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Erector Spinae and Multifidus Static Manual Release
Erector Spinae and Multifidus Static Manual Release is a type of therapeutic technique used to relieve pain, restore mobility, and boost strength in the back and spine. This technique involves the patient lying on the floor in a relaxed position, with the therapist manually pressing on and releasing trigger points of tension on the muscles of the spine. This helps to identify and release any knots and shortening of the muscles, allowing the patient to have an improved range of motion and improved coordination
Transcript
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This is Brent of the Brookbush
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Institute, and in this video we're bringing
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you another manual technique. Now if you're watching this video I'm assuming
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you're watching it for educational purposes, and that you are a licensed
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manual therapist following the laws regarding scope of practice in your
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state or region. That means athletic trainers, chiropractors, physical
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therapists, osteopaths, licensed massage therapists you are likely in the clear
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to do these techniques. Personal trainers this probably does not fall within your
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scope of practice, although you might be able to use the palpation portion of
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this video to aid in learning your functional anatomy in an educational
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setting, supervised by a licensed manual therapist. Now before we place our hands
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on a patient or client it is important that we assess and have a good rationale
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for doing so, and of course if we're going to assess then we should be
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reassessing to ensure that the manual technique we're using is effective, and
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we have a good rationale for continuing to use that technique. In this video were
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going to go over static manual release of the erector spinae muscle. I'm going
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to have my friend Melissa come out, she's going to help me demonstrate. We're going
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to use the same palpate and compress technique we've been using for all of
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our static manual release videos, using that that four-step process of
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differentiating, knowing where our common trigger points are, knowing what not to
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press on, and of course getting our patient inclined in good position and us
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in good position so that we have good technique. Starting with a
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differentiation of tissues your erector spinae are fairly superficial, and
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providing we're not talking about trying to differentiate the various erector
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spinae muscles, they're actually not that hard to palpate. The three muscles
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combined create a column of tissue on either side of the spine. I think you
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guys instinctually knew this right. this this valley is created by the skin and
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underlying fascia being tacked down to the spinous process, and then the
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thoracolumbar fascia and fascia along the spine here, all the way
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into like our cervical thoracic fascia create these columns wrapping around the
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erector spinae muscles that create hills on either side for our palpation. The
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only thing we have to consider outside of knowing where these hills are, is what
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direction of a diagonal these fibers go in, because we're going to want to go
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back to that stroke perpendicularly to find the densest fascicles, and then go
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parallel along the dense fiber to find the nodule hyperactive point,
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trigger point. Alright so here's how the diagonals work. most of the erector
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spinae, in fact all of the erector spinae have a diagonal that goes from lumbar
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spine essentially to shoulder. If you think in that direction from inferior
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medial to superior lateral, and then you just drew parallel lines in your head,
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that's the direction of the erector spinae. The only muscles that are a
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little different being erectors of the spine that can
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also develop trigger points is our multifidi, our trigger points for our
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multifidi are usually in our lumbar spine here is what we're talking about, and
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they go in the other direction. They go from inferior lateral to superior medial.
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If I'm going to palpate tissues that run this way again so we're back to a erector
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spinae, I'm going to set up my hips so they're even with Melissa's hips and
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then my hands are going to be going in the direction of Melissa's head, and that
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would be my perpendicular stroke. So that's not too bad. When I do my erector
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spinae I'm facing this way, and then I can just survey the length of my erector
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spinae. I'm just kind of picking up my hand,
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strumming over the tissues. Now it helps to know where your trigger points are.
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Your two common trigger points that we're usually releasing in the erector
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spinae are right in the middle of the lumbar spine, like in line with somewhere
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between l2 and l4, and then just above the thoracolumbar junction there tends
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to be another trigger point. So if I know that I might go right to those points
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first just to see if I can narrow this this search down a little
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bit, and when I find really dense fascicles again, I'm then going to go in
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line with a fiber, search the whole fiber here for a nodule and acute point of
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density and acute point of overactivity, And then you guys can use one of your
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various comfortable hand grips either thumb over thumb just again leaning in,
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you can use the technique I like to use as you guys know which is kind of
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having that dummy thumb underneath, or putting my pisiform hamate over my thumb,
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or putting my thumb in my thenar groove here. So in this case what I'm
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going to do is pisiform hamate, and I'm just going to hold 30 seconds to two minutes
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to kind of pin down the tissue. Notice I am I'm not pushing straight
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down, I'm kind of pushing this way, that does help to keep me from playing that
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game of like put your finger on top of a marble just and it just like keeps
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shooting out this way. I tend to not only push down but push a little bit so
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that I'm kind of like bowing this tissue this way, which holds that trigger point
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underneath my thumb. Now if I want to switch around and do the multifidus,
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maybe I have done all of my erector spinae,
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I'm then going to put my hips level with Melissa's shoulders, and I'm now facing
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her opposite hip. I can then go through, and guys these are going to be
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lumbar spine right, otherwise as we get up in the thoracic spine the multifidus
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are not well developed in the thoracic spine, and of course when we we do the neck that's a
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whole different set of techniques which we talked about in different video. So if
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we're doing multifidus it is going to be lumbar spine. We're going to go this way,
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this direction, a little closer to our spinous process until we find an acute
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point of overactivity or density. It does help to kind of bring the pants down a
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little bit, so that you don't have to feel through another
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layer of clothing right. You already have the skin to feel through, you already
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have some adipose tissue fascia, there's a lot going on back here that we
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got to feel through to just feel these small increases in tissue density. And in
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fact, the common trigger point here is actually somewhere between, in that
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little divot between our PSIS and then the spinous process of l4 l5. Like right
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in here there's like a very common trigger point, all right so if I push in
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there, how does that feel Melissa? Yeah a little a little tender. This is
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definitely a common trigger point. As far as is there anything in this area that
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maybe we shouldn't put our hands on, well no if providing that we're staying close
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to the vertebral column, our transverse processes for the most part protect us
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from being able to do damage to things that would be deeper and more sensitive.
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It would be pretty hard for example for me to push down so hard that I damaged a
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nerve or damaged an internal organ. Like you'd have to be way out here to
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get to some of your internal organs, and I know people worry about that, but the
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transverse processes protect us pretty well. Of course if somebody was or had
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acute lumbar pathology like a nerve root adhesion that was kind of new. Or they
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were experiencing some pretty significant sciatic symptoms, or you had
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like a lumbar herniation, obviously be careful. Don't go in and push
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down as hard as you possibly can. It's not so much that this is one of those
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things that you need to watch where you put your hands, but maybe how you put
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your hands. If I knew somebody was very sensitive to posterior to anterior
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pressure I might even bring the table up a little
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higher, so that I can get a little bit more of a horizontal pressure
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so that I'm not getting so much of this. We can still pin tissues pretty good by
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pushing them towards the spinous process. how does that feel Melissa? It's still very tender, of
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course she has no lumbar pathology that we need to worry about, but you guys can
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kind of imagine how this would be helpful. Back to client position,
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notice when I wanted a more horizontal direction I raised the table, when I want
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a more vertical direction of course I'm going to lower the table. What you don't
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want to do and this is just if you think about it some common sense, you don't
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want a high table and trying to be pushing down,
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we don't want arms like this. We want arms straight. We want to use our fingers
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maybe to palpate just because we need that sensitivity, but then when we
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palpated the tissue that we need and we're just applying pressure, we
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really want to apply pressure not with hand strength and arm strength, but just
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by weaning our body and using body weight. I'm actually not using any
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strength at all here. My elbows are just shy of lock, my arms are nice and
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straight, and I push down, I can tell you guys this is where having mirrors in
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your office comes in handy. I know not everybody has that, but if you have
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mirrors in your office check your own posture every once in a while. I know we
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put mirrors and offices for assessments of our patients, but I think sometimes we
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need as much assessment on our technique and posture while we work. Alright so
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just a real quick recap guys, common trigger points just above the
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thoracolumbar junction right in the middle of the lumbar spine, and then in
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that little soft area between the PSIS and spinous process of l4 l5 usually a
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multifidus trigger point, Eerector spinae perpendicular strokes are this way,
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because those fibers run this way multifidus run this way, so we set up
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this way. Stay tuned for a close-up recap. You guys
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can see the trigger points I've marked out, here are the most common trigger
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points in the erector spinae and the multifidus. One just above the
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thoracolumbar junction the other right in the middle of the lumbar spine, and
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then of course that multifidus trigger point often occurs right between the
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PSIS and the spinous process of l4 l5 and that soft tissue divot there. Now if
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we're going to palpate and release the erector spinae, because they had a
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inferior medial to superior lateral diagonal, I want to line my hips up with
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Melissa's hips, and then my hands are kind of going in the direction towards
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her opposite shoulder. I'm going to do my perpendicular strokes, strumming these
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fibers just like guitar strings, looking for the densest or tensest guitar
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strings. Once I find the densest tissues, I then go along the length of that
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tissue to see if there's any sort of nodule or acute point of hyperactivity, a
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trigger point, once I find that point then I can go -the palpating thumb
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becomes my dummy thumb, and I can just place either my thenar groove
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over that thumb, or my pisiform hamate over that thumb. Straighten out my arms,
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lean in, apply pressure for thirty seconds to two minutes. Once I get a
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release there, then maybe I keep palpating, keep strumming all these
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fibers looking for any other shorter points. You have to remember that your
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erector spinae is made up of tons of fascicles
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right that all run in parallel this way. So it is possible to have multiple
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trigger points in multiple different levels these are simply the most common
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trigger points. Now for the multifidus remember that instead of going this way,
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since the multifidus go superior medial to inferior lateral, I have to go this way,
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that I have to turn myself around, so now my hips are in line with Melissa's
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shoulders, my hands going towards her opposite
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hip, and it's a little different palpation, it's a little different feel than these
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big erector spinae muscles. The multifidus are usually a little flatter. But
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you're going to look for the densest fascicles. Once you find them, once again we'll go along that
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fascicle to find any tender nodule, and then once I find it, I can either do my
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thumb over thumb, pisiform hamate over thumb, or a my I can even do thenar
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groove over thumb like this, holding for 30 seconds to two minutes, until I get a
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release. So there you have it, knowing your functional Anatomy will definitely
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help your manual technique. It'll help you differentiate structures so that you
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can place your hands where they need to be, as well as make you aware of these
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sensitive structures around the tissue that you're trying to target. Things like
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nerves and lymph nodes, and arteries. Make sure that if you're going to place your
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hands on a patient that you have done an assessment and have a good rationale for
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placing your hands on that patient, and if you're going to assess make sure you
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reassess to ensure that your technique was effective, and you have a good
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rationale for using that technique again. Now with manual therapy, one on one live
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education is incredibly important, please be looking for opportunities like
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workshops and mentorships, and maybe even classes at your local university, that
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can get you some one-on-one individual instruction or at least some live
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classroom instruction, so you've had a chance to be critiqued and mentored by
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somebody senior to you with some experience in manual therapy techniques.
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And before you bring this stuff back to your rehab, fitness or performance
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setting, please practice on colleagues. There is no substitute for practice and
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it is going to take a while to get accustomed to some of the techniques
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that we show in these manual technique videos, don't expect to learn them in two
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or three, or even five minutes. You want to have hours of experience under your
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belt, working on various different body sizes and shapes, so
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that when you do get that first paying client, first paying customer then you're
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really trying to make a good positive impact, really trying to promote better
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outcomes, you feel comfortable with that technique. I look forward to hearing
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about your outcomes and hearing your questions in the comments section of
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this video. I'll talk with you soon.
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