0:04 This is Brent of the Brookbush Institute, 0:06 and we're going over manual release of 0:09 the gastroc and soleus complex. Keep in 0:12 mind this is a video for educational 0:14 purposes, and I'm assuming that if you're 0:15 watching this video to learn this 0:17 technique you are a licensed manual 0:20 practitioner, and you are going to pay 0:21 attention to the laws on scope of 0:24 practice in your state. Sorry personal 0:27 trainers this video doesn't fall within 0:30 your scope. I'm going to have Brian come 0:32 out, he's going to help me demonstrate 0:33 this technique. Now you can assume that 0:36 if I'm going to release the gastroc and 0:39 soleus complex, I have already done a set 0:41 of assessments that had given me an 0:43 indication that he either lacks 0:46 extensibility, over showing signs of over 0:48 activity in his gastroc and soleus 0:50 complex, that could be things like the 0:52 overhead squat assessment where feet, 0:54 flat feet turn out, or an excessive 0:56 forward lean may all indicate over 0:59 activity here. It might have just been 1:00 something as simple as a dorsiflexion 1:03 goniometry. I see a lack of 1:05 dorsiflexion these two muscles could 1:07 restrict that. I could have done my 1:09 gastroc soleus muscle length test and 1:11 that could have given me an indication 1:12 that there was some over activity here. 1:15 Now once we have determined that this is 1:18 an area we want to palpate and look for 1:21 further signs of over activity, it is 1:23 helpful to know your trigger points. All 1:25 right so your common trigger points are 1:27 very much related to motor points, which 1:31 is where we have the neuromuscular 1:33 Junction intervating the muscle, and 1:35 this is often a site of dysfunction 1:37 within these overactive muscles. All 1:41 right so you can see here I've I've gone 1:44 ahead and put circles where the common 1:46 soleus trigger points are, and then X is 1:50 where the common gastroc trigger points 1:52 are. It is helpful for me to kind of know 1:54 round about where those are, but i'm 1:56 going to show you guys how to find them 1:57 even if you didn't have them all 1:59 memorized. What I generally do is I take 2:01 one of the the pads of my thumb, and I 2:05 start kind of strumming perpendicular to 2:10 the fascicles, kind of like I'd be 2:11 rubbing over guitar strings. 2:12 Another little hint here guys is if you 2:14 use your thigh to press into 2:18 dorsiflexion a little bit, that helps put 2:20 some tension, helps lengthen out this 2:23 muscle, it'll help pop those fascicles 2:25 into your finger, so I can see here's a 2:28 tight fascicle. Now what I want to do is I 2:31 want to go proximal and distal to see if 2:35 what's causing the tightness in that 2:37 fascicle, is actually a nodule or a 2:41 specific location of a trigger point, and 2:44 so I can start doing my strumming, kind 2:48 of up and down and seem to be getting 2:50 cold there, warmer, warmer all right, right 2:56 there that's a nice spot. So once i found 2:59 that spot, to help my me pin that spot 3:02 down so that it doesn't end up feel like 3:03 I'm trying to put my finger on a marble 3:05 right, where it just kind of keeps 3:07 popping out, I want to go ahead and put a 3:10 little bit more tension by pressing them 3:11 into dorsiflexion. Actually let me have 3:12 you move down just a little bit Brian, 3:14 Be careful guys as you push 3:16 somebody into dorsiflexion you don't 3:17 push the front of their ankle into the 3:19 end of the table, that's painful. Alright 3:21 so find that little spot again. I'm going 3:23 to make sure I put a little stretch on 3:25 that muscle, that's going to help pull 3:26 everything down, help centralized that 3:29 trigger point, and then I'm actually 3:30 going to use a little distal to proximal 3:32 force with my thumb here, to kind of pin 3:36 it up this way. So rather than trying to 3:38 do this, I'm putting a little stretch and 3:41 pinning up this way, and then to add a 3:44 little bit more pressure i'm actually 3:46 going to go ahead and let this be my 3:48 dummy thumb. So i'm not using this hand 3:51 to apply pressure, i'm going to use this 3:52 hand to apply pressure. The amount of 3:55 pressure i apply is actually going to be 3:59 up to, I wouldn't say the first 4:03 resistance barrier, but the first 4:05 significant increase in resistance from 4:07 this tissue. I think you guys will find 4:09 that as you press into tissue it's 4:13 almost like an exponential curve right, 4:15 you have this nice linear increase in 4:18 how much pressure you get back, and then 4:20 all sudden it's like this really really 4:22 big increase in tension. So I'm going to 4:25 press right 4:25 up into that trough of that curve till I 4:29 got a significant resistance, but not 4:31 past it, and then all I have to do is use 4:34 my body weight, nice straight arms, nice 4:37 good posture, and hold it until that 4:41 point starts to go away; and then if i 4:44 have time, i can start moving through 4:46 some other trigger points that may exist 4:49 in this muscle. Okay so going through 4:53 this whole technique again, i went ahead 4:56 and put just a little bit of pressure 4:58 into Brian's foot here, that's going to 5:01 help dorsiflex his ankle, put a little 5:03 bit of tension into this system, lengthen 5:06 those fibers out so that they're going 5:08 to pop into my fingers a little bit. I 5:09 then run my thumb across the fascicles 5:13 of the gastroc or the soleus, in this 5:16 case alright I'm going to look for the 5:20 most tender fascicles. Once I find those 5:24 tighter denser fascicles, i'm going to 5:27 move proximal and distal and i find like 5:31 that's a pretty good spot right there. 5:33 Once i have a spot i'm going to go ahead 5:36 and kind of go up this way with the 5:38 pressure on the gastroc and soleus, put a 5:41 little bit more pressure into his foot 5:43 so I dorsiflex them a little bit more. 5:45 I'm going to use the opposite hand to 5:47 press right up to that resistance 5:49 barrier, and then I'm going to hold that 5:52 until that goes away. There is one other 5:55 protocol with four six to eight second 5:58 holds, if you guys prefer that protocol 6:00 you can do that too. So I could sit here, 6:02 hold two, three, four, five, six, relax. Go 6:11 back in maybe a little deeper into the 6:13 tissue this time one, two, three, four, five, 6:19 six. If not if i'm going back to just 6:22 that static hold, and it's usually a 20 6:24 to 30 second static hold. After I've done 6:27 that release technique, in Brian's case 6:29 I'd probably go ahead and flip them back 6:31 over do some joint mobilizations. If I 6:34 thought maybe 6:34 is his talus was shifted anteriorly, 6:37 or whatever other joint mobilizations 6:39 that needed to do in his ankle complex, 6:41 and then follow that up with a 6:42 lengthening technique if I thought these 6:44 muscles were short. So I wouldn't use 6:46 release techniques alone, but this would 6:48 certainly be the first step, and be 6:50 helping to regain some ankle mobility 6:53 and calm down any over activity in the 6:57 gastroc and soleus complex. Just to go 7:01 over quickly guys in a more close-up 7:03 view so you can see exactly what it is 7:06 I'm doing, notice i have my thigh, the 7:09 bottom of brian's foot here, so i can 7:10 control dorsiflexion and plantar flexion, 7:13 and the amount of tension in the system. 7:14 I can use this thumb to kind of dig into 7:19 about midway through the gastroc there, 7:22 just unto the first signs of tissue 7:25 resistance, and I can kind of move across 7:28 the fascicles perpendicular to them, and 7:31 kind of strum to find the most dense or 7:35 the highest activity in those fascicles. 7:39 We're going to assume that those 7:42 increased activity in those fascicles is 7:45 a sign of this over activity and 7:47 dysfunction. Once I get there I'm going 7:51 to go ahead and move proximal, distal and 7:55 actually I can feel that there's not as 7:56 much tissue density, not as much give 8:00 back resistance here, as there is here, so 8:04 I know I'm getting closer. And then right 8:05 about here I actually do feel a nice 8:08 tight nodule. Now I kind of mentioned to you 8:11 guys before, it's a little hard to pin 8:13 down if you just kind of go thumb over 8:15 thumb on top. It's also very very painful 8:17 to do it this way, it might help, be a 8:19 little bit more helpful to go a little 8:21 bit more broad with your finger, use this 8:24 as your dummy thumb. So now no more 8:25 pressure in this hand, I'm going to go 8:27 ahead and push into dorsiflexion just a 8:30 little bit, so i feel that a trigger 8:33 point come into my thumb, and then i'm 8:35 going to use my other hand to press 8:37 until i feel that that big increase in 8:41 tissue resistance. As I kind of mentioned 8:43 I think of an exponential curve right, 8:46 and if it's an 8:48 curve that I feel resistance, I want to 8:49 be right in the trough So I'm going to go right here again, and I'm going to go ahead and 8:58 hold that for 30 seconds, or as i 9:02 mentioned earlier in this video we 9:05 could do four, eight second holds. I think 9:08 this feels pretty good though, I should 9:10 get a release here. Brian is starting to 9:12 feel it let go a little bit, yeah usually 9:16 it's a very tender spot at first, and 9:19 then within a few seconds everything 9:21 calms down. So there you guys have it, 9:24 manual release of the gastroc and soleus 9:28 complex. Grab a partner, grab a colleague, 9:31 get to practicing. This is probably not 9:33 something you want to do to the next 9:37 patient that walks in the door if you've 9:38 never done it before. The gastroc and 9:40 soleus do tend to be very tender muscles 9:43 when it comes to compression and manual 9:46 release techniques. I would definitely 9:48 get another manual therapists with 9:51 experience in these techniques if you 9:54 can, getting the feedback from another 9:57 manual therapists is education that 10:00 cannot be replaced. If not if nothing 10:03 else, get a group of you guys together so 10:05 you can start talking about whose 10:07 pressures felt the best, or whose hands 10:09 felt the best, and what you guys are doing 10:11 to help dial this technique in. I hope 10:14 you learned from this video, I hope you 10:16 will integrate this technique into your 10:18 manual practices. I look forward to 10:20 hearing about what type of outcomes you 10:22 get by adding this to your repertoire.
