0:04 This is Brent of the Brookbush 0:06 Institute, and in this video we're going over 0:07 static manual release of the adductor 0:09 magnus. If you're watching this video, I'm 0:10 assuming you're watching it for 0:11 educational purposes and that you are a 0:13 licensed manual therapist. That is, a 0:15 physical therapist, an athletic 0:17 trainer, a chiropractor, a massage 0:19 therapist, or an osteopath, and the laws in your 0:22 state cover your scope of practice to 0:26 perform manual release techniques. If you 0:28 are unsure please look those laws up. 0:31 Personal trainers, this video probably 0:33 does not apply to you. I'm going to have 0:36 my friend, Melissa, come out. She's going 0:37 to help me demonstrate. Now, all of these 0:41 static manual release techniques follow 0:43 very similar protocols. We have to know 0:45 how to palpate the muscle we're 0:47 targeting. We get bonus points for 0:49 knowing the trigger points, because that 0:50 will definitely narrow down our search. 0:53 We need to know if there's any tissues 0:55 that, perhaps, we should be watching out 0:58 for that don't like compression. In the 1:00 case of the adductors, we do have to be 1:02 aware of the femoral artery. The femoral 1:04 artery isn't huge underneath our fingers. 1:08 Remember that arteries aren't going to 1:10 be any thicker than your pinkie. So if you 1:11 do happen to feel a pulse while doing 1:13 this, don't freak out, just move up or 1:17 down or side to side and you should be 1:19 able to find a way to the targeted 1:22 tissues without compressing that artery. 1:24 And, of course, we need to know what 1:26 position we're going to put Melissa in 1:28 so that I'm comfortable and can apply this 1:32 pressure for a long, sustained period of 1:35 time being 30 seconds to 2 minutes 1:37 without fatiguing, and that Melissa is 1:40 comfortable, and I'm not putting in her in a 1:42 position of pain. We need to be adding 1:44 some tension to this muscle so that we 1:46 pin down those nodules, or points of 1:50 hyperactivity and don't start playing the 1:52 "put your finger on top of a marble" game, 1:54 or that marble will just keep slipping out. 1:56 Now, in the case of the adductor magnus, I 1:59 use the same position that I use for the 2:02 adductor magnus stretch. So, I 2:05 put her foot up on my ASIS. Now I have 2:08 total control of how much tension is in 2:10 her adductor magnus, because 2:12 I can just move back and forth this way. 2:15 If this is way too much of a stretch for her, 2:17 I can back off this way. If this isn't 2:19 enough tension, I can take a step forward. 2:21 And, of course, if I get my table up nice 2:24 and high, I can get my arms out straight 2:26 with my elbows nearly locked, and I'll just 2:28 be applying pressure by leaning forward 2:30 and using my bodyweight instead of 2:32 trying to use my hands, which is 2:35 eventually going to wear me out. Now, 2:38 finding your adductor magnus isn't 2:40 particularly difficult. It is the most 2:42 posterior of the adductor muscles, so if 2:46 I kind of attack the adductors from the 2:51 posterior side going this way, I'll be on 2:55 the adductor magnus. The only thing I 2:56 have to differentiate is where is my 2:58 adductor magnus versus where is my 3:00 hamstrings. In an athletic population, you 3:04 might see their hamstrings popping out 3:06 just by looking down. In Melissa's case, I 3:09 can actually see a nice little bump 3:11 where her developed hamstrings are 3:13 sticking out, and I know if I put my 3:15 fingers right above that bump, I'm on adductor 3:18 magnus. If you can't see that bump, if 3:21 you can't get a good visual 3:24 indication of where the adductor magnus 3:26 starts, use one hand and kind of use like 3:29 a nice, broad area to kind of grab the back 3:32 and inside of their thigh. Use your other 3:35 hand against the back of their 3:37 heel and have them flex their knee. 3:40 Remember, your adductor magnus doesn't 3:43 cross the knee, but your hamstrings do, so 3:45 you'll feel an increase in tissue 3:48 density- you'll feel their hamstrings 3:51 contract, but their adductors won't. All 3:54 you have to do is go just above that 3:56 contracting tissue. Go ahead and relax 4:00 for me. Alright, now I mentioned I get 4:03 bonus points for knowing where those 4:05 trigger points are. In the adductor 4:07 magnus, we have one that's like basically 4:09 right in the middle of the thigh and 4:10 then one that's very close to the 4:12 ischial tuberosity, so way up close 4:15 to the origin of the 4:16 adductor magnus. Now, I'm going to use these 4:19 posterior to anterior kind of swiping 4:22 motions to find the most dense, most 4:25 tight fascicles, and then once I find 4:30 them, I can start moving a little bit 4:32 more proximal. In this case, I started 4:34 just a little distal of the midpoint of 4:36 her thigh, and I find a nice tender point 4:39 right there. Once I find the tender point 4:41 in this position, I'm going to use a 4:43 thumb over thumb technique. Alright, I'm 4:46 going to kind of lock out my elbows here, 4:49 and then I'm just going to lean. I'm only 4:52 going to lean enough to get some good 4:55 pressure on those dense fascicles. Now, 5:01 remember, I said good pressure is kind of 5:03 where you push until you start feeling a 5:07 little give back but you don't get that 5:09 huge increase and give back, that huge 5:12 increase in resistance. Because at that 5:15 point, you're probably getting guarding. 5:16 You're probably going to get some pain, 5:18 and it's actually going to be harder to 5:21 get a release. We want to go just up to 5:23 the point where we start getting an 5:24 increase in tissue resistance, or an 5:28 increase and push back on our fingers. 5:31 We're going to hold this for 30 seconds 5:33 to 2 minutes, or until we 5:36 feel a release, likely closer to 30 5:38 seconds once you get good at this. Once 5:42 they get a release, I can move on to the 5:43 next trigger point. Now, I've said this in 5:45 many videos, before you put your hands on 5:48 somebody, you should be 80% sure that 5:52 that muscle is involved. You don't use 5:56 manual techniques as assessments, at 6:00 least initially. Of course, everything we 6:02 do is an assessment, but you should have 6:05 a good reason for putting your hands 6:06 there. This is especially true of the 6:10 adductor magnus trigger point at the 6:12 ischial tuberosity. Your hands are going 6:14 to be very close to somebody's groin. 6:16 This is something that you're going to 6:18 want to explain to your client. Build 6:20 rapport. Don't just put your hands 6:23 somewhere and not give your client a 6:25 good indication why. 6:27 You also are going to want to probably 6:30 have a post-test. So, I had an 6:34 assessment, I think this might help, and I'm 6:36 going to do this post-test to show you 6:39 why I put my hands there. If you guys just 6:42 put your hands where I'm about to put my 6:43 hands and have no explanation, you 6:46 could get yourself into trouble. So, the 6:48 adductor magnus's origin is all the way 6:50 at her ischial tuberosity, which is 6:51 essentially what's holding her up on 6:53 this table right now. Those are the 6:55 bones deep in your backside. So, if I come 6:58 down closer to her backside and feel these 7:02 same tissues, I can feel a trigger point 7:05 right here. Same thing- notice, guys, I kind 7:08 of have my hands turned this way, right, I 7:11 don't want my hands over somebody's 7:13 groin. 7:14 If you needed to, if somebody felt more 7:16 comfortable, you could have them place 7:18 their hand over their groin, or use a 7:21 towel, or have them place a towel and 7:23 their hand over their groin so that they 7:26 feel safe. And, again, I'm going to go 7:28 ahead and hold for 30 seconds to 2 7:31 minutes until I get a release. How does 7:37 that feel? Starting to relax? Good deal. 7:41 And then, at that point I'd probably be 7:43 like, "Okay, why don't you get up and do a 7:44 squat?" Maybe that was where she was 7:46 feeling this pain. In the next segment, 7:49 we're going to do our close-up recap. Alright, 7:51 guys, for your close-up recap I'm 7:52 going to take her thigh into flexion and 7:54 abduction, just like I would for an 7:56 adductor magnus stretch. I'm going to 7:57 put her foot on my ASIS so that I can 7:59 control how much tension is within her 8:01 adductor magnus just by leaning forward 8:04 or leaning back. Now, we know that her 8:07 adductor magnus is the most posterior of 8:09 the adductor muscles, so we just have to 8:11 differentiate between the adductor 8:13 magnus and hamstrings. 8:14 Melissa has some pretty 8:16 well-developed hamstrings, but to show 8:18 you guys how I would differentiate on 8:20 somebody who, maybe, wasn't quite as 8:22 athletic or quite as well-developed, I'd 8:24 use a nice, broad part of my hand, so 8:28 that I could feel all of the inner thigh 8:30 and all of the posterior thigh. I add a 8:32 little pressure there so I know I'm 8:34 feeling through any adipose tissue. I'd 8:36 use my other hand to block the ankle, 8:39 and then have them flex their knee and 8:42 "boom" their hamstrings pop right out. 8:45 Remember, your adductor magnus doesn't 8:47 cross the knee and is not responsible 8:49 for knee flexion. So, if I go right above 8:52 those now contracted dense fibers of our 8:56 hamstring, I know I'm on adductor magnus. 8:58 Now, you guys can actually see this on 9:00 camera. If I just have Melissa go ahead 9:02 and flex her knee, being that she's 9:04 athletic and has these well-developed 9:06 hamstrings- go ahead and relax and flex 9:09 again. you can see her hamstrings just 9:11 pop out, and if I go right above those 9:14 hamstrings, I know I'm right on adductor 9:15 magnus. 9:16 Good. Go ahead and relax for me. Now, with 9:19 the adductor magnus, I know her trigger 9:22 points are going to be right about the 9:24 mid portion or middle of the length of 9:27 her thigh. Right around here. 9:29 And then there's another trigger point 9:32 that's pretty close to the origin of 9:33 this muscle near her ischial tuberosity. 9:35 So, I'm going to go ahead and take these 9:37 posterior to anterior strokes, making 9:40 sure I stay off the femoral artery, but I 9:43 look for the densest fascicles. Once I 9:45 find them, I can then start moving a 9:48 little bit more proximally here since I 9:51 started a little distal to the midpoint 9:52 of her thigh. Once I find that point, I'm 9:55 just going to go thumb over thumb, lock 9:57 out my elbows, and apply some pressure 10:00 until I get a little kickback from 10:03 that tissue. I'm going to try to hold as 10:05 still as I can ensure that Melissa is 10:08 fairly relaxed here. Hold 30 seconds to 10:10 120 seconds, and then hopefully I get a 10:15 release. 10:16 Now, the other trigger point we have is 10:18 very close to her ischial tuberosity 10:21 and close to her groin. I mentioned that you 10:24 could drape this area. You could have 10:27 your patient or client cover their 10:30 groin, so that you don't risk bumping 10:33 into it. Melissa is going to go ahead and 10:35 uncover herself, so that you guys can see 10:38 my hands for this particular technique. 10:39 Her ischial tuberosity are 10:41 essentially the bones that are holding 10:43 her up on the table. Those are 10:44 those that pelvis bones that are deep in 10:46 your gluteal area. But, if I kind of 10:49 start there around the origin of this 10:52 muscle, 10:53 you will notice that there's some 10:56 tightness, some density, these hyperactive 10:59 local points just two or three inches 11:02 distal from that origin. And then, again, 11:05 I'm going to go ahead and use my thumb 11:07 over thumb technique here. I'll hold for 30 11:10 seconds to 120 seconds. As I mentioned 11:14 before, guys, this is an important time for 11:17 you to have assessed and have a very 11:20 good reason for your hands to be here. 11:22 This might be one of those 11:23 techniques where I test right after I do 11:26 the technique to go, "Alright, this is 11:28 why we did the technique. Do you feel 11:30 better?" I hope you guys enjoyed the 11:32 close-up recap. There you have it- static 11:35 manual release for the adductor magnus. 11:37 Remember, if you're going to do a manual 11:39 release technique, you should be 80% sure 11:41 that that muscle is involved from your 11:44 movement assessment. Don't use manual 11:48 techniques alone as assessments, 11:52 especially in the case of this technique. 11:55 You're going to want to pre-test and 11:56 post-test, and then give your client or 11:58 patient confidence that you put your 12:01 hands where you put your hands for good 12:03 reason. I would definitely suggest, in the 12:06 case of this and all manual release 12:08 techniques, that you grab a friend, 12:11 grab a fellow student, grab a colleague, 12:15 grab a fellow professional. If you can, 12:19 grab an experienced manual therapist to 12:23 practice this technique on first, before 12:27 trying it on a client or patient. There 12:29 is no better education than being able 12:33 to practice this on a fellow manual 12:36 practitioner and have it done to you by 12:39 that practitioner and start exchanging 12:41 notes. These videos are great, but they do 12:44 not make up for the practical 12:46 application component that you will need 12:49 to feel comfortable in practice. I hope 12:51 you guys enjoyed this video. I look 12:53 forward to seeing your comments, your 12:55 questions. I'm happy to answer anything 12:58 you guys ask. I'll talk with you soon. 13:08
