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Infraspinatus and Teres Minor Static Manual Release (Soft Tissue Mobilization)

Infraspinatus and Teres Minor static manual release (soft tissue mobilization) is a manual therapy technique used to improve mobility and reduce pain in the shoulder by using soft tissue mobilization to help release tight soft tissues (muscles, fascia, and tendons) in the rotator cuff complex. The technique targets the infraspinatus and teres minor muscles of the rotator cuff, located on the back and outside of the shoulder blade, which often become tight and restricted

Transcript

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This is Brent of the Brookbush
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...blank
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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
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that tight nodule or trigger point until
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I get a release. So there you have it,
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knowing your functional anatomy will
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definitely help your manual technique.
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It'll help you differentiate structures
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so that you can place your hands where
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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
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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 mentorships and maybe even classes
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at your local university that can get
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you some one-on-one, individual
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instruction or at least some live
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classroom instruction, so you've had a
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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
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accustomed to some of the techniques
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that we show in these manual technique
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videos.
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Don't expect to learn them in two or
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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
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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