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 assisted 0:16 soft tissue mobilization within your scope 0:19 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 That particular patient or problem in this 1:07 video. We're going to go over posterior curl fascia and achilles tendon 1:10 instrument assisted soft tissue mobilization using 1:13 our Smart Tools. I'm going to have my friend Sonya come 1:16 out. She's gonna help me demonstrate. Now. The first thing odd you might have 1:19 heard me say in this video is posterior curl fascia 1:22 and not gastroc and Soleus instrument 1:25 assisted soft tissue mobilization, and that's because at 1:28 the brookbush Institute the research that we have seen really points 1:31 to this stuff being superficial 1:34 fossil structure 1:37 techniques and not deep muscular 1:40 techniques. What we're trying to do is perhaps 1:43 help Mobility, right and address 1:46 some of the dysfunction of these superficial layers not 1:49 try to address for example 1:52 hypertonicity inside of a muscle 1:55 itself. So with that being said, I'm 1:58 gonna go after the posterior curl fascia and 2:01 maybe these superficial connective tissue structures like 2:04 the 2:04 eastenden 2:06 With the idea that I'm gonna address mobility in 2:09 this case, you might think Mobility would 2:12 be can we get more dorsiflexion out 2:15 of Sonya or maybe if she wasn't getting 2:18 full knee extension. Could we get a little bit more knee extension 2:21 out of Sonya these would be great things for us to test 2:24 right and we could use an objective 2:27 measure like goingiometry to make sure 2:30 that this technique is actually giving us some 2:33 sort of measurable result now all 2:36 instrument assisted soft tissue mobilization starts with using a 2:39 little bit of cream. 2:41 You just want to use something. 2:44 To help reduce the friction with the skin 2:47 because what we want to do is address the fossil 2:50 structures, and we're going to have to use a little bit of pressure. 2:53 And with that pressure, we don't want to 2:56 irritate injure or just try to straight exfoliate 2:59 Sonia's calf here, right? We want 3:02 to actually get some good therapeutic effects before 3:05 irritating the skin now, 3:08 you'll see I'll go ahead and rub in this this kind 3:11 of lotiony Smart Tools cream here. 3:16 And while I'm doing that I might actually pay attention and see if I feel any 3:19 changes and tissue texture. If I feel any 3:22 changes in tissue tension, like the fascial tension, just 3:25 keeping mental notes for when I actually go through and 3:28 do this technique. 3:30 Now you'll notice that I have my thigh against Sonia's foot. 3:33 This is so I can control dorsiflexion and the amount of 3:36 tension. 3:37 in our posterior Coral fascia 3:40 Now the first thing you're going to do is we want to scan we want to assess the 3:43 tissues and what you're going to use is a fairly broad tool 3:46 for this, right? So we want to Broad tool 3:49 that's going to help us cover. A lot of area thinner smaller 3:52 tools like this to work a little 3:55 bit better for scanning than perhaps say 3:58 something like this. Although this is great to 4:01 do their therapy with right or 4:04 the the iastm with it's not 4:07 as easy to feel with that tool. So maybe we start here and 4:10 I'm just going to take the tool and go 4:13 all the way through. 4:16 all of this cruel fascia 4:20 all right, and what I'm trying to take note of 4:25 is any tissue abnormalities and what it feels like with this 4:28 tool is bumpiness, right? So I felt some bumpiness in here. 4:31 I felt some bumpiness in here and I 4:34 felt some bumpiness down here. 4:36 All right. So what's the next step now? We want to address this 4:39 stuff. 4:41 and what we're probably going to think about most we could 4:44 get into a fairly long conversation about how 4:47 fascia a data 4:50 not adapts but responds to dysfunction, we could 4:53 start talking about the schleet model and some 4:56 other adaptations that maybe happening in 4:59 response to manual therapy with fascia, but I 5:02 think the one the one hypothesized adaptation 5:06 that makes 5:08 Probably the most sense for our fossil techniques is this idea 5:11 that part of this dysfunction that 5:14 happens between fascia is the binding? 5:17 Of fascial layers by disorganized 5:20 connective 5:23 tissue in response to the inflammatory process and 5:26 perhaps maybe initially some 5:29 tissue damage. So we have a little bit of tissue damage that stimulates 5:32 the inflammatory response. We get hypercapitalization. 5:35 We get disorganized collagen Matrix 5:38 and then these fossil layers get bound down. 5:42 Now an important thing to consider is that fascia 5:45 doesn't align itself like this your posterior curl. 5:48 Fascia is not this way. Although we tend to think 5:51 about things this way when we look at the back of the leg because of the 5:54 calf and the Achilles tendon, the cruel fascia is 5:57 actually cross-hatched like this. 5:59 And that collagen Matrix that is getting 6:02 laid down is in every different direction. 6:05 So I want to go through some Strokes in a 6:08 lot of different directions that are going to maybe disrupt 6:11 that. 6:12 Right and maybe follow it up with a 6:15 little of active instrument assisted soft 6:18 tissue mobilization to try to get better 6:21 Mobility between those sheaths. So 6:24 here's what I like to do. Number one. I probably 6:27 won't use the scanner. I'll probably use something with rather 6:30 than a single bevel which 6:33 is pretty sharp. Go to something with a double bevel 6:36 which means it's shave from both sides just to reduce 6:39 the intensity a little bit. Now. What I tend to do 6:42 is try to go in every direction. So 6:45 this way this way this way this 6:48 way this way and this way so that's 6:51 about six different directions. I'm going and the way I do it is 6:54 actually pretty simple. I usually hold one side. 6:57 And then just kind of do a little quarter turn like that. 7:00 So that's that direction. Give me a couple this way. I'll go 7:03 a couple this way. 7:05 Turn it around couple this way couple this 7:08 way. I'll either go some long strokes this 7:11 way. 7:12 Or I can do some scooping short Strokes if you guys want 7:15 to do that. 7:17 Same thing and the other direction right and that's about it. 7:20 Now maybe I do two to four strokes in every 7:23 area. So we're talking what a maximum of 15 to 7:26 30 Strokes per area. It doesn't take a lot 7:29 of intervention using these techniques. 7:32 Let's go down to this area. Same thing I can 7:35 go here. 7:36 here 7:38 here 7:39 here here. 7:42 And here all right, and hopefully 7:45 that's broken up the collagen Matrix there. You don't have 7:48 to use this tool either. So if you don't like that tool. 7:52 You know just kind of keep in mind double bubbles are going to be less than tense 7:55 then. 7:56 Single bevel tools if you have a concave surface, 8:00 there's going to be more. 8:04 area against the skin which is going to decrease pressure 8:07 as opposed to a convex surface, which is 8:10 more pressure per square inch right so we can 8:14 use this tool if we want. 8:16 This shark shark tooth shark 8:19 fin. Whatever you guys want to Tool from 8:22 Smart Tools is actually like a really versatile tool because it kind of has all 8:25 the different edges. 8:27 All right, so I can come through here. 8:30 You know if I was doing the whole calf and especially if 8:33 somebody bigger, you know, maybe I want to use this bigger tool to get 8:36 a lot more area. I can do all the same stuff. 8:39 right 8:43 Just make sure you keep. 8:46 The Edge going in the direction you want and 8:49 you guys might also notice that the angle I'm 8:52 keeping with these edges is about 20 to 60 degrees 8:55 the one mistake. I see a lot is this 8:58 Right, which is just kind of like scratching at the skin. 9:01 We want to create. 9:03 Sheer between layers, which means you're going to have to 9:06 create an angle this way. So we're kind of like pushing that 9:09 tissue along. 9:12 As we go so 20 to 60 degrees is probably 9:15 a good way to go. 9:17 now a couple other things I'll do when I'm back here on the posterior part 9:20 of the lower leg is 9:22 frame the Achilles tendon 9:24 so 9:26 Back off on the pressure here guys. Keely tendons are very tender. 9:30 But I'll just go through here note where. 9:33 Things are a little more bumpy. And again if I 9:36 notice bumpiness, maybe I go in a couple different directions. 9:43 Right a couple different directions here. 9:48 and 9:51 then again, you're just trying to find tools that fit the 9:54 surface that you're working with. So if you wanted 9:57 to work the Achilles tendon all the way down to the periosteum of 10:00 the calcaneus, you could grab this little hook 10:03 tool. 10:04 Right figure out which one of the circles fits 10:07 best. 10:10 And I could try to break things up. 10:12 this way 10:16 I think people get way too caught up on Strokes. 10:19 You know what the fanciest stroke they can use and 10:22 and this is the right tool for this. 10:25 It's actually not that complicated and with 10:28 a little bit of experience. I think you guys will quickly find 10:31 which tools you like best for which 10:34 areas I know for me this 10:37 tool comes in handy for the lower extremity. 10:40 Right this tool is obviously very handy for the heel and 10:43 then if I'm trying to minimize what 10:46 I'm packing because this has so many 10:49 surfaces the shark fin tool. 10:51 I generally carry this by just putting it in my 10:54 pocket and now I can I can travel to people's homes 10:57 or whatever. I happen to be doing that day. I don't necessarily have 11:00 to hold have the whole set with me. Now. The 11:03 last thing I want to show you guys which is kind of an important point to 11:06 add to this. I would probably finish up 11:09 with a little bit of iastm's version 11:12 of pin and stretch. 11:14 So what you're gonna do? 11:17 Is you're going to block out some of the tissue? 11:19 And then what I'm going to have Sonya do is go 11:22 ahead and dorsiflex for me. 11:25 That is pull her foot up towards her knee. 11:28 right, so that's that's our first level of 11:31 Relative intensity and I can kind of hook up 11:34 into here pull up all the tissue and 11:37 then again good hook up into 11:40 here pull up. 11:41 all that tissue good 11:44 If I want to get a little bit more intense, alright, I 11:47 can time this with Sonya. She's doing a really good job here for me, but 11:50 I can hook into the tissue have her pull 11:53 up and then I can keep going. 11:55 And then if I want to take it one more which you 11:58 guys saw me do there. I could not only hook it have her 12:01 pull up keep going pulling through the tissue I could 12:04 use some overpressure. 12:06 Right. So that's getting pretty intense. Maybe not something 12:09 I would do with somebody the first time. 12:11 But I think it's definitely an important component of 12:14 this once you've gone through the different layers. 12:19 Right, you've tried to break up all of that adhesive tissue. 12:24 Now we're gonna get a little bit more functional. 12:28 Last trick of the trade and this is 12:31 more of addressing muscular dysfunction. I 12:34 do find a small benefit in carryover 12:37 when I use instrument assisted 12:40 soft tissue mobilization. 12:42 to reinforce release of 12:45 trigger points 12:47 from the manual therapy. I did prior to 12:50 this and here's what I mean. So let's say Sonia has 12:53 a trigger point in her lateral gastroc. I've 12:56 already done my release techniques. I've already done my joint 12:59 mobilization. And now what I'm going to do is I'm going to 13:02 go back to that trigger point. 13:04 And I'm just going to kind of go in every direction. 13:08 ensuring 13:10 that any inflammatory response 13:13 any tissue damage any 13:16 acute 13:18 Point of adhesion around that 13:21 trigger point is broken up. 13:24 You can almost think of this like cross friction massage 13:27 if you guys learned that in PT school only with 13:30 the tool. 13:33 And and what I find is is using 13:36 that technique. 13:38 I actually get a little better carry over to my 13:41 next session trigger points don't seem to come back as much 13:44 and and you guys have heard me talk about carry over 13:47 before it's probably one of the most important and under addressed 13:50 things in all of Rehabilitation 13:53 the idea that things last 13:56 longer or there's last 13:59 less of a backward step in between 14:02 sessions, right? That's just so important 14:05 for advancing therapy faster and faster. 14:08 So again guys, you're gonna scan. 14:13 You're then going to disrupt. 14:17 Right any area that you think is potentially 14:20 bound down right? There's an abnormal tissue quality 14:23 there. 14:25 We could then go back and do the trigger point thing if we wanted to. 14:28 Right any trigger points we found and then 14:31 we did that more. 14:33 active 14:35 kind of pin and stretch technique, right and 14:38 we can do it passively we can have them pull up 14:41 their foot. We can have them pull up their foot and push through 14:44 the tissue we can have them pull up their foot foot pull through 14:47 the tissue and add over pressure all 14:50 as means of trying to improve 14:54 mobility and function of the 14:57 connective tissue structure 14:59 being our cruel fascia, and 15:02 we did a little framing of the Achilles tendon. 15:05 Stay put for your close-up recap. And for a 15:08 close-up recap. We're just gonna take a little bit of the Smart Tools cream. 15:11 All right, lay it down on the calf. 15:15 We're gonna go ahead and kind of work that into the 15:18 tissue. 15:20 I've used a little too much there. As I said, I know some people 15:23 get all bent out of shape about how much you use. 15:26 Just kind of work it in. 15:28 You got too much. You can put it on the other side. The stuff 15:31 is more or less lotion anyway. 15:35 most people are not going to complain about 15:38 Who accidentally? 15:39 Having to moisturize their other calf. 15:43 That's a rub it in. I'm kind of feeling through the 15:46 different tissues here a little bit seeing if I feel 15:49 any abnormal tension. She definitely has a little bit of 15:52 increased tissue density here 15:54 All right. So the first thing I'm going to do is scan through 15:57 the tissue. 15:59 And you guys notice I just press down to where I 16:02 get a little push back from the muscle. 16:04 I'm at about a 20 degree angle and then I just 16:07 pull through. 16:10 That's it. She's got a little bumpiness right here. 16:16 Maybe I come down next layer. She's got a little bumpiness right 16:19 here. 16:22 a little bit right there 16:24 I have some keeping mental note of this stuff. 16:27 Just got a little bumpiness up there. 16:31 and then 16:34 yeah a little bit there. Alright, so we see a lot of stuff around the Achilles 16:37 tendon and then some stuff up here and here now. 16:42 Ideally, I would just use the handlebar tool 16:45 because I can cover a lot of ground very quickly and I'm gonna start 16:48 off by going in a lot of different directions, right so we 16:51 want to break up that disorderly. 16:54 collagen 16:56 that might be binding down the various fossil layers. 17:03 And I can turn it around and go up this way. 17:06 And up this way. I can use some scooping Strokes up 17:09 this way. 17:12 Scooping Strokes back down this way. 17:15 And maybe I would have used a couple more Strokes there but more 17:18 or less that's that's a treatment for that area. Let's go 17:21 down here. Same thing two three four. 17:26 You know, maybe two to five Strokes in each Direction. 17:29 Doesn't take a ton. 17:35 Some scooping this way. 17:38 some scooping back down 17:42 All right. Now I'm gonna put this tool down be a 17:45 little tough on the Achilles tendon. The Achilles tendon is pretty tender. So 17:48 maybe I'm gonna go ahead and use this tool 17:51 and I can go ahead and 17:53 frame down my acute extending which just means going along 17:56 the borders. 18:02 Alright and then I'm gonna use those Strokes in different directions as I 18:05 find bumpy spots 18:08 come up this way. 18:11 You might see there on the camera guys. She's getting a little bit of red 18:14 that's pretty normal normal histamine response. 18:18 If she had a ton of petechiae, you know, I think that's probably a 18:21 good sign that you need to back off just a little bit. There's 18:24 nothing actually beneficial. 18:27 About those petechiae. It's probably more coincidental that 18:30 were breaking up hypercapitalization 18:33 where there happened to be an injury. 18:37 And then maybe the last couple of things I want to do is I felt the 18:40 trigger point over here that I had released earlier. So I'm 18:43 gonna go back over this trigger point. 18:45 disrupt any scar tissue or 18:49 additional adhesive tissue that's developed around that 18:52 trigger point. Like I said, I have found a little 18:55 bit of a benefit to for improved carryover. 19:04 And maybe the last thing I want to do. 19:10 Is go over the heel? 19:12 Remember that this is I'm gonna use these this hook tool. I'm 19:15 using the smaller Circle for 19:17 Sonya's tiny little heels here 19:21 and just kind of 19:23 going through in different directions 19:28 I'm sorry almost actually forgot the last thing I want to do. 19:31 is 19:33 try to get a little bit of Mobility back since my 19:36 goal here was to increase your dorsiflexion. Let's 19:39 do a little bit of these pin and stretch techniques so I can 19:42 pin down some tissue kind of pull in and then 19:45 have her polar foot up. All right, that would be active. 19:49 Right. So boom pull up. 19:52 Right. I can make this a little bit more intense by pinning down 19:55 and then as she pulls up I go up to right especially 19:58 as I get down into this area. We knew there was some 20:01 stuff before right. 20:02 So pin down Pull up. 20:06 Good stuff pin down Pull up. And then 20:09 what I can do is I can actually use my knee to push her into 20:12 dorsiflexion and add some over pressure as 20:15 I go through. 20:16 one more time 20:20 So there you guys have it instrument assisted soft tissue 20:23 mobilization for the posterior cruel fascia and 20:26 achilles tendon. So there you have it instrument assisted soft 20:29 tissue mobilization, make sure to assess. 20:33 Address using the intervention and then of course 20:36 reassess and if you get the chance these 20:39 videos are not a replacement for 20:42 live education. Of course, if you get the 20:45 chance, you should take live workshops or find 20:48 a mentor who's experienced using these tools or maybe 20:51 a friend that wants to learn them too. So 20:54 at least you can practice on each other and give each other some tactile 20:57 feedback of what you feel how you 21:00 felt the next day what results you felt that you got. 21:04 I hope you guys enjoyed this video. Please. Feel free to leave your 21:07 questions below.
