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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
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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 therapist 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, osteopaths, 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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therapist. 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 infraspinatus and teres
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minor. I'm going to have my friend
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Melissa come out, she's going to help me
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demonstrate. Now in this video we're
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going to use the same "palpate and
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compress" protocol we've used for all of
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our static manual release techniques,
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paying attention to how to differentiate
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these tissues from other tissues in the
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area, where our common trigger points are,
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what tissues may be in the area we
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shouldn't compress and of course, patient
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and client position and our position to
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ensure that we have good technique.
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Knowing where infraspinatus and teres
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minor are is the first challenge and to
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find out where they are we really kind
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of need to know where the scapula is,
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specifically where is the vertebral
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border of the scapula, which I can feel
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right here. I'm going to
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leave my thumb right there so you
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can see that border and then the other
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border I need to find is actually the
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spine of my scapula, which is this bony
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ridge right here.
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That's just like that and this area in
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here is your infraspinous fossa, which is
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the origin of your infraspinatus so all
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this right here is your infraspinatus.
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You're teres minor, if I put my
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finger down just like this, just to where
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her armpit starts to crease right there,
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sorry I didn't mean to tickle you there
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Melissa, right just where her arm creases
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right there and I press down in towards
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her shoulder, I can actually feel a
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little tube shaped muscle right
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underneath the convergence of the fibers
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of my infraspinatus. They
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almost blend up in here, but if you
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kind of play around with okay palpating
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the tissues in this area I think you'll
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find that your infraspinatus
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is a fairly lumpy muscle. You can really
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feel the different fascicles and
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groupings of fascicles in your
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infraspinatus as they converge onto this
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tendon that goes into the back of
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your shoulder and then just underneath
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that, you can feel this little tube
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shaped muscle, that is your teres minor.
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Common trigger points generally fall
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right in the corner where the spine of your
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scapula meets the vertebral border of
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your scapula, which that would be the
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root of my spine of my scapula here, but
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generally in this area you get some
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pretty tender spots. How does that feel
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Melissa? I'm going to show you
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where those are marked off in the
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close-up recap but we'll definitely look
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to palpate those. And then as the teres
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minor trigger point ends up right in
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the middle of the muscle, which is going
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to be between the axillary border of the
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scapula and then the posterior portion
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of your shoulder, so you're going to be
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able to find a teres minor trigger point
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in here. I guess you could fall off
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the posterior delt almost right into
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that trigger point. The big question
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becomes with this one is we do have
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something called your quadrangular space,
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where your axillary nerve runs through
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so if we're not careful how we palpate
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these tissues you can get somebody's
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4th and 5th finger to go numb or
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them to start feeling numbness in this
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area in general because you'll pinch off
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the axillary nerve and that's a little
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problematic. It's not it's not very
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comfortable, it's not something we want
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to do often. If you do manage to do it,
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try to remember
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that nerves are fairly thin so chances
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are if you change the angle that you're
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going at that trigger point in, you're
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going to release pressure from that
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nerve or get off that nerve all together.
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The infraspinatus, we don't really
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have any contraindicated tissues that we
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need to to worry about missing or not
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compressing but when we get to the teres
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minor, we do have to be a little careful
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as we could end up compressing down on
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that quadrangular space, compressing down
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on the axillary nerve and getting
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somebody some uncomfortable nerve
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symptoms including numbness of the
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4th and 5th finger.
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Patient position, your position.
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On this technique, I wouldn't reach cross
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body, I would stay on the same side. Since
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these are our external rotators of our
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shoulder, to lengthen the tissue out so
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that I can anchor down these points of
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hypertonicity- these trigger points- I'm
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going to have Melissa do the hand's
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underneath the ASIS thing, there you go.
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And then what I find it easiest to do is
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rather than to be here at shoulder
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height, I'm actually going to go this way.
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These fibers run horizontal, kind
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of from vertebral border to the back of
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your shoulder, so I want to be able to
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strum this way and then I also find it
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easier to lock down trigger points this
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way. This is just what I found personally.
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If you find it easier to go this
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way, that's fine. I think if I was this
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way I would probably want the table a
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little higher and I would make sure that
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I'm back a little farther so that I
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can just lean. Try to get into a position
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where you're not using your hand
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strength. Just as with all techniques,
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I'm going to do my perpendicular to the
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fiber strokes. Fibers go this way,
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I'm going to run my fingers across the
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fibers this way and look for dense
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fascicles and in the infraspinatus
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it's a little challenging because
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they're all kind of dense.
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You really need to do a good survey
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and maybe think about looking for the
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densest fascicles. There's a good one
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right there and these tend to be really,
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really sensitive and somebody who needs
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this technique, so you need to go in
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gently. Only push until you get a little
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pushback from the tissue. Once you feel
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that tension start to increase, that's
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all the pressure you need. With this
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technique, I generally use my thumb over
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thumb technique, get my arms straight and
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lean or I'm using my perpendicular
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stroke with one hand and then the hand
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that's doing the perpendicular strokes,
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the feeling, once I found it, that
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becomes my dummy thumb, I relax that
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hand and I use this hand to apply some
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pressure. I'm going to hold for 30
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seconds 2 minutes until I get a good
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release and then I can go on to the next
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point in that muscle or the next muscle.
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In the case of the axilla or the
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teres minor, I'm sorry, which is more in
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the axilla, we're trying to get in here,
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this technique, we're going to find that
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muscle. If it needs it, the whole muscle
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might feel pretty dense, so we're going
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to look for the tightest nodule, the
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tightest point within that muscle which
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is going to be between again axillary
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border and posterior deltoid, we're talking
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about a space about yay wide. Once I
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find that dense point, I'm going to hold
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on. I know you can't see this
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particularly well. I'm more interested in
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this view for you seeing- notice my
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body mechanics are set up in such a way
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that I can apply pressure this way and
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down by essentially leaning in. My arms
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are nice and fairly straight, I can get
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into my thumb over thumb technique or my
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thumb and thenar groove here
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technique without having to use my
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hands. The last thing I want to do is
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fall back on my hand strength
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because if she is very athletic
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like Melissa is here and she needs a lot
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of work and I am going to
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have to hold these points for 30
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seconds to 2 minutes, I'm going to
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wear out my hands. I want to get into a
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position where I can find tight
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fascicles, go along the tight
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fascicle to find the tightest nodule,
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once I find it, I can just add my hand
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technique, get into a good position where
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my arms are straight and I can just lean
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as much as I need to which in this case
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is not very much, to get the pressure I
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need. And then I'm just going to wait for
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a release to happen. Stay tuned for a
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close-up recap. Now for the close-up
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recap of infraspinatus and teres minor
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static manual release the first thing we
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need to do is really identify where the
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borders of our scapula are. We want to
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find the vertebral border of our scapula.
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You can palpate there. I'm going to
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go ahead and lay my index finger down
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right along the vertebral border of her
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scapula so you can see that.
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Then I'm going to wrap the webspace of my
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thumb around the inferior angle of her
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scapula and then my thumb itself along
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the axillary border. Now you can
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kind of see I'm pinching her scapula so
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you know where that is. The only other
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thing what I need to find now is the
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spine of the scapula. The spine of the
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scapula is right here so if I lay my
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thumb down there for you, you
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should have a good little visual image
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of where my infraspinous fossa is, which
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is kind of where my infraspinatus lies.
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Once I found that
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infraspinatus fossa, I can go ahead and
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start doing my perpendicular strokes
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because I know all of these fibers
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converge towards her posterior shoulder.
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I'm going to gently go through here.
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As I mentioned before, if
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somebody needs this technique, these
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fascicles tend to get really, really
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tender. I'm looking for that densest
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tissue and not surprisingly I'm finding
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my densest tissue right around these X's
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which happen to be my common trigger
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point sites
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for the infraspinatus and teres minor
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respectively. Let's say this,
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we'll start with this one, let's say this
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is the first dense fascicles, I feel I'll
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then go along the length of the fiber
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and see if I can find a tight nodule,
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making sure I don't go further than the
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vertebral border of my scapula. Once I
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found that, I'm just going to do my thumb
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over thumb technique and lean my body in
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there to anchor down, apply some pressure
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and try to get a release from these
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tissues. Remember, I'm only pushing hard
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enough to get a little tension back from
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the muscle. Once I feel tension back from
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the muscle, I don't need to go any further. I
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don't need to try to press through
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her scapula. Once I get a release, I
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can move on to the next set of dense
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fascicles and I see some right there, oh
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yeah, that's a nice dense set of fasicles.
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I'm going to once again kind of go
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along the length of those fascicles to
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see if I can find a tight nodule, an
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acute point of hyperactivity. And again
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there's another common trigger point
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site, make sure I can get this set
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of fibers in this particular nodule
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anchored down and then once I do I can
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use my thumb over thumb technique or I
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can use my thenar groove over thumb
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technique again holding for
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30 seconds to 2 minutes until
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I get a release. Now the only one that's
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a little tricky is I have to kind of
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fall off my axillary border way up close
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to where my humerus meets my scapula,
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being your shoulder. But right up in
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there between these two points is my
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teres minor. Here is my axillary
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border of my scapula, here's my posterior
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shoulder, you see where this X is,
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that's actually the center of my teres
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minor, which feels like
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a band of tissue kind of underneath the
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converging fibers of my infraspinatus. If
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I've already done a really good job of
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exploring the infraspinatus and I felt
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those fibers going into the tendon, I can
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usually move just below
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that string of muscle fiber and
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tendon and find this tube shaped muscle
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really high in the armpit and then I
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just kind of have to search along the
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length of it to find the densest point,
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the nodule again and then I'm going to
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push up into the axilla there to anchor
00:13:5300:13:56
that tight nodule or trigger point until
00:13:5600:13:59
I get a release. So there you have it,
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knowing your functional anatomy will
00:14:0100:14:03
definitely help your manual technique.
00:14:0300:14:05
It'll help you differentiate structures
00:14:0500:14:06
so that you can place your hands where
00:14:0600:14:08
they need to be as well as make you
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aware of these sensitive structures
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around the tissue that you're trying to
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target- things like nerves and lymph
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nodes and arteries. Make sure that if
00:14:1600:14:18
you're going to place your hands on a
00:14:1800:14:19
patient, that you have done an assessment
00:14:1900:14:21
and have a good rationale for placing
00:14:2100:14:23
your hands on that patient and if you're
00:14:2300:14:25
going to assess, make sure you reassess
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to ensure that your technique was
00:14:2700:14:29
effective and you have a good rationale
00:14:2900:14:31
for using that technique again. Now, with
00:14:3100:14:35
manual therapy, one-on-one live education
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is incredibly important. Please be
00:14:3800:14:40
looking for opportunities like workshops
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and mentorships and maybe even classes
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at your local university that can get
00:14:4600:14:48
you some one-on-one, individual
00:14:4800:14:50
instruction or at least some live
00:14:5000:14:53
classroom instruction, so you've had a
00:14:5300:14:57
chance to be critiqued and mentored by
00:14:5700:14:59
somebody senior to you with some
00:14:5900:15:02
experience in manual therapy techniques.
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And before you bring this stuff back to
00:15:0500:15:08
your rehab, fitness or performance
00:15:0800:15:11
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
00:15:1700:15:20
accustomed to some of the techniques
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that we show in these manual technique
00:15:2200:15:24
Don't expect to learn them in two or
00:15:2400:15:27
three or even five minutes, you want to
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have hours of experience under your belt
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working on various different body sizes
00:15:3200:15:35
and shapes so that when you do get that
00:15:3500:15:37
first paying client, first paying
00:15:3700:15:39
customer and you're really trying to
00:15:3900:15:42
make a good positive impact, really
00:15:4200:15:45
trying to promote better outcomes, you
00:15:4500:15:47
feel comfortable with that technique. I
00:15:4700:15:49
look forward to hearing about your
00:15:4900:15:52
outcomes and hearing your questions in
00:15:5200:15:54
the comments section of this video. I'll