0:04 This is Brent of the brook Bush Institute in this video. We're going 0:07 over manual therapy techniques specifically instrument assisted soft 0:10 tissue mobilization. Now, if you're watching this video, I'm assuming 0:13 that you are a licensed Medical Professional with instrument 0:16 assisted soft tissue mobilization within your 0:19 scope of practice. Now, there's some gray area here not every 0:22 state has legislation around these tools. If you're not sure 0:25 check, I would hate to see somebody getting in trouble because 0:28 they watch one of our videos and used 0:31 it on a patient or client when things did not fall 0:34 within their scope of practice act. Now these tools 0:37 just like all of our other techniques fall within 0:40 a model of practice and we are very 0:43 big on assess a dress reassess. So 0:47 even though these tools are specific to 0:50 perhaps fossil tissue. We're still 0:53 going to base their use on reliable assessments. 0:56 We're going to use these techniques 0:59 and then we're going to reassess and if they're not 1:02 effective we're not going to use them again for 1:04 particular patient or problem this video. 1:07 We're doing the anterior and medial fasciada. That's 1:10 the front and in fascia of 1:13 the thigh. I'm going to have my friend Lisa step out. She's gonna help me demonstrate. 1:17 Now Lisa's gonna lie supine she's gonna scoot as 1:20 close as she can to the side of the table closer to me 1:23 that's gonna make things a little easier and then you guys will notice that 1:26 I have her in some pretty loose shorts. That's so that I can pull her 1:29 shorts up so I can see all of her thigh, right? I 1:32 want to get all the way up to like the insertion of maybe her 1:35 rectus femoris and and where that that fosh 1:38 a lot of kind of Blends into the inguinal ligament, right 1:41 which would be the end of the fossilada and then from modesty sakes 1:44 guys, you might ask them to go ahead and Tuck 1:47 their shorts underneath their underwear if you don't mind 1:50 doing that for me Lisa, so just kind of Tuck under 1:53 the Border there and what that'll do is pin down their shorts 1:56 so that nothing shows as we're moving around the 1:59 leg just a little modesty tip for you guys. Now, of course, 2:02 we're gonna use a little bit of this lotion here 2:05 because we want to make sure that we kind of protect the skin 2:08 that the idea is not to just scratch the heck out of the skin. I know 2:11 a lot of you guys are used to seeing videos with the really red petite but 2:14 what we're really trying to affect 2:17 The fossil layers underneath that so I just 2:20 have a little bit of the Smart Tools cream here. 2:23 Put it on the end of this clean tool and then I'm gonna 2:26 go ahead and rub it in so that we get this lubricant all 2:29 over. 2:31 All right, you guys can use your hands and my manual therapists out 2:34 there. Like this is a good time to 2:37 start getting a little bit of an assessment going on what you think might 2:40 be tight. 2:42 So I can feel she's a little tighter down here and towards the 2:45 knee. And so maybe the that end of the rectus femoris 2:48 has some trigger points in it or who knows maybe 2:51 her articular is genu right and then her inner 2:54 thighs just a little tight here. I know some people get really 2:57 bent out of shape about using too much of this cream 3:00 or too little I don't generally worry about it 3:03 much if you have extra you can just 3:06 go ahead and moisturize their other thigh. Most 3:09 people are not going to complain about it and 3:12 So the first thing we're going to do now is we're gonna scan. 3:15 We want to scan the whole thigh. And 3:18 what we're going to try to note in our heads is areas where 3:21 things don't feel uniform. Usually that's 3:24 a little extra roughness or a little bumpiness. So 3:27 I'm just gonna go ahead and take this tool here guys. And 3:30 this tool is the the scanner. It's 3:33 a single bevel. It's it's pretty sharp. Right? So 3:36 we don't need that much force. I'm just gonna go ahead and hold 3:39 it to like 20 to 30 degree angle. 3:41 Go right up to the point where I'm getting a little bit of push back 3:44 from her muscle tissue. 3:46 And then I'm just going to kind of drag through. 3:50 And what I noticed right away. 3:53 Is I got a little bit more? 3:55 Bumpiness here and a little bumpiness here. So we're gonna 3:58 keep keep that in mind and now I'm just going to kind of keep going. 4:03 Just one row one row at a time almost like 4:06 a mowing a lawn. All right, just kind of keeping track of where those 4:09 bumpy areas are again. It was like in here 4:12 and in here. 4:17 Going to keep going up and guys, I'm gonna go ahead and stop before I 4:20 hit the side of the thigh because there's actually a different position. I would use for 4:23 doing all of the lateral fossilata and 4:26 this will go through here. 4:30 and 4:31 all right. So now I've scan the tissue. 4:34 And I feel like there might be a little bit 4:37 of fascial dysfunction here and here. 4:41 the most 4:42 Ah, the theory that probably makes the 4:45 most sense for these particular tools is this idea that when 4:48 we get some tissue damage all right or tissue 4:51 dysfunction that we end up with binding of our fascia layers. 4:54 So we're going to try to do is is kind of break up 4:57 the collagen cross Bridging the disorderly collagen 5:00 cross bridging. We're gonna switch from this this sharper tool 5:03 and I'm actually gonna go with this 5:06 handlebar tool since the thigh is a pretty large area 5:09 to go after right we're gonna 5:13 Start going in One Direction with the tools. Same 5:16 thing. It's the same kind of Strokes. We were using for scanning. 5:21 only now 5:22 I don't just want to go in One Direction. 5:25 Because I think I mentioned in previous videos that your fascia 5:28 doesn't align with the direction of muscles. So it's not like 5:31 because we're on the thigh the fossil lines up this way. The truth 5:34 is is the the fossilata is multi-layered and 5:37 those layers are crisscrossed. Right? 5:40 So we have fossil the the natural fossil 5:43 lines going on a bunch of different directions not to 5:46 mention the disordered collagen is 5:49 going in all sorts of directions. So we want 5:52 to start maybe going up like this the way 5:55 I felt the bumpiness, but now I'm going to 5:58 mix it up and go all sorts of different ways. So maybe I go down for a few Strokes, 6:01 too. 6:02 and it just takes like 6:04 five six maybe seven strokes in each Direction, maybe 6:07 less maybe just three Strokes. The next thing I'm gonna do is 6:10 I'm gonna try to get some angles. So what I like to do is is kind 6:13 of think about fulcrum and then spin it 6:16 around this way, right? So I'll get that diagonal then 6:19 I'll switch it around and go that diagonal. 6:23 I'll go that diagonal. 6:26 I'll go this diagonal right and I've already done six directions, 6:29 right? That's a that's a fair amount of therapy. That's 6:32 that's probably a good 20 or 30 Strokes in 6:35 that one area and I would probably leave it at that go on 6:38 to the next area. So now we have close to the 6:41 knee again. I might go down. 6:43 I'm using just kind of like a little scooping stroke, or 6:46 you can just pull down just like you were using those scanning Strokes. 6:51 Up this way. Same thing just going right up against the muscle 6:54 tissue and then pulling this way trying to 6:57 cheer some of that fossil tissue with me again. We'll 7:00 go this way. 7:02 We'll go this way. 7:05 This way this way. 7:08 This way this way good now 7:11 we got that area completed. Now if you wanted to frame 7:14 the knee, right so 7:17 framing is where we kind of go around a bone or we 7:20 go around a ligamentous tissue. Make 7:23 sure that everything is is freed up 7:26 around that if you guys wanted to do that at the knee you could 7:29 You could we could go around the patella a little bit. 7:34 And we felt some dysfunction there. It's a 7:37 little harder to do multiple directions, but try 7:39 alright, so I'm just using this shark fin tool here better 7:42 fits this space and I'm getting right up against 7:45 the patella and not what I'm actually doing is kind of falling off the patella 7:48 and then going away from it. If you're gonna go towards it. Just make sure you use 7:51 your thumb. 7:52 To kind of block it out. 7:55 And then maybe I'll use the tip of the shark tool 7:58 to to kind of go sideways kind of like some cross friction 8:01 just to get some different directions. 8:05 Now after I've done that. 8:08 Maybe the next thing I want to do is if I've noticed any trigger points, 8:11 especially if I was doing my manual therapy first, which 8:14 I usually do. I usually do my manual therapy first because once you 8:17 get the lotion on it's a little harder to do the manual therapy, but let's 8:20 say I noticed a trigger point right here. 8:23 I can come back and 8:25 kind of break up any 8:28 binding of that connective tissue around the trigger point that I 8:31 thought might exist. 8:33 I have noticed that attacking trigger 8:36 points like this. 8:39 helps carry over a little bit 8:41 so these trigger points tend to 8:44 become a lot less sensitive and start to disappear a 8:47 lot faster. When I do my static manual 8:50 release techniques and then follow it up with a 8:53 little bit of this. And of course the last thing I'm going to do is we're 8:56 going to get a little bit more functional with this and I'm 8:59 gonna do a little pin and stretch 9:02 or at least iastms version of pin and stretch so 9:05 I could take this tool. 9:07 Just have her bring her leg this way. 9:11 And now she's gonna hold it for me for a sec. I'm gonna 9:14 go right back over where that area was a little dysfunctional. I'm gonna grab 9:17 some tissue and then I'm gonna have her try to 9:20 let her leg down. 9:22 Good, go ahead and let it all the way down. 9:24 And so I've pinned that tissue and she 9:27 just let pulled all that muscle tissue through where I've 9:30 pinned the fascia we can do that again. 9:33 Guys, this is a very aggressive technique. So you 9:36 only need a few reps go down again for me. 9:41 If I did want to get a little bit more aggressive than this I could 9:44 pin and then as she's going 9:47 down. 9:49 Go ahead. I can pull through. 9:51 the tissue 9:53 if I wanted to get more aggressive than that I could pin. 9:57 Have her slowly let down. 9:59 Go through the tissue. 10:01 and apply overpressure 10:03 and I'm sure she's thinking that's that's pretty that's pretty 10:06 intense. 10:08 All right, so we just did the front of the thigh and literally 10:11 that would be an entire treatment guys. That's it doesn't take 10:14 much of the stuff. A lot of I think the biggest mistake that gets made 10:17 with istm is people go really really hard and 10:20 leave a lot of of bruising and 10:23 stuff behind the inner thigh. We're going to use 10:26 the exact same techniques, right? So I'm gonna 10:29 put her in this position. 10:31 Right. So this is the same position we've 10:34 used for like some adductor release manually, but it 10:37 gives me nice access this way. 10:40 I could use my scanning tool. 10:48 Alright, so I'll come through here notice any bumpy areas. 10:54 So I noticed a little bit of bumpiness this way. 10:57 a little bit of bumpiness over here, of course once I find the 11:00 bumpiness 11:01 I can go back and do my Strokes in different directions. 11:06 If I had been working with her manually on her adductors before I could go after any 11:09 trigger points that I find. 11:12 And then I can follow that up. 11:14 With again a little bit of pin and stretch 11:17 some more Dynamic instrument assisted soft tissue mobilization. And all 11:20 I'm going to do is I'm going to help her out here a little bit with my 11:23 with my stomach. 11:25 Pin a little bit of tissue and then I'm gonna have her think 11:28 about driving her knee down towards the floor. 11:32 Perfect. 11:34 And I can do that a few times be careful with the inner thigh guys 11:37 inner thigh. It's a very sensitive region to be 11:40 doing instrument assisted soft tissue mobilization on 11:43 how's that feel Lisa fine? 11:47 Good. 11:49 I am trying to be a little easy on this lease as we've done a few 11:52 takes. 11:53 To make sure we got you guys a nice clear video 11:56 but there you guys have it anterior and 11:59 medial fossilata, right? So we 12:02 did this position you got this position for 12:05 the dynamic. 12:07 This position for adductors and then 12:10 Dynamic would just be this way with the adductors 12:13 and stay tuned for your close-up recap. Alright 12:16 guys for a close-up recap. We're going to use a little 12:19 bit of the Smart Tools cream. 12:21 Get that skin a little lubricated so 12:24 that we're not just a braiding the skin as we're trying to do fossil techniques. 12:27 Now, of course as I'm rubbing this in personally as 12:30 a manual therapist, I'm taking in some information on what 12:33 where I feel some extra tissue density, you know, 12:36 maybe that's somewhere I might expect to feel something as I 12:39 pull the tool through the layers of 12:42 fascia. All right. Now I'm using this scanning tool to 12:45 start off with guys single beveled. It's it's pretty 12:48 sharp relatively speaking and I'm 12:51 gonna go ahead and take it at 20 to 30 degrees 12:54 here and I'm just going to start from the bottom very systematically and 12:57 work my way through 12:59 all of this tissue noting any discrepancies. 13:02 All right, so anything that feels abnormal 13:05 to me 13:08 I feel a little bit of extra tissue stuff there. 13:11 little extra bumpiness 13:14 I also feel a lot of extra now that I'm going through this. I'm 13:17 noting that like every time I start this is 13:20 much more restricted much 13:23 more bumpy than the rest of it. 13:25 So let's say I've gone through all the tissue all the way from England or 13:28 ligament all the way down to the knee and I noticed 13:31 here and here of course now I want to do those multidirectional Strokes. 13:34 I probably wouldn't use the scanning tool 13:37 for that you could but this sharp edge which makes 13:40 it great for feeling through the tissue. There's also pretty aggressive. 13:45 Maybe I'll try using this double beveled. 13:47 battering looking tool from Smart Tools 13:50 and again, I could go down Strokes. I notice 13:53 I'm using the same angle 30 degrees pull down 30 degrees pull 13:56 down. 13:57 Can go up this way. 13:59 Pull up guys notice there's some redness already. So if 14:02 I see redness that quick, you know, we're looking at like three to six 14:05 Strokes per Direction probably gonna lean towards 14:08 three because I also want to go maybe in this 14:11 direction. 14:12 and this direction 14:15 and this direction 14:17 this direction right? I want to I don't want to get stuck where 14:20 I've gone All in One Direction and now 14:23 I've already got so much 14:26 redness so much of a histamine response, maybe so much 14:29 petechiae that I know if I do anymore, I'm 14:32 just gonna lead to bruising. All right. So keep your eye on 14:35 how red Things become how fast of course 14:38 I can do this area. Same thing up down. Of 14:41 course, if if we're talking about a larger area here, I can 14:44 switch my tool to something like The Handlebar tool. 14:48 Right and get a lot more area done go through 14:51 a lot of different directions. 14:56 Once I get through that maybe I'm gonna go back through and do 14:59 my trigger points. 15:00 So any trigger points, I noticed while I was doing my manual 15:03 therapy. I could then do that like 15:06 cross frictiony in all directions around 15:09 the trigger point that I had mentioned really helps 15:12 with carryover. 15:19 and then we always want to 15:21 get a little bit of that pin and stretch in and really work 15:24 on improving range of motion. So we 15:27 started down here at the knee. 15:29 All I'm going to have Lisa do is hang her leg 15:32 off the table. 15:34 Pin and then just let her sink her 15:37 leg down, right? So now as heard the 15:40 weight of her lower leg is pulling all that muscle tissue and those 15:43 deeper layers of fascia through the the pinned 15:46 tissue. So let's try that again. 15:49 We'll do three reps there good so I got pinned up. 15:52 All right, let it go. Of course 15:55 if I want to be more aggressive I could have actually pulled through. 15:59 As she was going down. 16:01 All right, so I could 16:02 pull through go ahead and let your leg go and go 16:05 against it kind of Against the Grain there and then 16:08 of course if I really wanted to get aggressive I could add over pressure with 16:11 my knee and push her further. 16:13 into flexion 16:15 Now we also did the adductors. 16:18 Right so adductors. I mentioned that this was probably 16:21 the best position. 16:23 And note that this area is very tender guys 16:27 like adductors or just a sensitive area to do 16:30 manual therapy on they're sensitive for instrument assisted soft tissue 16:33 mobilization. Keep that in mind as you're going through the adductors 16:36 don't don't start off really aggressive, but I'm 16:39 gonna do the same thing. I'm gonna scan. 16:42 Once I find some really tissue that 16:45 I think is dysfunctional more bumpy more restricted. I'll 16:48 do my 16:49 multi-directional Strokes 16:52 and so maybe it's right around her adductor Magnus that we 16:55 see here. 17:04 See she's getting red pretty quick. 17:09 All right, that's not an abnormal amount of redness. That's probably fairly 17:12 normal. 17:13 and then of course, we'll make sure we get a little 17:16 bit of 17:17 mobility in there, but I'm going to hold up her leg a little 17:20 bit. 17:22 pin the tissue 17:24 and then I'm going to have her think about as I kind of let my 17:27 leg go which is holding her leg up. I'm gonna 17:30 kind of let my leg go and have her press her knee down as I'm 17:33 pinning this tissue. 17:36 and then I can use the same methodology there so I can 17:41 have her pull down and pull through if I want to get a little bit more. 17:45 Aggressive and I can get really aggressive. 17:48 by 17:49 having her pull down and pull through. 17:52 And then maybe adding a little bit of overpressure. 17:56 So there you guys have it. 17:58 instrument assisted soft tissue mobilization for the 18:01 anterior and medial 18:04 fascia Lata or fascia of the thigh. So 18:07 there you have it instrument assisted soft tissue mobilization, make 18:10 sure to assess. 18:13 Address using the intervention and then of course 18:16 reassess and if you get the chance these 18:19 videos are not a replacement for live 18:22 education. Of course, if you get the chance, 18:25 you should take live workshops or find a 18:28 mentor who's experienced using these tools or maybe 18:31 a friend that wants to learn them too. So 18:34 at least you can practice on each other and give each other some tactile 18:37 feedback of what you feel how you felt the 18:40 next day what results you felt that you got. 18:44 I hope you guys enjoyed this video. Please. Feel free to leave your questions 18:47 below.
