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Anterior Adductors Static Manual Release

Anterior adductors static manual release is an advanced massage technique used to assess, diagnose, and treat muscular pain and dysfunction in the adductor muscles located in the anterior thigh. Using gentle, sustained pressure on the area, this technique works by activating the body's natural restorative processes to reduce tension, decrease pain, and promote healing. This approach is often used in combination with other treatments such as stretching, strengthening, and mobilization, creating a synergistic effect towards restoring well-being

Transcript

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