you guys will find this technique sometimes 9:50 convenient if you were combining it with a bunch of other release techniques. I 9:54 hope you guys enjoyed static manual release of the vastus lateralis. Remember 9:59 if we have somebody up on the table, we're about to perform the manual 10:02 release, we want to be eighty percent sure that's what they need based on our 10:06 movement assessment. If we're talking about the vastus lateralis, things get a 10:10 little complicated in the sense that we have to include the vastus lateralis in 10:14 the tensor fasciae latae, iliotibial band, vastus lateralis complex, and then we 10:21 start to see that the vastus lateralis gets included 10:25 whenever the TFL does, on things like our overhead squat assessment. So that would 10:30 be signs like feet turns out, knees bow in, excessive forward lean, anterior 10:36 pelvic tilt. If I was doing goniometric assessment while the vastus lateralis is 10:42 a knee extensor, so if I saw a limitation in knee flexion that might 10:46 give me an indication in a limitation in hip extension, as well as hip internal 10:52 rotation, may also be indications of vastus lateralis over activity. Once 10:59 again please mind your scope of practice. if manual release techniques do not fall 11:04 within your scope do not attempt this. If you can find individuals to practice on 11:09 before you actually attempt this on patients, that would be beneficial. There 11:14 is no substitution to having a mentor or taking a manual therapy course, but even 11:21 just practicing on your colleagues will be very beneficial. Being able to talk to 11:26 another manual therapists about hand position, and what things felt like, and 11:32 body position, and whose pressures felt the best is invaluable information. I 11:36 hope you guys enjoyed this video. I look forward to talking to you soon. 11:47
