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This is Brent of the Brookbush Institute, and in
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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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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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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.
00:12:4400:12:46
I look forward to talking to you guys