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

00:00:0400:00:06
This is Brent of the Brookbush Institute,
00:00:0400:00:06
...blank
00:00:0600:00:07
in this video we're bringing you another
00:00:0700:00:09
manual technique. Now if you're watching
00:00:0900:00:10
this video I'm assuming you're watching
00:00:1000:00:12
it for educational purposes, and that you
00:00:1200:00:14
are a licensed manual therapist
00:00:1400:00:16
following the laws regarding scope of
00:00:1600:00:18
practice in your state or region. That
00:00:1800:00:20
means athletic trainers, chiropractors,
00:00:2000:00:23
physical therapists, osteopaths, licensed
00:00:2300:00:25
massage therapists, you are likely in the
00:00:2500:00:28
clear to do these techniques. Personal
00:00:2800:00:29
trainers this probably does not fall
00:00:2900:00:31
within your scope of practice, although
00:00:3100:00:32
you might be able to use the palpation
00:00:3200:00:35
portion of this video to aid in learning
00:00:3500:00:38
your functional anatomy in an
00:00:3800:00:40
educational setting, supervised by a
00:00:4000:00:42
licensed manual therapist. Now before we
00:00:4200:00:44
place our hands on a patient or client,
00:00:4400:00:47
it is important that we assess and have
00:00:4700:00:50
a good rationale for doing so; and of
00:00:5000:00:52
course if we're going to assess, then
00:00:5200:00:54
we should be reassessing to ensure that
00:00:5400:00:56
the manual technique we're using is
00:00:5600:00:58
effective and we have a good rationale
00:00:5800:01:00
for continuing to use that technique. In
00:01:0000:01:02
this video we're going to go over static
00:01:0200:01:03
manual release of the levator scapulae.
00:01:0300:01:04
I'm going to have my friend Melissa come
00:01:0400:01:05
out, she's going to help me demonstrate.
00:01:0500:01:08
Now our manual release techniques
00:01:0800:01:11
generally follow a very similar protocol
00:01:1100:01:15
of differentiate between the target
00:01:1500:01:17
tissue and other proximal structures, be
00:01:1700:01:20
aware of any tissues that we do not want
00:01:2000:01:21
to press on, those are sensitive
00:01:2100:01:24
structures that could be insulted by
00:01:2400:01:26
compression. We get some bonus points for
00:01:2600:01:28
knowing where our trigger point trigger
00:01:2800:01:30
points are, or our common trigger point
00:01:3000:01:32
sites, as that's going to help us
00:01:3200:01:34
increase the accuracy of our palpation.
00:01:3400:01:36
And last we want to consider our
00:01:3600:01:39
position and the patient's position. Now
00:01:3900:01:42
Melissa here has her back to you guys so
00:01:4200:01:43
that we can see some of the bony
00:01:4300:01:44
landmarks that are going to help us
00:01:4400:01:46
differentiate the levator scapulae from
00:01:4600:01:48
some of the other proximal structures,
00:01:4800:01:51
and she has her arm out of her sleeve so
00:01:5100:01:54
that you guys can see her scapula. Now
00:01:5400:01:56
under most conditions I would not ask
00:01:5600:01:59
Melissa to take her arm out of the
00:01:5900:02:02
sleeve of her gym shirt, gym clothing is
00:02:0200:02:04
generally thin enough that I can palpate
00:02:0400:02:07
through it to feel bone, and I can
00:02:0700:02:09
perform the technique without any extra
00:02:0900:02:14
strain on my hands. So if I put my hand
00:02:1400:02:15
right down here guys you can see
00:02:1500:02:19
that I come right up against the medial
00:02:1900:02:22
border of the scapula. If I follow the
00:02:2200:02:24
medial border of the scapula until it
00:02:2400:02:28
starts turning around the top right,
00:02:2800:02:30
where it started turning around the top
00:02:3000:02:34
is the superior angle of the scapula. The
00:02:3400:02:36
superior angle of the scapula is the
00:02:3600:02:39
insertion of your levator scapulae, and
00:02:3900:02:40
that is where we are going to start our
00:02:4000:02:43
palpation. Now most of this that you
00:02:4300:02:47
guys see is upper trapezius, your upper
00:02:4700:02:49
trapezius is the most superficial muscle
00:02:4900:02:53
of your posterior and lateral neck. We
00:02:5300:02:55
want to palpate through it, and there is
00:02:5500:02:57
a little trick to knowing the difference
00:02:5700:02:58
between upper trapezius and levator
00:02:5800:03:01
scapulae, and that has to do with the, I
00:03:0100:03:05
guess direction and organization of the
00:03:0500:03:08
muscle fibers themselves. The trapezius
00:03:0800:03:11
is a fairly flat muscle whereas the
00:03:1100:03:14
levator scapulae is a very ropey bundle
00:03:1400:03:18
of muscle. In fact the levator scapula is
00:03:1800:03:23
four ropes that twist as they go up the
00:03:2300:03:26
neck, each rope attaching to one of the
00:03:2600:03:30
transverse processes c1 through c4. You
00:03:3000:03:32
can kind of feel the difference in
00:03:3200:03:35
texture by simply falling off the
00:03:3500:03:38
superior angle of the scapula, and then
00:03:3800:03:42
you're going to strum across the length
00:03:4200:03:47
of the fibers here until you feel those
00:03:4700:03:51
ropey bundles. Alright so I know that
00:03:5100:03:54
this is probably trapezius, but if I go a
00:03:5400:03:57
little deeper and I do my strumming
00:03:5700:03:58
strokes here, I can feel like this isn't
00:03:5800:04:01
that right, I can feel those little ropes.
00:04:0100:04:03
Now before we go any further let me
00:04:0300:04:06
think to myself are there any tissues
00:04:0600:04:10
that I could injure if I start pressing
00:04:1000:04:12
in this area, the truth of the matter is
00:04:1200:04:15
not really. I mean there's always tissues
00:04:1500:04:17
we could injure, we press hard enough and
00:04:1700:04:20
we're really careless. But for the most
00:04:2000:04:22
part if we are posterior the transverse
00:04:2200:04:25
processes, most of the sensitive
00:04:2500:04:28
structures of the neck are anterior the
00:04:2800:04:30
transverse processes. So as long as I
00:04:3000:04:32
don't grossly miss this palpation and
00:04:3200:04:35
end up here, chances are i'm not going to do
00:04:3500:04:38
anything like compress the carotid
00:04:3800:04:41
artery or stretch the brachial plexus. As
00:04:4100:04:43
long as I stay around here, and even as I
00:04:4300:04:45
track up the length of the tissues I
00:04:4500:04:47
stay posterior to these transverse
00:04:4700:04:50
processes, I'm probably okay. Now then the
00:04:5000:04:52
question is is where do we get these
00:04:5200:04:54
acute points of hyperactivity? Where did
00:04:5400:04:56
we get these acute points of tenderness?
00:04:5600:04:57
And I said you get bonus points for
00:04:5700:04:59
knowing where your trigger points are. In
00:04:5900:05:00
the case of the levator scapulae the
00:05:0000:05:02
trigger points tend to be just
00:05:0200:05:06
superficial and medial to the superior
00:05:0600:05:07
angle of the scapula, or right at the
00:05:0700:05:10
insertion and then about halfway up the
00:05:1000:05:13
length of the levator scapulae, just
00:05:1300:05:18
anterior to the angle of the upper
00:05:1800:05:20
trapezius. Actually at this point guys
00:05:2000:05:22
the levator scapulae becomes a
00:05:2200:05:25
superficial muscle bordered by the
00:05:2500:05:28
trapezius here, and then the middle
00:05:2800:05:32
scalene in front of it. But going back to
00:05:3200:05:35
where we were with our palpation if I do
00:05:3500:05:37
my strumming strokes across those
00:05:3700:05:41
bundles, find the densest bundle which
00:05:4100:05:43
we're going to assume is the most active
00:05:4300:05:48
bundle, and then I start going proximal
00:05:4800:05:50
to distal, or actually distal to
00:05:5000:05:52
proximal- proximal to distal, looking for
00:05:5200:05:55
any tender nodules or any points of
00:05:5500:05:58
increased density. We're going to assume
00:05:5800:06:00
that those are the trigger points were
00:06:0000:06:03
looking for. Right and i find one right
00:06:0300:06:05
there, and if I held this pressure
00:06:0500:06:08
chances are i could get a release. Now the
00:06:0800:06:10
last thing we have to think about is
00:06:1000:06:12
position, and this is obviously not the
00:06:1200:06:14
position that i would normally do this
00:06:1400:06:16
technique in guys. We have
00:06:1600:06:18
Melissa's back to the camera so that you
00:06:1800:06:20
guys can see what i'm working on with my
00:06:2000:06:22
hands, but i'm essentially doing this
00:06:2200:06:25
completely by feel without any visual
00:06:2500:06:27
alignment here. So what I'm going to have
00:06:2700:06:29
Melissa do is I'm going to have her put
00:06:2900:06:31
her arm back in the sleeve of her
00:06:3100:06:33
shirt, like i said i don't actually need
00:06:3300:06:34
her to take her arm out of the sleeve of
00:06:3400:06:35
her shirt, i can do this technique right
00:06:3500:06:37
through her shirt. I'm going to have her
00:06:3700:06:40
flip around.
00:06:4100:06:45
Now I have seen this done in a seated
00:06:4500:06:46
position, i'm going to show you guys how
00:06:4600:06:48
to perform this technique in a seated
00:06:4800:06:50
position, although it's not the way i
00:06:5000:06:53
prefer to do this technique. What you
00:06:5300:06:54
guys would do is you'd start off by
00:06:5400:06:56
putting the levator scapulae in a
00:06:5600:07:00
lengthened position, that lengthening
00:07:0000:07:02
helps us pin down those points of
00:07:0200:07:04
overactivity right. It gives us like a
00:07:0400:07:06
little bit of tension on either side of
00:07:0600:07:08
it, so we don't play that game where
00:07:0800:07:09
we're trying to put our finger down on
00:07:0900:07:11
top of the marble and it keeps spinning
00:07:1100:07:13
out all over the place. The way we
00:07:1300:07:15
stretch our levator scapulae, and some of
00:07:1500:07:17
you guys already know this is by doing
00:07:1700:07:19
the pocket stretch, which is having the
00:07:1900:07:21
patient look in the opposite pocket. So
00:07:2100:07:23
we're going to do a little contralateral
00:07:2300:07:27
rotation, contralateral flexion and
00:07:2700:07:31
flexion, and then I've seen two ways of
00:07:3100:07:33
holding the head for a little bit of
00:07:3300:07:35
control. I happen to have fairly large
00:07:3500:07:38
hands, so I can kind of do something like
00:07:3800:07:42
this and kind of palm the back of the
00:07:4200:07:45
head, which some people are fine with.
00:07:4500:07:46
If this doesn't make you very
00:07:4600:07:48
comfortable, if you feel like you have to
00:07:4800:07:49
put a lot of pressure into somebody
00:07:4900:07:51
scalp that's not going to feel great; you
00:07:5100:07:54
can use the other position commonly used
00:07:5400:07:57
in like cervical manipulations, which is
00:07:5700:08:00
kind of a forehead headlock, where you're
00:08:0000:08:02
going to put the person's forehead right
00:08:0200:08:05
inside the crease of your elbow here, and
00:08:0500:08:07
then you can even place their head
00:08:0700:08:10
against your your chest right so that
00:08:1000:08:12
they're completely locked in. Now they're
00:08:1200:08:14
completely stable and I can use this
00:08:1400:08:17
hand to apply pressure. I'm still going to
00:08:1700:08:18
use the same technique, I'm going to find
00:08:1800:08:20
the superior angle of the scapula, I'm
00:08:2000:08:24
going to do my stroking across the
00:08:2400:08:26
length of the tissue this way. I'm going to
00:08:2600:08:28
stroke this way looking for the tightest
00:08:2800:08:31
nodules or the tightest fascicles, and
00:08:3100:08:34
then I'm going to go from distal to
00:08:3400:08:39
proximal looking for any increases in
00:08:3900:08:40
tissue density, which we're going to
00:08:4000:08:43
assume are a nodule or a trigger point. Now
00:08:4300:08:47
if i press and I hold for
00:08:4700:08:50
30 seconds to 2 minutes, I should notice
00:08:5000:08:53
a reduction in tissue density, Melissa
00:08:5300:08:55
should notice a reduction in tenderness,
00:08:5500:08:57
and I'll have a successful release
00:08:5700:08:59
technique. Now the problem with this
00:08:5900:09:04
position is this hand. Essentially I
00:09:0400:09:06
can't get my hand into a position where
00:09:0600:09:09
i can actually get my forearm parallel
00:09:0900:09:12
to the direction of force, and i'm having
00:09:1200:09:14
to use essentially the strength of my
00:09:1400:09:19
hand to do all of the work. Fine if
00:09:1900:09:21
you're just trying to get something done
00:09:2100:09:24
real quick, you're not doing this a lot
00:09:2400:09:28
of times throughout the day it's fine. If
00:09:2800:09:29
you happen to be doing a bunch of
00:09:2900:09:31
techniques in seated position, and you
00:09:3100:09:33
think that this might help you take that
00:09:3300:09:35
next step. But I'm going to go ahead and
00:09:3500:09:36
show you guys how I like to do this
00:09:3600:09:38
technique, which is in the supine
00:09:3800:09:40
position. So I'm going to have Melissa go
00:09:4000:09:43
ahead and lay down, we're going to need
00:09:4300:09:47
to bring the table up a little higher,
00:09:4700:09:49
and I think you guys will see pretty
00:09:4900:09:51
quick that this is a much much easier
00:09:5100:09:54
technique for the clinician, and the
00:09:5400:09:55
patient doesn't seem to mind the
00:09:5500:09:57
technique. I'm going to use this hand
00:09:5700:10:02
right underneath the occiput, you guys
00:10:0200:10:04
can see I have total control of her head,
00:10:0400:10:07
she's very relaxed right, so I can kind
00:10:0700:10:10
of just have her flop her head over this
00:10:1000:10:13
way. She's literally just rolling her
00:10:1300:10:15
head over as if she just she just went
00:10:1500:10:18
down for a nap, totally relaxed. You guys
00:10:1800:10:20
can see that this is still the same
00:10:2000:10:22
position, the same pocket stretch that we
00:10:2200:10:27
were in before, and now I can get in here
00:10:2700:10:30
most of my arm is rested which feels a
00:10:3000:10:34
little better to me; and once I get in
00:10:3400:10:38
position I can use a combination of her
00:10:3800:10:42
bodyweight against my fingers as well
00:10:4200:10:45
as friction on the table, to take off
00:10:4500:10:46
some of the pressure that I would have
00:10:4600:10:50
to put on with my hands. Alright so if i
00:10:5000:10:54
strung tissue this way,
00:10:5400:10:58
I can find the densest fascicles and
00:10:5800:11:00
then I go from distal to proximal here,
00:11:0000:11:03
in this case looking for that nodule and
00:11:0300:11:07
boom. I got my tender point, i'm in a nice
00:11:0700:11:10
relaxed position and I just wait for the
00:11:1000:11:12
release to happen. If I want I can take
00:11:1200:11:14
her into a little bit more rotation, I
00:11:1400:11:16
can take her into a little bit more of a
00:11:1600:11:18
lateral flexion, and again this arm
00:11:1800:11:22
once I move it, I can set it down and
00:11:2200:11:25
forget about it. Alright it doesn't
00:11:2500:11:26
take a lot of energy on my part. If you
00:11:2600:11:30
guys are doing a lot of neck treatments,
00:11:3000:11:32
you're doing a lot of scapular dyskinesis
00:11:3200:11:34
type treatments where the
00:11:3400:11:35
levator scapulae would be something that
00:11:3500:11:37
you would treat out, I definitely
00:11:3700:11:41
recommend this technique. Guys stay tuned
00:11:4100:11:43
for the close of recap. For a close-up
00:11:4300:11:45
recap of levator scapulae release. You
00:11:4500:11:48
guys can see I have the levator scapulae
00:11:4800:11:50
trigger point marked off there, at least the
00:11:5000:11:52
higher one that's about midway up the
00:11:5200:11:54
length of levator scapulae. We can see
00:11:5400:11:56
this muscle right here which is the
00:11:5600:11:59
upper trapezius will help, that will help
00:11:5900:12:01
us as a landmark. We're going to go ahead
00:12:0100:12:03
and lengthen the levator scapulae, so we
00:12:0300:12:06
can help pin down those hyperactive
00:12:0600:12:09
points or those nodules of increased
00:12:0900:12:11
tissue density. I'm just going to go
00:12:1100:12:13
ahead and pull her into a levator
00:12:1300:12:15
scapulae stretch, which is letting her
00:12:1500:12:18
head fall into my opposite hand. We're
00:12:1800:12:19
going to pull a little bit in the
00:12:1900:12:21
contralateral flexion, a little bit
00:12:2100:12:24
into flexion, and now I have all of this
00:12:2400:12:26
area to start working through with my
00:12:2600:12:29
palpation. If you guys remember the other
00:12:2900:12:31
trigger point was just above the
00:12:3100:12:33
superior angle of the scapula, that's
00:12:3300:12:35
also where we started palpation of our
00:12:3500:12:37
levator scapulae. So if Melissa gives me a bit
00:12:3700:12:39
of a crunch here, you guys can notice
00:12:3900:12:42
this trigger point right here, and the
00:12:4200:12:45
the superior angle of her scapula is
00:12:4500:12:47
right here, and I'm just going to go
00:12:4700:12:49
ahead and put my thumb down there. So you
00:12:4900:12:51
guys can see kind of what that looks
00:12:5100:12:55
like when I have my hand between her and
00:12:5500:13:01
the table, searching for those overactive
00:13:0100:13:05
or tight fascicles. Alright so I'm
00:13:0500:13:07
doing my strumming from
00:13:0700:13:10
superior lateral to inferior medial.
00:13:1000:13:14
Although unlike the trapezius angle that we
00:13:1400:13:17
were using for strumming, this angle is
00:13:1700:13:19
much more lateral to medial. It's just
00:13:1900:13:23
slightly turned this way because the
00:13:2300:13:24
levator scapulae it's so much more
00:13:2400:13:28
vertical on the cervical spine. So
00:13:2800:13:30
I'm moving across these fibers a little
00:13:3000:13:32
bit this way, and then I can move from
00:13:3200:13:36
distal to proximal to find the tightest
00:13:3600:13:40
nodule, and then I can push in a little
00:13:4000:13:42
bit, get the pressure that I need which
00:13:4200:13:45
the pressure that I need is just pushing
00:13:4500:13:49
in until I get a little kickback from
00:13:4900:13:51
the tissue. So I'm going to go right up
00:13:5100:13:54
to the point where I feel an increase in
00:13:5400:13:57
tissue density and then I'm just going
00:13:5700:14:00
to lay my arm down, and allow the table
00:14:0000:14:03
to keep my arm there. So the friction
00:14:0300:14:06
between my arm and the table is actually
00:14:0600:14:09
whats keeping me in position. I'm going to
00:14:0900:14:11
hold for 30 seconds to 2 minutes and
00:14:1100:14:14
wait for a nice release. Melissa how's that
00:14:1400:14:17
feeling? Ok. Starting to relax a little
00:14:1700:14:22
bit. Good this other trigger point guys
00:14:2200:14:24
is a little tricky, a little bit more of
00:14:2400:14:27
an advanced palpation. It is just
00:14:2700:14:33
anterior to the upper trapezius. So this
00:14:3300:14:34
is the upper trapezius and I can
00:14:3400:14:37
actually kind of pull this away, and then if
00:14:3700:14:40
i push down in here I have to make sure
00:14:4000:14:44
I stay just posterior to my transverse
00:14:4400:14:46
processes, which you can feel is these
00:14:4600:14:50
like bony tips right in here. Now these
00:14:5000:14:52
are not something you want to press real
00:14:5200:14:53
hard on. You press down on somebody's
00:14:5300:14:55
transverse process you make them very
00:14:5500:14:59
very uncomfortable. If I go right on top
00:14:5900:15:01
of the transverse process I end up on
00:15:0100:15:04
the scalenes. If I go too far back I end
00:15:0400:15:09
up on the Splenii, but if I kind of
00:15:0900:15:13
follow the levator scapula up.
00:15:1300:15:17
Note how those taught bands feel
00:15:1700:15:19
underneath my fingers, and then fall
00:15:1900:15:24
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.