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This is Brent of the Brookbush
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Institute in this video we're bringing
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you another manual technique 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 are a licensed
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manual therapists following the laws
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regarding scope of practice in your
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state or region that means athletic
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trainers chiropractors physical
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therapists osteopath licensed massage
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therapists you are likely in the clear
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to do these techniques personal trainers
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this probably does not fall within your
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scope of practice although you might be
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able to use the palpation portion of
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this video to aid in learning your
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functional anatomy in an educational
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setting supervised by a licensed manual
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therapists now before we place our hands
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on a patient or client it is important
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that we assess and have a good rationale
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for doing so and of course if we're
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going to assess then we should be
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reassessing to ensure that the manual
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technique we're using is effective and
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we have a good rationale for continuing
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to use that technique in this video
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we're going to go over static manual
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release of the deep cervical extensors
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that's the semispinalis capitis and
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cervicis as well as the transversospinales
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multifidus and rotatores
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muscles I'm gonna have my friend Melissa
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come out she's going to help me
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demonstrate now we're going to go
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through the same four step process we've
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gone through with all of our static
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manual release techniques the first
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being how do we differentiate and
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palpate these tissues well to palpate
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these tissues is actually not that hard
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if you have somebody extend their head
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then you really tilt their head back
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against some resistance you'll see these
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two column or at least feel these two
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columns of muscle pop up on either side
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of the spinous process what those two
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columns of muscles are is literally the
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semispinalis contracting and bulging
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up a little bit as well as the
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transversospinales muscles those
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rotatores sand multifidus muscles
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underneath it contracting and bulging up
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underneath them so that we push these
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two big columns of muscles up into my
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fairly thin upper trap all right so we
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know where these columns of muscles are
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we know where these muscles are as a
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group the question then becomes how do
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we differentiate them how do I know that
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a rotatores muscle versus my semispinalis
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muscle the truth is we probably can't
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differentiate we probably can't be
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accurate and reliable without palpation
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but we might not have to be right we if
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we're just trying to correct a movement
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if we're going back and putting our our
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thinking caps on with my assessment
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showed that I had a restriction and an X
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movement maybe its rotation to the left or
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extension or maybe it's a combination of
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flexion and rotation right we would need
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to show that these muscles do different
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things if we really needed to
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differentiate them and actually all of
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these muscles have a similar obliquity
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they all go from superior medial to
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inferior lateral now they have different
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fiber angles but they all somewhat
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contribute to extension because they're
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on the posterior side of the neck since
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they're on the side of the
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spinous process they all contribute to a
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little ipsilateral flexion and since
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they have this obliquity they all
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contribute to just a little bit of
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contralateral rotation so all these
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muscles do the same thing it's probably
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not that important for us to have to
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know exactly how I'm gonna get on
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semispinalis capitis or how I'm going to
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get on my multiifdus at c3 c4 I just
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need to know that I am on this column of
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muscle at the right segment where at
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least I've found the tissue density
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that's restricting me now second step is
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there anything close to these tissues
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that could be insulted abraded injured
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by compression well I'm posterior to the
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transverse processes right I'm posterior
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on the cervical spine most of the
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sensitive stuff is on the anterior side
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of the cervical spine so chances are i
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can't really injure a nerve or injure a
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vessel all I can do is is press here and
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trust me if you press hard enough you
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can you can mess somebody up pretty bad
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just by bruising
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and damaging some muscle tissue but if
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I'm careful and I only press as hard as
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I need to I shouldn't run into any
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issues okay so step three what about
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trigger points well trigger points occur
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in the middle of the muscle bellies of
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these muscles problem these muscles are
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tiny little muscles that run from
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segment to segments and are segmentallyl
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nnervated which means we can have
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trigger points between any segment so
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you don't really have to memorize where
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a trigger point is that's not
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necessarily going to be helpful but you
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may have to search the entire cervical
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spine and maybe even going all the way
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down to the mid thoracic spine if there
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happens to be trigger points in the
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semispinalis muscles which originated way
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down here all the way down to like t6
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number four positioning all right so how
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do I get us positioned in a way where I can
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hold the technique long enough to get a
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release and my client or patient is
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comfortable enough to relax to allow a
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release to happen while honestly sitting
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isn't the greatest way to go but you
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might be able to get away with having
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the patient's face away from you
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doing our forehead headlock position
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like so I think I showed you guys that
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in the previous video and I could use my
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thumb probably best in a downward
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direction this way to strum these
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tissues right so these tissues run kind
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of like this to like this i'm going to
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strum kind of downward as I maybe flex a
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little bit you'll contralaterally rotate
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to lengthen or maybe I'll shorten up a
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little bit so you get the traps out of
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the way I can definitely control a
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little bit this way but I got to tell
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you over all guys standing with your
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patient and sitting isn't really an easy
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way to do these techniques I think
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probably the best way to do these
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techniques is in supine if you lay down
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I think you guys have seen a lot of neck
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massage maybe neck manual techniques
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cervical neck static release techniques
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by various manual practitioners and
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various professions and they all kind of
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do this thing well chances are they're
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on the cervical extensors and as long as
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there's a good reason for them to be
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releasing the cervical extensors we're
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on the right track this is actually a
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very comfortable position to do this
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because I can just let my hands relax
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into that natural curl position that our
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hands kind of get into and I can let the
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weight of Melissa's head do all the work
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now of course I need to do my my
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strumming here taking some short strokes
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so I don't take so much skin with me I'm
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going to be kind of going from medial to
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lateral as I as I do these short strokes
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from inferior to superior so I'm just
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kind of going through this way
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to see where my densest fascicles are and
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I have a couple good ones right there
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and it's once I find a good good
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fascicle here I can look for any nodules
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within that fascicle and then I'm just
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going to hold this position until I get
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a release once i get a release i can
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continue searching remember with these
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muscles since we're not just dealing with
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a single muscle since we are dealing
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with a group of muscles it's probably
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worth continuing your search to make
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sure you clear the entire deep cervical
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extensor group from mid thoracic spine
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all the way up to the occiput look feel
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good so then I would continue on alright
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and I can even get down in here right
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and I got to work my hands underneath a
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little bit but maybe right in here start
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feeling some stuff it's a little harder
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in your hands in this position and
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actually the lower fibers you might be
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able to go back to that seated position
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and and you get better leverage and be
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more comfortable as the practitioner
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since I have large hands are still fine
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with this technique is a little bit more
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comfortable for me stay tuned for the
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close-up of recap this is our close-up
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recap of deep cervical extensor release
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that's my semispinalis multifidus
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and rotatores muscles I wanted to
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show you guys close up what that column
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a muscle looks back looks like so we
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also go ahead and extend your head right
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you guys see that pop up right there all
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yeah that's that's all the deep cervical
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extensors right there so that's a that's a
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good start for knowing where to put your
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hands now these muscles have a slight
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obliquity from like ear to shoulder
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alright so that superior medial to inferior
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lateral so as i stroke I want to stroke
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from lateral to medial superior to
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inferior so in opposition
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to that fiber direction so that I
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stroke across those fibers and I'm just
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going to gently kind of stroke across
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those fibers with both hands until I
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find some tight fascicles some dense fascicles
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and then I can move medial and
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lateral to kind of narrow in on the the
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tightest part of those fascicles the
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nodule trigger point point of
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hyperactivity and then I can just use
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that kind of curled finger position and
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the weight of Melissa's head to add a
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little compression until I get a nice
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release and then i can reassess
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once again guys I will turn Melissa's head
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here a little bit which is not
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necessarily I would some not necessarily
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something i would suggest for this
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technique but all I was doing was
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stroking this way in towards the
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spinous process as I moved superior to
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inferior and wait until i found the
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tightest fascicles once I found some
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tight fascicles and I can move medial
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and lateral superior to inferior really
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try to narrow in to any sort of knot and
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then I'm just using the weight of
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Melissa's head to apply compression to
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this kind of curled finger hand position
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and I can wait for a release so there you
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have it knowing your functional Anatomy
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will definitely help your manual
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technique it'll help you differentiate
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structure so that you can place your
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hands where they need to be as well as
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make you aware of these sensitive
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structures around the tissue that you're
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trying to target things like nerves and
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lymph nodes and arteries make sure that if
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you're going to place your hands on a
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patient that you have done an assessment
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and have a good rationale for placing
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your hands on that patient and if you're
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going to assess make sure you reassess
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to ensure that your technique was
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effective and you have a good rationale
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for using that technique again now with
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manual therapy one-on-one live education
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is incredibly important please be
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looking for opportunities like workshops
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and mentorship and maybe even classes at
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your local university
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that can get you some one on one
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individual instruction or at least some
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live classroom instruction so you've had
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a chance to be critiqued and mentored by
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somebody senior to you with some
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experience in manual therapy techniques
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and before you bring this stuff back to
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your rehab fitness or performance
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setting please practice on colleagues
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there is no substitute for practice and
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it is going to take a while to get accustomed
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to some of the techniques that
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we show in these manual techniques
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videos don't expect to learn them in two
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or three or even five minutes you want
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to have hours of experience under your
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belt working on various different body
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sizes and shapes so that when you do get
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that first paying client first paying
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customer and you're really trying to
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make a good positive impact really
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trying to promote better outcomes you
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feel comfortable with that technique I
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look forward to hearing about your
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outcomes and hearing your questions in
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the comments section of this video I'll
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talk with you soon