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Levator Scapulae Static Manual Release (Soft Tissue Mobilization)

Levator Scapulae Static Manual Release (Soft Tissue Mobilization) is a technique used by practitioners to address pain, tightness, and restricted range of motion in the upper spine and shoulder region. The release is performed manually by the practitioner, who applies direct pressure to specific points along the Levator Scapulae muscle. The manipulation helps to improve circulation, reduce adhesion of stuck tissue, and stretch the muscle in order to reduce pain and regain range of motion. Additionally

Transcript

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This is Brent of the Brookbush Institute,
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...blank
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in this video we're bringing you another
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manual technique. Now if you're watching
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this video I'm assuming you're watching
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it for educational purposes, and that you
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are a licensed manual therapist
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following the laws regarding scope of
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practice in your state or region. That
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means athletic trainers, chiropractors,
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physical therapists, osteopaths, licensed
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massage therapists, you are likely in the
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clear to do these techniques. Personal
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trainers this probably does not fall
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within your scope of practice, although
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you might be able to use the palpation
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portion of this video to aid in learning
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your functional anatomy in an
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educational setting, supervised by a
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licensed manual therapist. Now before we
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place our hands on a patient or client,
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it is important that we assess and have
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a good rationale for doing so; and of
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course if we're going to assess, then
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we should be reassessing to ensure that
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the manual technique we're using is
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effective and we have a good rationale
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for continuing to use that technique. In
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this video we're going to go over static
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manual release of the levator scapulae.
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I'm going to have my friend Melissa come
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out, she's going to help me demonstrate.
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Now our manual release techniques
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generally follow a very similar protocol
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of differentiate between the target
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tissue and other proximal structures, be
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aware of any tissues that we do not want
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to press on, those are sensitive
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structures that could be insulted by
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compression. We get some bonus points for
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knowing where our trigger point trigger
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points are, or our common trigger point
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sites, as that's going to help us
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increase the accuracy of our palpation.
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And last we want to consider our
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position and the patient's position. Now
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Melissa here has her back to you guys so
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that we can see some of the bony
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landmarks that are going to help us
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differentiate the levator scapulae from
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some of the other proximal structures,
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and she has her arm out of her sleeve so
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that you guys can see her scapula. Now
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under most conditions I would not ask
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Melissa to take her arm out of the
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sleeve of her gym shirt, gym clothing is
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generally thin enough that I can palpate
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through it to feel bone, and I can
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perform the technique without any extra
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strain on my hands. So if I put my hand
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right down here guys you can see
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that I come right up against the medial
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border of the scapula. If I follow the
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medial border of the scapula until it
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starts turning around the top right,
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where it started turning around the top
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is the superior angle of the scapula. The
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superior angle of the scapula is the
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insertion of your levator scapulae, and
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that is where we are going to start our
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palpation. Now most of this that you
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guys see is upper trapezius, your upper
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trapezius is the most superficial muscle
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of your posterior and lateral neck. We
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want to palpate through it, and there is
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a little trick to knowing the difference
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between upper trapezius and levator
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scapulae, and that has to do with the, I
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guess direction and organization of the
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muscle fibers themselves. The trapezius
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is a fairly flat muscle whereas the
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levator scapulae is a very ropey bundle
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of muscle. In fact the levator scapula is
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four ropes that twist as they go up the
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neck, each rope attaching to one of the
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transverse processes c1 through c4. You
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can kind of feel the difference in
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texture by simply falling off the
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superior angle of the scapula, and then
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you're going to strum across the length
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of the fibers here until you feel those
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ropey bundles. Alright so I know that
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this is probably trapezius, but if I go a
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little deeper and I do my strumming
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strokes here, I can feel like this isn't
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that right, I can feel those little ropes.
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Now before we go any further let me
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think to myself are there any tissues
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that I could injure if I start pressing
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in this area, the truth of the matter is
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not really. I mean there's always tissues
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we could injure, we press hard enough and
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we're really careless. But for the most
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part if we are posterior the transverse
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processes, most of the sensitive
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structures of the neck are anterior the
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transverse processes. So as long as I
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don't grossly miss this palpation and
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end up here, chances are i'm not going to do
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anything like compress the carotid
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artery or stretch the brachial plexus. As
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long as I stay around here, and even as I
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track up the length of the tissues I
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stay posterior to these transverse
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processes, I'm probably okay. Now then the
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question is is where do we get these
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acute points of hyperactivity? Where did
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we get these acute points of tenderness?
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And I said you get bonus points for
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knowing where your trigger points are. In
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the case of the levator scapulae the
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trigger points tend to be just
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superficial and medial to the superior
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angle of the scapula, or right at the
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insertion and then about halfway up the
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length of the levator scapulae, just
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anterior to the angle of the upper
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trapezius. Actually at this point guys
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the levator scapulae becomes a
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superficial muscle bordered by the
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trapezius here, and then the middle
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scalene in front of it. But going back to
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where we were with our palpation if I do
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my strumming strokes across those
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bundles, find the densest bundle which
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we're going to assume is the most active
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bundle, and then I start going proximal
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to distal, or actually distal to
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proximal- proximal to distal, looking for
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any tender nodules or any points of
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increased density. We're going to assume
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that those are the trigger points were
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looking for. Right and i find one right
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there, and if I held this pressure
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chances are i could get a release. Now the
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last thing we have to think about is
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position, and this is obviously not the
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position that i would normally do this
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technique in guys. We have
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Melissa's back to the camera so that you
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guys can see what i'm working on with my
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hands, but i'm essentially doing this
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completely by feel without any visual
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alignment here. So what I'm going to have
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Melissa do is I'm going to have her put
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her arm back in the sleeve of her
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shirt, like i said i don't actually need
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her to take her arm out of the sleeve of
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her shirt, i can do this technique right
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through her shirt. I'm going to have her
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flip around.
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Now I have seen this done in a seated
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position, i'm going to show you guys how
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to perform this technique in a seated
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position, although it's not the way i
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prefer to do this technique. What you
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guys would do is you'd start off by
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putting the levator scapulae in a
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lengthened position, that lengthening
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helps us pin down those points of
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overactivity right. It gives us like a
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little bit of tension on either side of
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it, so we don't play that game where
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we're trying to put our finger down on
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top of the marble and it keeps spinning
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out all over the place. The way we
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stretch our levator scapulae, and some of
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you guys already know this is by doing
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the pocket stretch, which is having the
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patient look in the opposite pocket. So
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we're going to do a little contralateral
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rotation, contralateral flexion and
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flexion, and then I've seen two ways of
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holding the head for a little bit of
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control. I happen to have fairly large
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hands, so I can kind of do something like
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this and kind of palm the back of the
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head, which some people are fine with.
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If this doesn't make you very
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comfortable, if you feel like you have to
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put a lot of pressure into somebody
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scalp that's not going to feel great; you
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can use the other position commonly used
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in like cervical manipulations, which is
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kind of a forehead headlock, where you're
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going to put the person's forehead right
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inside the crease of your elbow here, and
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then you can even place their head
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against your your chest right so that
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they're completely locked in. Now they're
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completely stable and I can use this
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hand to apply pressure. I'm still going to
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use the same technique, I'm going to find
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the superior angle of the scapula, I'm
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going to do my stroking across the
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length of the tissue this way. I'm going to
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stroke this way looking for the tightest
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nodules or the tightest fascicles, and
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then I'm going to go from distal to
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proximal looking for any increases in
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tissue density, which we're going to
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assume are a nodule or a trigger point. Now
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if i press and I hold for
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30 seconds to 2 minutes, I should notice
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a reduction in tissue density, Melissa
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should notice a reduction in tenderness,
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and I'll have a successful release
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technique. Now the problem with this
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position is this hand. Essentially I
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can't get my hand into a position where
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i can actually get my forearm parallel
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to the direction of force, and i'm having
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to use essentially the strength of my
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hand to do all of the work. Fine if
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you're just trying to get something done
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real quick, you're not doing this a lot
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of times throughout the day it's fine. If
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you happen to be doing a bunch of
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techniques in seated position, and you
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think that this might help you take that
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next step. But I'm going to go ahead and
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show you guys how I like to do this
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technique, which is in the supine
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position. So I'm going to have Melissa go
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ahead and lay down, we're going to need
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to bring the table up a little higher,
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and I think you guys will see pretty
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quick that this is a much much easier
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technique for the clinician, and the
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patient doesn't seem to mind the
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technique. I'm going to use this hand
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right underneath the occiput, you guys
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can see I have total control of her head,
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she's very relaxed right, so I can kind
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of just have her flop her head over this
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way. She's literally just rolling her
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head over as if she just she just went
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down for a nap, totally relaxed. You guys
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can see that this is still the same
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position, the same pocket stretch that we
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were in before, and now I can get in here
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most of my arm is rested which feels a
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little better to me; and once I get in
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position I can use a combination of her
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bodyweight against my fingers as well
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as friction on the table, to take off
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some of the pressure that I would have
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to put on with my hands. Alright so if i
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strung tissue this way,
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I can find the densest fascicles and
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then I go from distal to proximal here,
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in this case looking for that nodule and
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boom. I got my tender point, i'm in a nice
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relaxed position and I just wait for the
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release to happen. If I want I can take
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her into a little bit more rotation, I
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can take her into a little bit more of a
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lateral flexion, and again this arm
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once I move it, I can set it down and
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forget about it. Alright it doesn't
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take a lot of energy on my part. If you
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guys are doing a lot of neck treatments,
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you're doing a lot of scapular dyskinesis
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type treatments where the
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levator scapulae would be something that
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you would treat out, I definitely
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recommend this technique. Guys stay tuned
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for the close of recap. For a close-up
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recap of levator scapulae release. You
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guys can see I have the levator scapulae
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trigger point marked off there, at least the
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higher one that's about midway up the
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length of levator scapulae. We can see
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this muscle right here which is the
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upper trapezius will help, that will help
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us as a landmark. We're going to go ahead
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and lengthen the levator scapulae, so we
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can help pin down those hyperactive
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points or those nodules of increased
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tissue density. I'm just going to go
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ahead and pull her into a levator
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scapulae stretch, which is letting her
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head fall into my opposite hand. We're
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going to pull a little bit in the
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contralateral flexion, a little bit
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into flexion, and now I have all of this
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area to start working through with my
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palpation. If you guys remember the other
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trigger point was just above the
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superior angle of the scapula, that's
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also where we started palpation of our
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levator scapulae. So if Melissa gives me a bit
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of a crunch here, you guys can notice
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this trigger point right here, and the
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the superior angle of her scapula is
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right here, and I'm just going to go
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ahead and put my thumb down there. So you
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guys can see kind of what that looks
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like when I have my hand between her and
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the table, searching for those overactive
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or tight fascicles. Alright so I'm
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doing my strumming from
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superior lateral to inferior medial.
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Although unlike the trapezius angle that we
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were using for strumming, this angle is
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much more lateral to medial. It's just
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slightly turned this way because the
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levator scapulae it's so much more
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vertical on the cervical spine. So
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I'm moving across these fibers a little
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bit this way, and then I can move from
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distal to proximal to find the tightest
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nodule, and then I can push in a little
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bit, get the pressure that I need which
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the pressure that I need is just pushing
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in until I get a little kickback from
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the tissue. So I'm going to go right up
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to the point where I feel an increase in
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tissue density and then I'm just going
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to lay my arm down, and allow the table
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to keep my arm there. So the friction
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between my arm and the table is actually
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whats keeping me in position. I'm going to
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hold for 30 seconds to 2 minutes and
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wait for a nice release. Melissa how's that
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feeling? Ok. Starting to relax a little
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bit. Good this other trigger point guys
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is a little tricky, a little bit more of
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an advanced palpation. It is just
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anterior to the upper trapezius. So this
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is the upper trapezius and I can
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actually kind of pull this away, and then if
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i push down in here I have to make sure
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I stay just posterior to my transverse
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processes, which you can feel is these
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like bony tips right in here. Now these
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are not something you want to press real
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hard on. You press down on somebody's
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transverse process you make them very
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very uncomfortable. If I go right on top
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of the transverse process I end up on
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the scalenes. If I go too far back I end
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up on the Splenii, but if I kind of
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follow the levator scapula up.
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Note how those taught bands feel
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underneath my fingers, and then fall
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right off the anterior border of the
00:15:2400:15:27
upper trap and then do my same
00:15:2700:15:30
strumming. This time I'm a little bit
00:15:3000:15:33
more posterior to anterior, then I can
00:15:3300:15:37
move distal to proximal and I can
00:15:3700:15:40
do the same thing. So this is still
00:15:4000:15:43
levator scapulae but oddly i'm actually
00:15:4300:15:46
now not going through the trap, whereas
00:15:4600:15:48
before i was pressing through the upper
00:15:4800:15:50
trapezius to get the levator scapulae.
00:15:5000:15:52
Your levator scapulae is actually a
00:15:5200:15:54
superficial muscle here, the only thing
00:15:5400:15:56
to note is this is also a different
00:15:5600:16:01
trigger point than we were on before. So
00:16:0100:16:04
just a quick recap guys with all these
00:16:0400:16:06
levator scapulae releases. You are going
00:16:0600:16:11
to pull or gently place the neck into
00:16:1100:16:14
contralateral rotation, contralateral
00:16:1400:16:16
flexion, a little bit of flexion. You're
00:16:1600:16:18
going to find the superior angle of the
00:16:1800:16:21
scapula, work your way up from there with
00:16:2100:16:26
mostly lateral to medial stroking, until
00:16:2600:16:30
you get just anterior to the upper trap.
00:16:3000:16:32
And then you're using very short strokes
00:16:3200:16:35
but more of a posterior to anterior
00:16:3500:16:37
strumming. You're always going to be
00:16:3700:16:39
looking for taut bands, and this is a
00:16:3900:16:41
very ropey muscle when compared to the
00:16:4100:16:45
upper trapezius. And then once you've found
00:16:4500:16:48
the taut band you can look for dense
00:16:4800:16:51
nodules within those taut bands to
00:16:5100:16:54
hold some compression on, until you get a
00:16:5400:16:56
release. So there you have it knowing
00:16:5600:16:58
your functional Anatomy will definitely
00:16:5800:17:00
help your manual technique. It'll help
00:17:0000:17:01
you differentiate structure so that you
00:17:0100:17:03
can place your hands where they need to
00:17:0300:17:05
be. As well as make you aware of these
00:17:0500:17:07
sensitive structures around the tissue
00:17:0700:17:09
that you're trying to target; things like
00:17:0900:17:12
nerves and lymph nodes, and arteries. Make
00:17:1200:17:13
sure that if you're going to place your
00:17:1300:17:15
hands on a patient, that you have done an
00:17:1500:17:17
assessment and add a good rationale for
00:17:1700:17:19
placing your hands on that patient. And
00:17:1900:17:21
if you're going to assess, make sure you
00:17:2100:17:23
reassess to ensure that your technique
00:17:2300:17:23
was
00:17:2300:17:25
effective, and you have a good rationale
00:17:2500:17:27
for using that technique. Again now with
00:17:2700:17:31
manual therapy, one-on-one live education
00:17:3100:17:34
is incredibly important. Please be
00:17:3400:17:37
looking for opportunities like workshops
00:17:3700:17:40
and mentorships, and maybe even classes
00:17:4000:17:42
at your local university, that can get
00:17:4200:17:45
you some one on one individual
00:17:4500:17:47
instruction; or at least a live classroom
00:17:4700:17:51
instruction so you've had a chance to be
00:17:5100:17:54
critiqued and mentored by somebody
00:17:5400:17:56
senior to you, with some experience in
00:17:5600:18:00
manual therapy techniques. And before you
00:18:0000:18:03
bring this stuff back to your rehab
00:18:0300:18:06
fitness or performance setting, please
00:18:0600:18:08
practice on colleagues. There is no
00:18:0800:18:11
substitute for practice, and it is going
00:18:1100:18:15
to take a while to get accustomed to some
00:18:1500:18:17
of the techniques that we show in these
00:18:1700:18:19
manual technique videos. Don't expect to
00:18:1900:18:22
learn them in two or three, or even five
00:18:2200:18:25
minutes. You want to have hours of
00:18:2500:18:27
experience under your belt working on
00:18:2700:18:29
various different body sizes and shapes.
00:18:2900:18:32
So that when you do get that first
00:18:3200:18:34
paying client, first paying customer, and
00:18:3400:18:36
you're really trying to make a good
00:18:3600:18:39
positive impact, really trying to promote
00:18:3900:18:42
better outcomes, you feel comfortable
00:18:4200:18:44
with that technique. I look forward to
00:18:4400:18:46
hearing about your outcomes and hearing
00:18:4600:18:48
your questions in the comments section
00:18:4800:18:53
of this video. I'll talk with you soon.