0:04 This is Brenda 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 gonna reassess and if they're not 1:02 effective we're not going to use them again for 1:04 particular patient or problem in this 1:07 video. We're going to go over brachial fascia and forearm fascia 1:10 instrument assisted soft tissue mobilization. I'm going to have my friend a vet 1:13 come out. She's gonna help me demonstrate these techniques. I don't 1:16 think you'll find these techniques very hard to do or very complicated. The 1:19 hardest thing to do is with the arm. You're going to need one hand to 1:22 move and stabilize the arm, which means we're probably going to use for 1:25 the most part smaller tools or tools that we can at least handle with 1:28 one hand. 1:29 Now we're going to start with a little 1:32 bit of lotion here. 1:35 And there's a lot of iastm stops out 1:38 there who are very particular about which lotion they 1:41 use and and how much lotion they 1:44 use and which tools they use and 1:47 what Strokes they use and I think you guys have seen in other 1:50 videos that 1:51 I think way too much attention is paid all that 1:54 stuff. Like you definitely need to use something on the arm. You 1:57 want to be consistent with what you use so you get used to 2:00 what it's supposed to feel like. 2:02 All right, you can see here. I'm just kind of this this stuff that we're 2:05 using the Smart Tools cream is very much like lotion. 2:09 If I use too much, it's just going to build up on 2:12 the tool as I go which I can always wipe off on the towel 2:15 or 2:16 wipe off on somebody's other hand right? It's just it's just lotion. It's 2:19 not a big deal. 2:21 As far as which tools you use these techniques will definitely 2:24 work with a lot of different tools that happen like the Smart Tools the 2:27 best just because they're really high quality. I like the edge 2:30 on them and they're fairly affordable compared to other other 2:33 tools that are out there now the tool I 2:36 like to use for the arm is the the battering tool. 2:39 We could use the scanner to start which 2:42 is is what Smart Tools recommends, but I 2:45 have a little bit of a problem with this very flat tool 2:48 trying to match the very round surface of 2:51 the arm. So even with my scanning I'm 2:54 going to go ahead and start with this. 2:58 And what I'm going to do here is I was kind of mentioning there or as I 3:01 kind of foreshadowed is we start with scanning Strokes scanning Strokes 3:04 are meant to assess the entirety of 3:07 the arm. And then I'm going to keep a mental 3:10 note of where I find any irregularities in 3:13 the tissue which for the most part are 3:16 going to feel like more bumpiness or excessive bumpiness. So I'm 3:19 gonna start up here at the deltoid. Fascia. Just work my 3:22 way down. 3:25 And that feels pretty good nothing there. 3:28 All right. 3:29 Go down this way. 3:31 Maybe a little bit of something in there. 3:34 All right. Now the tricky part. 3:36 Got to use both hands. All right, so I'm gonna 3:39 go ahead and use my other hand to control her arm. And 3:42 you guys can think of the majority of the brachial fascia is actually a 3:45 tie-in to the pectoral clavy pectoral 3:48 and axillary fascia. So if I do this like 3:51 I'm stretching her peck, it will add tension to 3:54 the brachial fascia like the sleeve of a shirt. 3:57 We'll pull this way. 4:00 So I can do scanning strokes and guys. It doesn't matter which direction you're 4:03 scanning Strokes are. 4:05 I feel a little bit up in here. 4:08 We actually noticed that when we were doing the the pectoral to anterior 4:11 adult stuff. 4:12 Be very careful as you go through the inside of 4:15 the arm, right you do have some some nerves 4:18 and an artery there. We don't 4:21 want to just roughly scrape over those not that 4:24 I think you could do a massive amount of damage, but it's not going to feel very good. 4:27 And actually don't feel all that much. 4:31 In events arm here, maybe a little bit up here. 4:34 Right, and then of course for for maybe the tricep I can 4:37 kind of get into one. 4:38 of these positions 4:40 Say mercy. No, not that hard guys. Just just turn 4:43 over until to end range. 4:46 And I can kind of pull through here. If I really felt some 4:49 stuff on our tricep. Maybe I would turn her prone. 4:52 Right, and then we could experiment with like a different position maybe arm 4:55 hanging off the table, right or maybe I could 4:58 even have her sit up and face me and polar arm across just find 5:01 a position that allows you to add some tension now. She 5:04 really doesn't have all that much. I did find a little bit of 5:07 abnormality kind of in her. 5:11 upper or proximal medial anterior 5:16 brachial fascia, somebody go ahead and write that down, right? 5:19 So right about this area in here. 5:22 Which you know we found some stuff in her. 5:25 Her pectoral fascia, so maybe this is just kind of 5:28 a continuation of that dysfunction right through here. 5:31 All right, so we'll address that. 5:33 The way we're going to address this stuff is is kind 5:36 of in a three-pronged attack. 5:39 I wanted disrupt any binding 5:42 down. 5:43 Of fossil layers, right so we know that 5:46 like when the inflammatory process happens like we 5:49 get collagen laying down in a 5:52 disorderly pattern that could probably affect the 5:55 amount of sheer strain that's allowed between tissues. 5:58 I want to break that up. I'm gonna go in all directions fascia 6:01 doesn't follow the direction of your muscles. 6:05 So I'm going to start here. I'm going to be very careful because this is a sensitive area and 6:08 all I'm going to do. 6:11 Is try to get a few Strokes in each 6:14 Direction. Alright? 6:17 Maybe for the arm these concave surfaces 6:20 work better. You can see I'm using the shark fin tool 6:23 here. 6:27 And turn the tool around this way and do some Strokes 6:30 up. 6:33 You guys can see I just kind of I went in one diagonal this way and 6:36 then I'm going this way. 6:38 In this way. 6:40 Right, and I could even go straight across. 6:43 Right almost like a cross friction sort of deal. 6:48 Be careful as you get up here too if you 6:50 twing 6:52 a kind of strum the 6:55 The biceps tendon that's not gonna feel very good either. 6:58 She did get just a little bit of petitechy I right up in here. 7:01 All right. 7:02 And that's it. That's it. That's that's all the therapeutic 7:05 intervention. She needs for that 7:08 one area. Now after I've gone over the bicep, you 7:11 know, maybe we're treating a vet for 7:14 Some lateral epicondylitis, so 7:17 maybe I want to go over her forearm fascia. 7:21 Same thing. 7:24 I'm gonna go through. 7:26 Do my scanning Strokes? 7:30 Try to identify any abnormal tissue quality 7:33 and I'm actually noticed a little stripe right across here. 7:40 Maybe a little bit in there. 7:43 How's that feel of that? 7:49 A little bit in there but not much not like the back of her arm 7:52 and I have do actually have just a little 7:55 bit. 7:57 in this area here 8:00 All right again, if if I was going to go after that area completely. 8:04 Maybe I would. 8:06 Flip her over into prone so that I 8:09 could attack just like I would triceps so I can attack it in a 8:12 position where it's a little easier for me to stabilize her arm. 8:15 But let's say I'm gonna go after this little stripe here. 8:18 I'm gonna do the same sort of thing. I could actually use 8:22 the rounded edge here to kind of 8:25 you guys can see it kind of 8:27 fits perfectly 8:28 Right around her forearm that works out 8:31 pretty good. I'm just going to do some down strokes and I 8:34 kind of have a angle coming this way, and then maybe I want to 8:37 get an angle going that way and then maybe I'll go up in 8:40 a couple different directions. 8:43 Angled angled and then maybe pure up. 8:47 Pure down and with all 8:50 this scraping, you know, and forgive me for not mentioning it right 8:53 off of the beginning of the video. I'm at about a 30 degree 8:56 angle and I'm just pushing into the tissue enough to feel 8:59 some feedback from the muscle. So I'm 9:02 not trying to push through the muscle the muscles actually not my target the 9:05 fascia at the top of the muscle and 9:08 the fossil layers above the muscle is my target. So once 9:11 I get down to the muscle, I know I'm there and then I just 9:14 pull through. 9:16 Alright, so 30 degrees only enough 9:19 pressure to give some. 9:21 Some feedback from the muscle some push back from the muscle and 9:24 then there you guys have it. That's all the therapy we 9:27 need for one little area now a couple other things 9:30 we can do we can go after trigger points and we can do some pin and stretch now 9:33 trigger points in the arm are actually fairly rare 9:36 to get an active trigger point like the biceps are 9:39 brachialis or triceps, or maybe the 9:42 only trigger point that is actually really common. 9:45 is the 9:47 Extensor, Mass. 9:49 So 9:50 what I would do was trigger points is I tend to 9:53 go and try to disrupt fibers in all directions 9:56 around the trigger point now trigger points 9:59 are nothing more than dysfunctional motor end plates. 10:02 I don't know if I'm actually getting desensitization with this or 10:05 if I happen to be getting a disruption of scar 10:08 tissue and collagen that's been 10:11 laid down due to the dysfunction of that end plate. But either 10:14 way what I found an outcomes 10:17 and she has a trigger point right about there. 10:20 So I'm just going to go around in a circle with the edge of this shark fin 10:23 tool and I got a nice little Edge there. 10:28 What I get an outcomes. 10:30 Is better carryover? 10:32 You get less sensitivity in the next session. 10:36 trigger points tend to come back less viciously 10:40 We all know that like we do a treatment and we get really 10:43 great results by the end if we've done a good job, and then 10:46 they come in the next session and they take a little step back compared to the end of 10:49 their last treatment with stuff like this. I find that my carry over 10:52 is a little better I get less of a step back. 10:55 And so I'll go after the trigger point there. 11:04 So that's good stuff and guys, I'm not overly concerned about 11:07 how I'm holding this tool. 11:09 Hold it how you're comfortable. Try to get your 30 degree 11:12 angle. Make sure you're getting enough pressure to kind of Glide along and 11:15 experiment with different hand positions if you want to use two hands like 11:18 this. 11:19 Fine fine if you want to use one hand and 11:22 a different Edge fine. I suggest you use 11:25 every tool in your toolbox. 11:29 Until you find the technique that works best for maybe you guys 11:32 want to use the edge here. 11:35 Kind of scrape around that way. 11:38 Just make sure that whatever you're doing you're trying to 11:41 make it as comfortable for you and your patient and you're reassessing after 11:44 you're done to make sure that this was effective. 11:48 Now the last technique I'm going to show you guys and Smart 11:51 Tools does do a wonderful job of teaching this techniques as 11:54 like pin and stretch with iastm. Just a great idea. 11:57 When you think about how these fossil layers move over 12:00 one another and how they have to be able to like 12:03 The Superficial fossilator has to be able to stay while 12:06 the muscle fibers move all over the place. 12:09 These these pin and stretch techniques like pin the fascia and 12:12 then make all the fibers underneath it move around. So let's 12:15 say we go back up to here. 12:17 What I would do is I would okay 30 12:20 degree angle get down to the muscle and I'm 12:23 gonna pin this isn't gonna feel good. 12:27 And I'm gonna passively pull her through not that bad though. Okay. 12:30 So as I mentioned before it 12:33 does help to know a little anatomy in this case the that 12:36 the brachial fashion in this case is an extension of the axillary 12:39 and pectoral fascia. And even the Cloudy factorial fascia. 12:43 right 12:44 So if I take her through kind of a chest stretch, I'll get 12:47 some stretch over. 12:48 Over the brachial fascia. Now if I 12:51 want to take this up a knots. What I can have her do is have her 12:54 reach up that way right in the direction of my 12:57 fingers and I'm gonna have you now go back towards the 13:00 table in that direction, right and I'm pinning so this is active and 13:03 I can add overpressure. Oh, yeah. 13:06 And then if I wanted to get really intense I 13:09 can pin and you're not 13:12 going harder with the tool guys. It's I saw that 13:15 cringe there. She's no no, we're not gonna go harder with the tool 13:18 but we can do is have her go active with my overpressure as 13:21 I pull the tool through. 13:24 The fossil layer. So now I'm like opposing I'm 13:27 using opposing force with this tool as opposed to 13:30 the direction. She's moving. 13:32 Now again, be careful how much therapy you give 13:35 in one session. We don't want to add pain to 13:38 painful conditions, right? You can Brew somebody and like 13:41 if I was treating her for either shoulder or elbow or wrist dysfunction, 13:44 which is where I would use some of these techniques 13:47 then the last thing I want to do is do a 13:50 great job improving her impairments, but 13:53 then add a painful stimulus which 13:56 is a bruise that she's gonna have to get over in the 13:59 next week. We know kind of that centralization of pain and 14:02 how pain works that's not going to help our outcomes 14:05 any to add another 14:07 A fairly more afferentation that is 14:10 not positive, right? So 14:15 You guys be careful, you don't have to do all of these techniques all on 14:18 the same bout. You could try just the scanning 14:21 strokes and disrupting any abnormal fiber 14:24 and then coming back and doing that plus 14:27 pin and stretch you could try doing. 14:31 The scanning strokes and just doing pin and stretch 14:34 you could try combining any two of them 14:37 in the next session and it might be a couple sessions before you feel comfortable with 14:40 the patient and the outcomes that you're getting that you 14:43 want to do. All three of the things I showed you which was the disruption of 14:46 abnormal areas trigger points 14:49 and pin and stretch in the same 14:52 session. That's actually a fair amount of therapeutic intervention. Stay tuned 14:55 for your close-up recap. All right guys, so we're gonna start with 14:58 a little lotion here on our forearm fascia, 15:01 specifically The Forum fall show 15:04 over the extensor Mass here. 15:07 Say I'm working on some lateral epicondylitis. We 15:10 know that the extensor Mass 15:13 has a tendency to get overactive. So maybe this fascia has a propensity 15:16 to become dysfunctional. 15:19 All right with some binding and maybe even some adaptive shortening via 15:22 the Davies principle. 15:25 So let me get this lotion on the skin make sure that we get the skin 15:28 well lubricated because we don't want to abrade the skin 15:31 and now I'm just going to use my scanning Strokes. I'll 15:34 use my scanning tool here. 15:38 About 20 to 45 degrees go right up to the 15:41 the muscle. 15:43 So just as soon as the muscle or tendon gives 15:46 me kick back here. 15:48 And we're going to run along. 15:52 The entire fossil sheath fact, I could go all the 15:55 way up the arm if I wanted to and I noticed there was a little bit 15:58 of bumpiness here a little bit of bumpiness here. 16:03 Same thing bumpiness here bumpiness here. 16:09 Starting to see a trend lumpiness here bumpiness 16:12 here, right? So we got this kind of area in here 16:15 this area and through here that maybe 16:18 deserves a little extra attention, right? This is maybe 16:21 where I'm gonna focus on my 16:23 my multi-directional Strokes to try 16:26 to free up those fossil layers 16:28 So I'm going to go ahead and use this battering 16:31 piece because I like how this matches 16:34 the curvature of the 16:37 forearm real. Well now what I'm going to try to do is I'm going to try to go 16:40 in this direction. 16:41 This direction this direction. 16:45 And then I'm going to go the other direction, right? So I'm going to go this way this way 16:48 and this way. 16:52 Just getting as many directions as I possibly can. 16:56 Probably three to five Strokes in each Direction. 17:03 this is a double beveled tool which means the 17:06 the tools shave down from both sides. So it's you 17:09 can flip it over and get the exact same feel. 17:18 All right, so that was about 20 strokes and you can see that that caused 17:21 some redness that's about all I would do there. 17:24 We could go down to the wrist. We saw a little 17:27 bit here. 17:28 All right. Don't push too hard. We're not trying to push through 17:31 the tendons. 17:33 Just up to the tendons. We 17:36 want to get all the superficial. 17:38 fossil layers 17:46 All right. So now I've done my two areas where 17:49 I thought maybe there was some difference in 17:52 tissue texture, right? I did all my 17:55 different angled Strokes hopefully adding some 17:58 Mobility between those fossil layers now, maybe I can 18:01 use my 18:03 Shark ventil, you know, maybe I won't use my shirt fin 18:06 tool. Maybe I'll use this tool to come after the trigger 18:09 point that I had found earlier. 18:15 And the extensor mask, we 18:18 know this is a very common point for trigger points. 18:22 And I'm just going in a lot of different directions. 18:25 This is not a double double tool. So we kind of have to be careful here. 18:29 when we switch 18:31 directions notice I switch sides of the tool to the 18:34 double bevel so I could 18:36 use my same hand. 18:40 Not as coordinated with my left hand with these tools. I got to 18:43 admit. I keep trying to get better. 18:47 All right now once I've done that. 18:51 We know last but not least we might want to do some pin and 18:54 stretch technique and I didn't get to show this on the the further 18:57 outshot. So the way 19:00 this works for the wrist is I'm going to start in 19:03 wrist extension and just a little bit of elbow flexion. I'm 19:06 gonna pin down and then I'm gonna pull down into 19:09 extension. 19:12 and wrist flexion 19:14 As I go down. 19:16 Let's try that one more time. 19:17 All right. 19:24 the hard part is to like 19:26 follow what you're doing. 19:28 With the tool now, I could ask a vet 19:31 to do this more actively. All right, so assist me no. 19:34 And then I could add over pressure at the end. 19:37 That would be a little bit more intense. And of course 19:40 the most intense would be pin. We're going active me 19:43 adding over pressure and pulling through and there's 19:46 definitely has some stuff up in here. 19:49 One more time down. 19:52 And pull through all right, and that's it 19:55 guys, that would be more than enough treatment for a 19:58 vet. That's actually quite a bit. We did some 20 20:01 Strokes for a trigger point. We did all the different multi-directional strokes 20:04 here all the different multidirectional strokes here and two to 20:07 five of those pin and stretch techniques. I think one of the mistakes I 20:10 see most often with these istm treatments is 20:13 people go overboard. 20:16 They do like 10 15 minutes on one area. It really 20:20 shouldn't take you more than a minute two minutes on any 20:23 one area. 20:24 And then it's probably time to do another technique. 20:27 This is definitely one of those times where more is not necessarily 20:30 better if you didn't get the objective that you were 20:33 looking for. 20:34 Right. Let's say you did your assessment this intervention and then reassessment. 20:39 And you got no results. Maybe this isn't the right technique maybe the 20:42 idea is not to just go more intense and see if 20:45 you get an objective. That way you might be able to try that and increase 20:48 the intensity a little bit but I would not take that path of 20:51 logic too far. You're probably more likely to do more damage 20:54 create bruising. And of course if we get bruising 20:57 we could add another painful efferent to 21:00 this already dysfunctional system, and we definitely don't 21:03 want that. So if you guys have any questions, I 21:06 hope you enjoyed the video. Please feel free to leave in the 21:09 comments box below. So there you have it instrument assisted soft 21:12 tissue mobilization, make sure to assess 21:15 address using the intervention and then 21:18 of course reassess and if you get the 21:21 chance these videos are not a replacement 21:24 for live education. Of course, 21:27 if you get the chance, you should take live workshops or 21:30 find a mentor who's experienced using these 21:33 tools or maybe a friend that wants to 21:36 learn them too. So at least you can practice on each other and give 21:39 each other some tactile feedback of what you feel how 21:42 you felt the next day what results you felt 21:45 that you got. 21:47 I hope you guys enjoyed this video. Please. Feel free to leave your questions below.
