0:04 This is Brent of the Brookbush Institute, and in 0:06 this video we're doing static manual 0:08 release of the adductors, the anterior 0:10 adductors that is- pectineus brevis, 0:13 adductor longus, and gracilis. Now, I'm 0:15 assuming if you're watching this video, 0:16 you're watching it for educational 0:19 purposes and you're a licensed manual 0:21 therapist. So, the laws around your scope 0:24 allow you to do static manual release 0:26 techniques. That's athletic trainers, 0:28 physical therapists, chiropractors, 0:30 osteopaths. If you're not sure 0:33 whether your scope covers manual release 0:36 techniques, please look those up before 0:38 trying this on a patient or client. Sorry 0:40 personal trainers, this video probably 0:42 doesn't apply to you, although some of 0:44 the palpation techniques may be helpful 0:46 and you learning anatomy. I'm going to 0:48 have my friend, Melissa, come out. She's 0:49 going to help me demonstrate. Now, all of 0:51 these static manual release techniques 0:54 follow some pretty similar protocols. We 0:56 basically need to be able to locate the 0:57 muscle and compress it. Alright, so we 1:01 need to know how to palpate this muscle. 1:03 We get bonus points for knowing where 1:06 the trigger points are, because that will 1:07 help narrow our search a little bit. We 1:09 need to also keep in mind if there are any 1:11 tissues that we could compress that 1:14 could be harmful. So, at one point 1:18 we're going to end up with our thumbs in 1:19 the femoral triangle. We need to be aware 1:21 that the femoral artery, lymph nodes, and 1:24 femoral nerve are there, and we're going 1:25 to watch out to make sure that we don't 1:27 compress or abrade those tissues. And then, 1:31 of course, we need to know what the 1:32 best position is to put Melissa in for her 1:35 comfort, for our comfort, and to increase 1:38 tension in her adductors, so that we pin 1:42 down those local points of hyperactivity. 1:45 Now, the best position for this 1:48 particular technique is to go ahead and 1:50 have Melissa put her foot right up 1:53 against the opposite knee. Now, for the 1:56 sake of the camera, I'm also going to 1:58 have Melissa go ahead and throw this leg 2:02 off the table, because Melissa has 2:04 some hypertrophied quads that kept 2:06 blocking our view no matter what angle 2:09 we tried to film this at. So, from this 2:12 position, guys, the way I find my 2:15 adductor logus and gracilis is pretty 2:18 easy. I'm going to use a pretty broad 2:20 surface to start my search, 2:22 from tip of index 2:24 finger to tip of thumb and all of my 2:25 webbed space right across her inner 2:28 thigh there. I'm going to use this hand 2:30 to block her knee and then ask her to go 2:32 ahead and lift that knee off the table 2:34 an adduct. Very strong. But, what 2:37 I noticed most is her adductor, there's 2:40 this column of muscle right here that pops 2:43 right out into my hand. That is her adductor 2:46 longus and gracilis. Now, I 2:49 mentioned getting bonus points for 2:50 trigger points, or knowing where your 2:53 trigger points are. Your trigger points 2:54 for your adductor longus and gracilis 2:56 are kind of at the one-third mark and two- 2:59 third mark of the length of her thigh. So, 3:02 when I go to search for these 3:05 hyperactive fascicles, these overactive 3:08 fascicles, and then eventually the 3:09 nodules that might be contributing to 3:11 that over activity, I'm going to start 3:13 kind of at the one-third mark and the 3:14 two-third mark. I'm going to do these 3:16 posterior to anterior swipes. I find 3:19 those overactive fascicles right there. 3:21 And then, I found- that was quick. I 3:25 found a nice tight little nodule right 3:27 there in her adductor longus, I think. I 3:29 can use my thumb over thumb to apply 3:32 pressure. I can use pisiform over thumb. I 3:35 can use hypothenar groove over my 3:38 thumb 3:41 to apply pressure. I straighten out 3:43 my arms and just go ahead and lean a 3:45 little bit. If she had hip pain for 3:48 whatever reason, I could put a bolster 3:49 under her knee so that she's held up 3:51 like this, so when I'm pushing down, I'm 3:53 not pushing her further and abduction. 3:55 Once again, I'm only going to push to the 3:57 point of getting some push back from our 4:01 tissues, so some increase in tissue 4:03 density. I'm not going to push her to the 4:05 maximum amount of tissue increase in 4:08 tissue density or maximum amount of 4:10 push back, because that just means she's 4:11 probably going to guard or she's going 4:13 to be in a lot of pain, and I'm unlikely 4:15 to get a release. Now, since we are 4:17 dealing with multiple muscles here, guys, 4:19 it is okay to release a trigger point 4:22 and then move on and start searching for 4:26 more trigger points. 4:27 I just found one here. This one tends to 4:31 be a little bit more posterior on her 4:34 inner thigh, so maybe this is a gracilis 4:36 trigger point. Alright, so we want to 4:39 get that taken care of. Once again, I just 4:43 push right up to that subtle increase 4:46 and give back from her tissues, and I'll 4:50 wait for a release. Now, the next two 4:55 muscles we're going to do are the 4:56 pectineus and brevis, and they're a 4:58 little trickier but not terrible. Most 5:02 texts I see talk about using the adductor 5:05 tendons as a means of finding the 5:08 pectineus and brevis. And, of course, the 5:11 way we would do that is I would start at 5:13 her belly button with my fingers. I would 5:15 use my thenar emini here to kind of 5:19 go down and find her pubis. And then, if I 5:22 fall off the lateral edge of her pubis, 5:25 kind of underneath her inguinal ligament, 5:28 you can feel the adductor tendons. 5:30 You can follow just superior to 5:35 adductor tendons to find that pectineus 5:37 and brevis, which kind of overlap one 5:39 another at the bottom of the femoral 5:41 triangle, or you can follow them all the 5:44 way down to the adductor longus. The 5:46 problem with this technique, obviously, is 5:48 it's uncomfortable, it can be a little 5:49 invasive, and if you happen to be a little 5:51 clumsy with your hands, of course, you 5:52 could miss and end up on somebody's 5:54 groin, which is not very comfortable. I 5:55 find that the easiest way to go after 5:58 these trigger points, which are actually 5:59 a few inches below the inguinal ligament 6:05 and a few inches away from the pubis is if I, once again, have her adduct, I can 6:09 see this nice column of muscle. That's 6:11 her adductors, and actually, I can see her 6:13 rectus femoris right here. Now, her adductor 6:16 longus and rectus femoris border 6:19 the femoral triangle, and I can put my 6:22 thumbs down right in the bottom of that 6:23 femoral triangle, which is where the 6:26 trigger points for the two muscles that 6:29 are the floor of my femoral triangle, the 6:30 pectineus and brevis, are. The only thing 6:33 I have to be aware of is if I press down 6:36 and she 6:36 notices any burning, tingling, electric 6:40 pain, I might be on the femoral nerve. If 6:43 I feel a pulse, I need to move, because 6:46 that's probably her femoral artery. And, 6:47 if I feel like a weird wobbling 6:50 around, and it's just really 6:51 uncomfortable, I might be on those lymph 6:53 nodes, and, obviously, I don't want to be 6:55 on those either. So, as you guys are using 6:58 your strokes from side to side and up 7:01 and down to search for those 7:03 overactive fascicles and trigger points, 7:06 make sure if they start complaining 7:08 about any weird pain, that's not that 7:10 trigger point associated pain that you 7:12 just demonstrated for them doing their 7:14 adductor longu,s that you get off it 7:16 and look for a different point to 7:20 press on. The last thing we want to do is 7:23 create any sort of inflammation or 7:25 swelling when we're trying to fix a 7:28 problem. I found a nice little 7:30 trigger point right there. I'm going to 7:33 go ahead and press, wait for it to let go, 7:36 and then, of course, I could do my retest. 7:39 I hope you guys enjoyed this little 7:41 demonstration. Next, we'll do our close-up 7:43 recap. Alright, guys, for the close-up 7:44 recap, notice I have Melissa's foot next 7:46 to her knee and her thigh is abducted. If 7:50 I want to find her anterior adductors, it's 7:52 actually pretty simple. I can use the webbed 7:54 space here over her inner thigh, have her 7:57 press up against my hand and putting a 8:00 little pressure on her knee, and boom, I 8:02 can feel her adductor longus and 8:03 gracilis just pop right up into my hand. 8:05 They make a nice little column of muscle 8:07 right down the middle of her inner thigh. 8:09 Now, the trigger points for you're adductor 8:11 longus and gracilis tend to be 8:15 one-third up and two-thirds up. So, 8:18 we got trigger points that kind of hug 8:21 the middle third of the length of these 8:23 muscles. I'm going to go ahead and use my 8:25 posterior to anterior strokes here to 8:28 find the most dense fascicles. Once I 8:32 find them, I then can move proximally or 8:35 distally to find the tightest nodules, 8:39 those little points of hyperactivity. And, 8:41 I can apply pressure using my thumb over 8:43 thumb technique, or I can use pisiform 8:46 over thumb. 8:48 I press right into the point where I get a 8:50 little tissue kick back and not any further. 8:52 We don't want pain. We don't want 8:55 guarding. We don't want a muscle that's 8:56 trying to contract against us. Hold just 8:59 until you feel some tissue resistance, 30 9:02 to 120 seconds. That's adductor 9:05 longus and gracilis. Now, we still have 9:07 pectineus and brevis. And, although I've 9:11 seen a lot of texts that refer to 9:13 falling off the pubis, finding the pubis 9:16 is relatively easy. You just 9:18 start with the bellybutton, move 9:22 the base of your hand down, and you'll run right into the pubis there. 9:23 Then you can fall off and find the 9:26 tendons. I actually don't find that 9:28 particularly useful, and it's a little 9:31 invasive and a little uncomfortable for what 9:33 we're trying to do. If you just have 9:36 somebody adduct again, you can see that 9:39 column of muscle. That's their adductors. 9:41 Then there's another column 9:43 of muscle here, which is the rectus 9:45 femoris. In between the rectus 9:47 femoris and adductor longus is their femoral 9:49 triangle, and the floor of the 9:52 femoral triangle is the pectineus and 9:53 brevis. Now, as long as you're paying 9:56 attention to the fact that we have the 9:59 femoral artery, nerve, and lymph nodes 10:01 here, and you try to stay off anything 10:03 that is strangely or acutely painful, you 10:08 try to stay off anything that pulses, and you 10:09 try to stay off anything that tingles, 10:11 you should be able to kind of move your 10:15 your thumb around the floor of the 10:19 femoral triangle there until you find 10:22 the densest fascicles and any nodules 10:26 that might be creating some 10:28 hyperactivity or be hyperactivity. Once 10:31 again, you can apply pressure for 30 to 120 10:34 seconds, get your release and move on to 10:38 the next muscles. So, there you guys have it, 10:40 static manual release of the anterior 10:43 adductors. I hope you guys enjoyed the 10:45 video. I hope you guys are going to enjoy 10:47 doing these techniques and the outcomes 10:50 they will provide you. Once again, we are 10:52 on some sensitive areas here. This goes 10:55 for all release techniques, but maybe 10:57 especially these techniques that 10:59 put our hands in some uncomfortable 11:01 areas. You should be eighty percent sure 11:04 or better that the muscle you're about 11:08 to put your hands on is involved in 11:10 their dysfunction from their movement 11:12 assessment alone. If you haven't done a 11:15 movement assessment, you really have no 11:17 business doing these manual release 11:20 techniques. Manual release techniques by 11:22 themselves make fairly poor assessments. 11:25 And, of course, just for patient 11:27 confidence, you might want to have a 11:29 pre-test post-test, that one quick test 11:32 that you did that gave them symptoms and 11:35 showed their dysfunction. For 11:38 example, maybe I did the overhead squat and 11:40 their knees bow in, I have them do the 11:43 overhead squat, take a picture, do this 11:46 technique, have them do the overhead 11:47 squat again, and take a picture and 11:49 hopefully see an improvement. That, of 11:53 course, will then reinforce why you had 11:56 your hands on this individual's adductors, 11:58 their inner thighs, which is a sensitive 12:00 area. As I said in all these videos, 12:02 please find friends fellow practitioners, 12:09 if at all possible, a mentor to practice 12:13 these techniques on and to have these 12:15 techniques demonstrated on you, because 12:17 you will learn a lot from feeling 12:20 these techniques, doing these techniques, 12:22 and then having that fellow professional 12:24 to compare techniques with. That'll 12:27 really refine your hands, really refine 12:29 your touch, and you guys will learn a lot 12:32 in what's comfortable and what's 12:34 uncomfortable. I hope, once again, you 12:37 learned a lot from this video, and you 12:38 enjoyed this video. I look forward to 12:41 hearing about your outcomes. If you have 12:42 any questions please leave them below. 12:44 I look forward to talking to you guys 12:46 soon. 12:54
