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This is Brent of the Brookbush Institute and
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in this video we're going over a static
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manual release of the biceps femoris, or
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the lateral hamstring group. Now, if
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you're watching this video, I'm assuming
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you're watching it for educational
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purposes and that you're a licensed
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manual therapist following the laws of
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your scope of practice in your state.
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That means athletic trainers, physical
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therapists, massage therapists,
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chiropractors, osteopaths, you're probably
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all in the clear. Personal trainers, this
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video probably doesn't fall within your
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scope, although, you could use the
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palpation portion of this video as part
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of a learning experience, especially
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learning your anatomy. I'm going to have my
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friend, Sonya, come out. She's going to
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help me demonstrate this technique. Now,
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of course, before I do any manual
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technique, I'm pretty much eighty percent
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sure that the muscle I'm going to target
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is involved in the dysfunction, and the
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only way I can get there is through
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assessment. So, with Sonya, we're going to
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make up a little case. We'll say she came
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in complaining of a little knee pain.
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When I did her overhead squat, maybe she
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had some knees bow in. When I did gniometric
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assessment, she was missing a
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little hamstring length. It's that
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test where we're at 90 degrees of hip
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flexion and then we see how much knee
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extension is left over. So, I have a
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pretty good idea that biceps femoris
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overactivity is part of her dysfunction.
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Now, all of these static manual release
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techniques follow a very similar
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protocol. We need to be able to palpate
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the muscle. We get bonus points for
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knowing where the trigger points are. We
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should probably know if there's any
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other structures around that muscle that
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we could potentially insult, something
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like a nerve or an artery that we want
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to stay away from. And then,
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once we get all of that figured out, we
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want to know what position should the
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patient be in for their comfort, our
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comfort, and so that we have some control
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over the amount of tension within the
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muscle so that we can help localize or
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stabilize those tight fascicles and
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trigger points. In this case, the biceps
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femoris is on the lateral side of
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the posterior thigh, so this is the outer
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hamstring group. You can see I've marked
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off the trigger points. We have a long
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head in a short head of our biceps
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The long head trigger point is right about
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here and the short head is right about here.
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You guys will see that a little closer
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when we do the close-up recap.
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Generally speaking, these trigger
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points are right in the middle of these
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muscle bellies. So if you know that the
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biceps femoris goes from ischial
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tuberosity to fibular head, then
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that's about center. And then the short
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head of the biceps femoris comes off
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that linea aspera at about halfway down,
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so if I go half the distance of her
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femur to fibular head, that's pretty
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close to center. Now for the short head,
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we can go in prone and still have some
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control over how much tension we have in
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this muscle. Remember, your short head
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doesn't cross your hip, so all I have to
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do is be able to
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control how much knee flexion and
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extension I have. I'm then going to use
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my palpations this way, my
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strumming palpations from medial to
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lateral to try to figure out where are
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these tight fascicles. Alright, so I'm
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just going from medial to lateral, and I
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notice that this fascicle is pretty
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tight. You'll notice I put my
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hands down pretty close to where those
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trigger points are, but if I start moving
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from proximal to distal now, I want to
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see if those tight fascicles are
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attached to maybe a tight nodule, maybe a
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local point of hyperactivity. Then I can
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really pin down. I'm going to add
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just a little bit more attention to this
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muscle here, because as I've explained in
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some of these other manual release
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technique videos, if you don't put a
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little tension within the muscle you
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start playing that game of trying
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to put your finger on top of a marble.
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Every time you push down, it slips
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out. So, I want enough tension this way
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that I stabilize that point.
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I think right about there I got Sonya
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making a little face, that's a good point.
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I'm just going to use pressure from my
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thumb. Now, if I wanted to, if I felt
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like I needed both hands, if I was a
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smaller therapist let's say and Sonya
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was a huge individual, which obviously
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she is not, I could use a dowel or maybe
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my knee to keep her in this position, and
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then use my thumb over thumb technique
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here so that I don't have to to wear out
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my hand. Notice that my elbow is locked,
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like I'm trying to get my body
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weight up and over the pressure I'm
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using. I'm not using my grip
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strength. You don't want to wear yourself
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out. And, of course, after about 30 to 120
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seconds, I actually start to feel the
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increase in tissue density that I
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identified disappear. It'll actually
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start to melt or release, which is where
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the name these techniques come from.
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Sometimes you can actually feel a
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release happen. If you ask your patient,
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"How does this feel compared to when I
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put for first put my fingers down? Is it
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as tender?" No. She said it's not as tender.
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Usually it'll be really tender when you
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put your fingers down and over like 30
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seconds it starts to calm down, a lot of
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it calms down within the first 10
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seconds. Alright, so that's short head,
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guys. And, once again, I'm going to do a
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close-up recap. So if you didn't see
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exactly what was going on, don't worry
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about it just keep watching. Go ahead and
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flip over for me, Sonya.
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Now, for the long head of the biceps
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femoris, the long head actually crosses
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the hip, so I have to be able to control
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both her knee and her hip. In this case,
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all I'm going to do is take Sonya's leg
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and put it on my shoulder.
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I'm then going to use my same palpation
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skill of medial to lateral, kind of
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strumming to find the
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tightest fascicles. In this case, I'm
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going to start a little a little distal
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of where that trigger point is. Once I
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find the tightest fascicles, I can then
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start moving a little bit more proximally.
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Once I find the tightest
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point- and that's a little trickier with the
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with the biceps femoris and some of the
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other muscles we've gone over. They're long
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stringy muscles, so you might have to
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search just a little bit. There we go.
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Make sure I have enough tension in her
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biceps femoris to stabilize that point, so
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it's not flopping all over the place
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underneath my thumbs. And then you guys
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notice, I've actually gone thumb over
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thumb here. I'm obviously not going to be
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able to get my arms straight in this
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position, but at least I can use both
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hands to apply that pressure. I am
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using, or trying to use my body weight here
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to lean forward with my hands. How does
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that feel? It feels good. Sonya's a little
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masochistic, she likes pain. This
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is one of those techniques where if
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somebody does enjoy massages though,
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they'll like it because they'll feel
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that release happen. And it's usually pretty
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quick, usually 30 seconds and you'll start to
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get a good release. You could be here up
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to two minutes if you have somebody
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who's really really overactive. So, once
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again, guys, make sure that you are
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careful with your own body position.
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Everybody is all about patient comfort. I
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don't I don't see a lot of patients in
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super uncomfortable positions. I do see a
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lot of therapists
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put themselves in uncomfortable
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positions, which is going to affect your
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longevity. If you plan on doing this
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for a long time, you need to really watch
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your own mechanics. I'm lucky in this
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office that I have so many mirrors, but
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I'll even catch my own bad posture on
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these techniques. Next, we're going to go
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to the close-up recap, guys. We
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have Sonya in position to do the long
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head of her biceps femoris. Remember, when
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we're releasing the long head of the
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biceps femoris, we want control over hip
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flexion so that we can place a little
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bit more tension in those tissues, so
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that we can pin down those overactive
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fascicles as well as the trigger point
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we're going to go after. I'm going to
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start with my medial to lateral or
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lateral to medial strokes pretty close
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to the center of the belly of that
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muscle, which is where that trigger point
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tends to be. I'll go medial to lateral and
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lateral to medial here, looking for the
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most overactive or the densest fascicles.
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You guys can notice that I'm between
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this mass here, which is her vastus
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lateralis and this mass here, which is
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actually her medial hamstrings. I
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actually notice a nice tight fascicle
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right there. I then can move from
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distal to proximal
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or proximal to distal to try
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to see if that overactive fascicle is
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associated with a trigger point. I have a
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nice little, a little tense nodule right
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there. Once I find that trigger point, I'm
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going to go ahead and press just enough
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to start getting a little bit of tension
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back from the tissue. Alright, so as I'm
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pressing, you'll notice tension kind of
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increases on an exponential curve there.
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I want to be right in the trough of that
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exponential curve. I don't want to press
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it all the way down. I'm not trying to
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put a hole in her leg. I don't want
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to see how far or how much tension I
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could place in those tissues. Just apply a
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moderate amount of tension, and then I'm
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going to hold. Notice that my arms are at
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about 90 degrees here, guys. So all I have
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to do to increase tension is lean
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forward a little bit.
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I don't need to use my grip strength. I
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can also use my body here. I can lean
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forward a little bit to add a little bit
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more hip flexion and increase the
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tension in the long head of her biceps
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femoris if I need to to pin down these
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tissues. Once I get a release, I get a
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reduction in discomfort from my patient,
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I can go ahead and move on to the next
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muscle or the next trigger point. In this
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case, we're going to move on to the short
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head of the biceps femoris. I'm going
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to have Sonya flip over for us. You
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guys can see here that I have this trigger
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point marked off, too, but we'll pretend
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that this X isn't here for a second. We
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know that the short head of the biceps
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femoris attaches to the linea aspera and
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the fibular head, and right between it, in
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the middle of the belly of the muscle,
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tends to be where the trigger point is.
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So, I'm going to go ahead and use those
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same medial to lateral and lateral to
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medial strokes to find the the tensest
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fascicles. And once I do, I can start
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moving either proximal to distal or
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distal to proximal to try to find any
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nodule that may be associated with those
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overactive fascicles. Once I find it, I
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can use my thumb over thumb technique. Of
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course, if you guys wanted to play with
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the amount of tension within that muscle,
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I can control the knee with one
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hand and use one hand to do the release
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technique. Once again, we'll hold 30 to 120
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seconds or until we feel a reduction in
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the density of the tissue. Make sure
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you're not pressing too hard. It does
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take a little bit of practice to know
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how much pressure to apply with these
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techniques. So, there you guys have it, the static
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manual release of the biceps femoris, or
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lateral hamstring group. Make sure that
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before you do these manual release
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techniques, you have a good working
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hypothesis of why that structure may be
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overactive. Ideally, before you would try
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any of these techniques on a patient or
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client, you would also practice
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them on a colleague or maybe a mentor
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with great manual skills who you look up
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to. There is no substitute for getting
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feedback from another manual
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practitioner. I hope you guys enjoyed
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this video. I look forward to hearing
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your comments. Please leave your comments
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below. I'll talk with you soon.