Name: Cervical Fascia IASTM
Uploaded: 2023-04-23T07:03:38.000Z
Duration: 18 min 31 s
Description: Learn evidence-based IASTM techniques (a.k.a. Gua Sha, Graston, Muscle Scraping, etc.) for the Cervical Fascia in this expert-led instructional video. Reduce pain, address soft tissue restriction, increase mobility, and improve performance with this targeted soft tissue mobilization technique.

English captions

https://stream.mux.com/G5o267kSK2urnFWaGZ4vKS0027cz9DJRvBJPdjoAXUT4.m3u8

Learn evidence-based IASTM techniques (a.k.a. Gua Sha, Graston, Muscle Scraping, etc.) for the Cervical Fascia in this expert-led instructional video. Reduce pain, address soft tissue restriction, increase mobility, and improve performance with this targeted soft tissue mobilization technique.

Introduction to Instrument Assisted Soft Tissue Mobilization

Cervical Fascia Techniques with IASTM

Scanning and Assessing the Cervical Region

Disrupting Fascial Boundaries and Addressing Trigger Points

Pin and Stretch Techniques for Enhanced Mobility

Therapeutic Patterns and Client Progression

Conclusion and Best Practices for IASTM

Cervical Fascia IASTM

This is Brenda The brookbush Institute in this video. We're going over manual therapy techniques specifically instrument assisted soft tissue mobilization. Now, if you're watching this video, I'm assuming that you are a licensed Medical Professional with instrument assisted soft tissue mobilization within your scope of practice. Now, there's some gray area here not every state has legislation around these tools. If you're not sure check, I would hate to see somebody getting in trouble because they watch one of our videos and used it on a patient or client when things did not fall within their scope of practice act. Now these tools just like all of our other techniques fall within a model of practice and we are very big on assess a dress reassess. So even though these tools are specific to perhaps fossil tissue. We're still going to base their use on reliable assessments. We're going to use these techniques and then we're going to reassess and if they're not effective we're not going to use them again for That particular patient or problem in this video. We're going to go over cervical fascia and cervical thoracic Junction. Fascia with instrument assisted soft tissue mobilization. I'm going to have my friend a vet come out. She's going to help me demonstrate. Now. The easiest position to do this technique with is actually sitting with them facing away from you. Make sure if you're doing this technique on a female that they are aware that you need to have access to all of this skin. So they might want to wear a sports bra something where they can move the straps around pretty easy or you're gonna need to find some like shirts in your clinic that you can cut the neck out of obviously the stuff doesn't work over clothes. So I'm gonna go ahead and have that move this strap over her shoulder. Perfect. That's all we need. We're gonna do all this area here. So this is our cervical thoracic Junction and then we're doing all of this cervical fascia now, We're going to add just a little bit of this cream because we don't want to. We don't want to just exfoliate the skin or irritate the heck out of the skin. We actually want to be able to apply some Force. To the fascia underneath the skin which means I need to protect the skin with a little lubricant. once I get this rubbed in the other thing you might want to have handy is hair ties, right because we got to get the hair out of the way. Otherwise, they will get this lotion or whatever cream or oil you happen to use. We use Smart Tools cream here. Happen to like the smart tool set a lot and I like the Smart Tools cream. So that's what we use but you could use other stuff. Most of the stuff is pretty simple lotion or Vitamin E oil. So it's not going to do any harm to somebody's hair. Now first step is always to go through our scanning Strokes. Now as I've mentioned in the past we think of these iastm techniques as superficial fascial techniques, which means I'm gonna treat this whole area Like one piece this to me is just cervical thoughts. I'm not really thinking about lat or I'm sorry trap or levator scapula or scalines at this point just investing cervical fascia. So I'm going to start here. I'm going to have her stretch out this Foster just a little bit for me by tilting your head away. Maybe a little bit of flexion and then I'm going to go ahead and Stroke down this way. And what I noticed is everything was pretty smooth until I got to this point right here. And then we'll go here. And again right in here. And then I'm going to come through here. And again, I feel just a little bumpiness as I kind of went over the superior angle of the scapula there. I kind of felt a little bumpiness in the in the fossil tissue too. And then some of you guys probably already have seen the thoracic fascia and for spinatus fashion deltoid video so I can come straight across here the same way I did in that video. You can kind of see how those two videos blend together really. Well a lot of people will need this kind of whole area done if they have that combination of cervical and upper body dysfunction. Now once I've done my scan you guys might be able to see from some previous takes I did find some bumpiness in here some bumpiness in here and some bumpiness in here from those previous takes we have a little bit of redness already. The first thing I'm probably going to go after is think about disrupting those areas a little bit. So I think of those fossil sheaths and the fact that if we have any sort of tissue injury and that could be very Subacute very subclinical tissue injury that just causes enough of an inflammatory process that we got some binding of those collagen are binding of those fossil layers via some additional collagen being laid down we want to break that up. The way we're going to do that is I'm actually going to switch from this fairly sharp scanning tool to tool tools here. I'm going to use the shark fin tool and I'm going to use this little battering tool comes pretty handy. I'm going to start down here. We'll go low to high this time and I'm just gonna try to do strokes and a bunch of different directions now since this is the neck and the neck gets flared up pretty quick. I see Pete I pretty quick. I'm probably only gonna do two to three two to four strokes in each Direction because I want to make sure I can go on a lot of directions. Right. So you guys just let me go this direction this direction this direction. Maybe I go up a little bit I come and do this thing where I'm pinning one side and just kind of going around a little bit go sideways. Come down this way and then this way a little bit. All right. And again 15 to 20 Strokes is probably good for one area. She's already pretty red in that area. If I see petechia, I know I've done enough because after Pete I becomes bruising. I don't think Pete I have anything to do with the therapeutic effect. Personally. I haven't seen any evidence to make me think that petitiki I are healthy. but Again, petechia themselves is a good little indicator that you know, if we do this much further, we could create a little painful stimulus ourselves just by creating some bruising. Now the next thing I felt it was in here, maybe since we're so close to the neck and I have less space. I'll go to the smaller tool again. Let's get as many directions as I can. This way this way this way. All right. Break that all down and then of course I could do the same thing on the neck. Of course. If we get into here in these smaller areas, it definitely gets a little harder to get in there. Right, so I'm using this end of the tool. Just taking it easy. You know, I have the tool set at like 30 degrees here. I'm really only pushing hard enough that I'm just feeling the layers of tissue underneath the skin. right So there's no need to like. More and create a bunch of redness like that's not the goal. Alright now that I've gone through and I've broken up The Binding of those collagen fibers. Between layers of fascia that I felt didn't feel the way the other fascia felt maybe the next thing I could go after is trigger points. Now trigger points. I found it helpful to just literally almost do like a cross friction. shearing Force in all directions So we'll go like this. all the way around Now this could be desensitization. This could be breaking up more. of that disorderly collagen Matrix that's being laid down from a dysfunctional motor end plate and acetylcholine and other cytokines and inflammatory chemicals kind of launching that inflammatory process but what I found from an outcomes perspective is that when I do this, I get a little bit better carryover. So I get less sensitivity from session to session in those trigger points trigger points have a tendency to come back less, right or at least with less strength. We know we always take a little step back between sessions but I find that that step back is a little less when I do it this way the last thing we want to do. And this is obviously the most intense technique is that the pin and stretch with these tools? The reason I do them despite their intensity is because think of how wonderfully functional that is, right. So if we want to get Mobility back the idea of pinning some of this dysfunctional tissue and then making sure that we pull other layers of fossil and muscle through that tissue. Is probably exactly what we're trying to get at with some of these foshly intended techniques. So here I'm kind of going over the fascia that is connected to my levator scapulae a good way to stretch out my levator scapula and that fascia would then be to stretch the elevator scapulae I can just pin this way and then if I remember my anatomy, I would go into flexion lateral flexion and contralateral rotation to stretch. Cool, and you can feel it under the tool as that that tissue gets pulled underneath the tool. So just passive with the tool pinned statically would be the first step. The next thing I could do is ask a vet to do that actively. Okay, so now chin down Good and look over this way and then I could add a little overpressure. Right? So now we got active but this stays static with overpressure. and then the most intense technique would be as she's going active and I add overpressure. I'm also pulling the tool through the tissue. Right and that gets real intense and you can see she reddened up a lot be careful with these techniques two to five strokes and anyone spot with those pin and stretch is plenty don't think that you have to do 10 15 20 repetitions likely normally would with an exercise. A little bit of this goes a long way. Just what I did here the 15 to 20 Strokes over each spot in different directions, the trigger points stuff and the two to five. Pin and stretch Strokes. That's a lot of therapy. I'm not exactly I'm not suggesting that you necessarily do all of this techniques on the first session with a patient. So you might start with your scanning strokes and then just trying to break up. Any adhesive or abnormal feeling area and then just see how the the patient comes back to you the next time did that help if they felt really good good. Now maybe go ahead and add the trigger point stuff in and then maybe the third session you could add the pin and stretch or maybe the second session you did the breakup and the pin and stretch and in the third session you add the trigger point stuff. Just kind of keep track in your notes on how they're responding to each one of these techniques and of course be reassessing to make sure that We are having the intended outcome and this is having an effect on your objective measures for example, something like what cervical lateral flexion goniometry. All right. So there you guys have it stay tuned for the close-up recap. I'll show you the petechiae that we created on this side and I'll go ahead and treat this side of the neck and that close-up. All right guys, so for the close-up recap I'm gonna grab a little of our Smart Tools cream here. Throw a little lotion and get the skin nice and lubricated so we can get to those deeper layers without a braiding the skin. Maybe I used a little bit too much lotion. I tend to use a little too much lotion. Maybe more often than not I guess it's better too much than too little you guys will see if you use too little lotion. It like feels like a a rug burn real fast All right, so we'll get that all. All in there. All right good stuff. All right. Now we're gonna start with our scanning strokes. But before I do that, I want to lengthen out this cervical fascia. And I'm going to go ahead. and just gently take The Tool 30 degree angle push it into where I feel muscle kick back. And then just do nice little. Organized Strokes so that as I'm going through each. Little strip of skin I can take note on where I felt dysfunction and I feel a little bit up in here. a little bit right here You know, if you felt nothing at all going through all of this, you could probably try to go a little deeper. But generally speaking you don't have to go. That deep you don't have to go that hard with these tools. I felt a little bit in here. So we got a little bit here a little bit here a little bit here. And then we can come through this thoracic wash this way. We can even bring in some of that infraspinatus. Fascia if you saw Those videos now once I've found the spots that I want to go back to to do a little bit of treatment on. Think of those those binding of those tissue. Maybe I'll start up here. at the top of the neck and I'm just going to in this way. I'm gonna almost treat this one like a treated the trigger point in the previous one because I have such a small surface area to go after it's going to be hard for me to get various directions. Maybe I can get a little bit. this way But I'm probably just as well grabbing the tip of this shark fin tool. and trying to Break things up. That way. Remember I'm gonna go on multiple directions. Because fascia the collagen fibers don't necessarily match. the muscles underneath them All right, you guys can see. I got a little bit of batikia. I right there. And so then I went this area was next. So I can go in this direction right towards her neck and then maybe I go to diagonal towards the front of her neck. diagonal towards the back of her neck I can go maybe across. this way and back just breaking up as much as I possibly can. And as many directions as I can. I don't know if you can see if you'd scoot lean back just a little bit. There you go. You guys can see I developed a little bit of petechiae. Once again, I don't think there's anything therapeutic about the petite guy, but I do think it's a good indication that maybe we should stop and you can see I only did about 15 Strokes there. We get past batikia. We start getting bruising. All right. So the next spot we're gonna do let me have you lean forward just a little bit of that. There you go. Is this spot here which we felt a little disruption and now I'm just using this. Con cave side and I'm just doing my little. Sweeping Strokes. I guess you call them. You know, I do think way too much tension is paid to the name of strokes and the fanciness of Strokes. You're really just trying to get a 20 to 45 degree angle and pull tissue across other tissue. You're trying to create shearing forces. So as long as you're going in multiple directions, I think We're going to be as congruent with what the research is indicating as we can at this point. Now the next thing I might want to do is go after trigger points, and now it's funny because the common trigger points sites. We already went after that's where we felt the most abrasive or the most abnormal tissue anyway, so I'm not going to go back over this but you guys can imagine I just use the end of this shark fin tool and go around in a circle like so alright really trying to break up that tissue. As much as I can sometimes I get a petechia eye sometimes I don't but it definitely helps with that carryover and then last this pin and stretch techniques. We actually could use this tool right and go just like so get that 30 degree angle and then pull through but we also kind of use some of the other tools like we used this tool fit the the Trap Mound. We'll call it fit the Trap Mound real good. So maybe I come down over like this and then we kind of had some different levels of intensity. We had pin and passive pull through we had pin and active pull through with over pressure. And then we had pin opposing pull through with the tool. And active pull through with overpressure, right? Let's do that one more time just like so and then I go this way. And you only need two to five Strokes like that. It's a very intense technique guys. I hope you enjoyed this video. If you have any questions, please leave them in the comments box below. So there you have it instrument assisted soft tissue mobilization, make sure to assess. Address using the intervention and then of course reassess and if you get the chance these videos are not a replacement for live education. Of course, if you get the chance, you should take live workshops or find a mentor who's experienced using these tools or maybe a friend that wants to learn them too. So at least you can practice on each other and give each other some tactile feedback of what you feel how you felt the next day what results you felt that you got. I hope you guys enjoyed this video. Please. Feel free to leave your questions below.

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Cervical Fascia Iastm

 Pressure should be sufficient to feel resistance from the target tissue; that is, pressure should be applied to the "first resistance barrier".

 It may be beneficial to increase tissue tension by lengthening the target tissue. Pressing a tool into tissue that is in a passively shortened position can result in a lack of tissue resistance, which will result in little if any shear force to the target tissue.

 The tool angle to the skin should be approximately 30° - 45°.

 Start with long, slow strokes over the full length of the target tissue to note irregularities in tissue consistency.

 Treatment strokes should be shorter, performed at a moderate tempo, in multiple directions, and over tissue assessed as irregular. The goal is to disrupt connective tissue that may be impeding optimal extensibility.

 10 - 30 strokes per region is likely sufficient, with the total dose dependent on the size of the area and the individual's tissue tolerance. Note, that scanning strokes should be included in total strokes.

 Perform 2-5 strokes in each direction. It can be helpful to visualize a clock or compass face and perform strokes in line with each number or direction (e.g. N, NW, W, SW, S, SE, E, NE).

 The development of petechiae or excessive redness is an indication to stop treatment in that area. Initially, this dosage may feel inadequate; however, petechiae and redness are often signs that bruising and significant soreness may follow (Note, bruising may take 24 - 72 hours to become visible). Although Traditional Chinese Medicine (TCM) and the practice of "Gua Sha" considered petechiae the goal of treatment, IASTM as taught by the Brookbush Institute, is performed with the intent to increase mobility and potentially decrease tissue sensitivity. Patechaie and some bruising are not abnormal, but it is likely an indicator that either pressure or dose (total strokes) should be reduced if IASTM is performed in subsequent sessions.

 Addressing active and latent trigger points with IASTM, which are often areas of assessed irregularity in tissue consistency, may improve carry-over from session to session. That is, the addition of IASTM to an integrated treatment plan may aid in maintaining the reduction in trigger point over-activity and sensitivity that results from a session.

Advanced Technique - IASTM with Pin and Stretch:

 This technique is "more aggressive" and should likely be used in small doses to address "stubborn" mobility issues, with patients/clients who have already exhibited good tolerance to IASTM techniques (tissue tolerance and pain tolerance). Following the identification of an area of altered tissue consistency, the IASTM tool is used to "pin" the tissue in the opposite direction of lengthening (generally, pressure has a distal to proximal vector). This technique may be progressed in intensity with the following additions:

Static IASTM tool with passive lengthening (manual lengthening by the practitioner)

Dynamic IASTM tool (strokes in the opposing direction) with passive lengthening

Static IASTM tool with active or active-assisted lengthening (lengthening by the client or patient)

Dynamic IASTM tool with active or active-assisted lengthening

Static IASTM tool with active-assisted lengthening and over-pressure (client/patient and practitioner force)

Dynamic IASTM tool with active-assisted lengthening and over-pressure

 As with all techniques, IASTM should only be recommended when indicated by a reliable objective assessment (e.g. goniometry), and continued use should be based on a significant improvement on that assessment (> 5° improvement in ROM). Note, "feelings are not facts".

Superficial cervical and cervicothoracic:

 The superficial layers of the fascia of the cervical spine and thoracic spine create a fascial sheath that has similarities to the thoracolumbar fascia, with continuity into the infraspinatus fascia (superficial layer of fascia over the scapula) and deltoid fascia. Note, the pectoral fascia invests into the periosteum of the clavicle with continuity to the deep cervical fascia enveloping the sternocleidomastoid. The superficial fascia of the anterior cervical spine invests in the platysma and is continuous with the subcutaneous tissue over the clavicle and chest.

 Increased tension in the posterior cervical fascia can be achieved via cervical and thoracic spine flexion, cervical rotation, and cervical contralateral flexion. Increased tension in the anterior cervical fascia can be achieved via cervical and thoracic spine extension, cervical rotation, and cervical contralateral flexion.

IASTM cannot be done over the clothing. It is advised that the client/patient is instructed to wear clothing that allows access to the cervical spine, thoracic spine, and shoulder region on the affected side (e.g. a tank top, sports bra with an open back, etc.). Although it is never our intent to make a client uncomfortable, we also do not want embarrassment to impede great therapy. Often authentic communication, a little empathy, and some planning can reduce or eliminate potentially embarrassing moments.

It may be possible to address assessed areas of tissue inconsistency with the client/patient on a table in a prone position. However, most often the best position for access to the entire cervical region and control of tissue tension is with the client/patient in a seated position, facing away from the practitioner.

 The brachial plexus may be stretched/stressed if excessive posterior-to-anterior pressure is used near the transverse processes of the cervical spine, or if excessive superior-to-inferior pressure is used on the cranial or anterior aspects of the upper trapezius.

 are on the posterior aspect of the superior portion of the middle of the muscle and assessed with superior-to-inferior and slight posterior-to-anterior force.

 are at the insertion, near the superior angle of the scapula, and the center of the muscle belly at approximately the level of C5 and C6.

 The most common trigger point for the splenius cervicis is approximately in line with C7, and the most common trigger point for splenius capitis is approximately in line with C2.

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