0:04 This is Brenda the brook Bush Institute in this video. We're going 0:07 over manual therapy techniques specifically instrument assisted soft 0:10 tissue mobilization. Now, if you're watching this video, I'm assuming 0:13 that you are a licensed Medical Professional with instrument assisted 0:16 soft tissue mobilization within your scope 0:19 of practice. Now, there's some gray area here not every 0:22 state has legislation around these tools. If you're not sure 0:25 check, I would hate to see somebody getting in trouble because 0:28 they watch one of our videos and used 0:31 it on a patient or client when things did not fall 0:34 within their scope of practice act. Now these tools 0:37 just like all of our other techniques fall within 0:40 a model of practice and we are very 0:43 big on assess a dress reassess. So 0:47 even though these tools are specific to 0:50 perhaps fossil tissue. We're still 0:53 going to base their use on reliable assessments. 0:56 We're going to use these techniques 0:59 and then we're going to reassess and if they're not 1:02 effective we're not going to use them again for 1:04 That particular patient or problem in this 1:07 video. We're going to go over instrument assisted soft tissue mobilization for the 1:10 pectoral. Fascia. I'm going to have my friend a vet come out. She's going 1:13 to help me demonstrate. We'll do a little bit of the anterior deltoid 1:16 fascia as well. Now she's gonna lay down 1:19 in supine which is going to help us get her 1:22 out of like an active position. We don't want the muscles active. 1:25 She is gonna put her hand behind her head though and 1:28 let this elbow come down which is gonna put a little bit of tension 1:31 through her pectoral fascia. It is kind of important to 1:34 have a little bit of stretch. Otherwise these techniques don't 1:37 work all that. Well, I think you guys will find like if you do this and 1:40 we're to shorten the fashion try to scrape through like 1:43 there's just scraping through mush. You don't get any feedback. 1:46 Now we did ask her to pull her arm out 1:49 of her tank top here and sports bra right because 1:52 we want to get to all of the pectoral fascia and then 1:55 when I had her do just a little tip for you guys, like she's pulling 1:58 down the center of this very tight 2:01 athletic gear that she 2:04 has on 2:04 that I can get to all all the way down to her sternum 2:07 and then she's using her fingers to cover 2:10 herself up so that I don't risk bumping her with the back 2:13 of my hand and stuff as I'm doing this techniques. Obviously, we 2:16 don't want to let embarrassment or the 2:19 chance of touching sensitive areas getting 2:22 the way of doing just really good physical therapy. 2:26 So the first step we're going to do is we're going to add a 2:29 little bit of the Smart Tools cream. We do need some sort of 2:32 lotion or oil on the skin. Otherwise, we just 2:35 end up like exfoliating the skin. It doesn't feel very good. 2:40 Just need a little bit. If you use too much, it's okay. 2:43 All you're gonna do is I guess over moisturize. 2:48 Guys will notice that I put the clean tool 2:51 in the lotion and not my fingers. That's 2:54 just to help keep from spreading any Gunk or 2:57 bacteria as I use that lotion for 3:00 patient after patient much better to put a sterilized 3:03 tool in there once I get 3:06 all of this lotion rubbed in 3:10 all right the next step. 3:13 Is going to be to scan right so our first step. 3:16 with the tool is always to scan the 3:19 tissue to look for areas that 3:23 are not even are not the same as other 3:26 tissue in the area. So I'm just going to go ahead and start here. 3:29 You guys will notice I'm using this. This shark's tool. 3:32 Usually I would use the scanner tool. But of 3:35 that here is kind of a small person. So the scanner tool 3:38 would would take up. 3:40 A good portion of her torso. It's just not going to work out very 3:43 well. So as I mentioned in other videos use the 3:46 tool that fits the area that you're working on. I'm just 3:49 going to use the convex surface on 3:52 the shark fin tool and take one pass. 3:56 noting any change 4:00 in tissue 4:01 and what I noticed just there guys is I came through here. 4:04 This was all smooth. And then right as I got up in here. I 4:07 felt a little bump like this this tissue 4:10 definitely doesn't feel like the rest of it. All right, 4:13 so then we'll go to the next patch here. 4:17 And same thing right in that area right 4:20 in the pectoral fascia deltoid fascia interface. We 4:23 have a little bit of like 4:25 some different tissue texture. And so 4:28 I'm going to kind of go through here with my other hand one more 4:31 here. 4:34 All right. We do have some some stuff at the edge here. 4:38 Tends to be a sensitive area right in through 4:41 here the lateral border of her Peck, right 4:44 as that pectoral fascia runs through now, I 4:47 know you guys can find videos on like axillary fascia 4:50 techniques with this stuff. I actually don't recommend it. 4:53 I've never found good outcomes with it. I've 4:56 never seen changes in shoulder Mobility or pain with it 4:59 and there is so many sensitive lymph nodes and nerves in 5:02 through this area. I personally just don't like to take 5:05 the risk. If you have a good reason for doing it by 5:08 all means give it a shot. But keep those 5:11 those sensitive structures in the back of your head now after 5:14 we've gone through and I kind of took a mental 5:17 note that through here. I have changes 5:20 in tissue. We've talked a little bit about this binding of 5:24 fossil layers and how that might affect mobility and 5:27 what we're gonna do to address that is we're 5:30 just going to scrape a few times in each 5:33 direction. We're gonna hold the tool at about a 30 degree angle 5:36 and I'm just going to kind of come through here and go 5:38 One two three four, maybe go 5:41 this way for four. 5:44 I come up for four. 5:48 30 degree angle. Sorry one two, three 5:51 four, maybe come 5:54 this way a little bit. 5:56 Good, and then I might do that a 5:59 little bit here, too. 6:02 Just a couple different angles. 6:06 Just kind of working my way around and like a clock like pattern. It's 6:09 a good idea to keep in mind. 6:12 that fascia 6:14 does not fall in line with the 6:17 direction of the muscle. 6:19 Often you'll have like crosshatching of fossil layers 6:22 and that disorganized. 6:26 Fossil binding that can occur definitely happens in 6:29 all directions. So don't worry about trying to follow the 6:32 fibers as much as just breaking up every direction to 6:35 try to get some smoothness back. Now you guys will be 6:38 able to see when we do the close-up recap. We have a little bit of petechiae here, 6:41 right? So that's maybe some indication that there 6:44 was inflammation there at one point. She had some hypercapularization but 6:48 I don't consider petechiae therapeutic like 6:51 petsiki. I are more coincidental. 6:55 The particular themselves don't actually help us or 6:58 are indications that we did enough therapy. 7:01 They might be indications that we need to. 7:04 Settle down and maybe not do any more thing anymore therapy 7:07 because the next step after petechia. I will definitely 7:10 be bruising. Now the one other thing I want to show you guys is 7:13 if you use 7:16 the tool like this 7:19 right now 7:20 I can get into here. 7:23 And I can go lateral. 7:26 Sorry, let's just let me have you tilt your 7:29 head this way for me good. 7:31 All right, and now I can get around that lateral 7:34 border over pectoral. 7:36 fascia into her anterior delt 7:39 It just fits real nice 7:41 This isn't something special or complicated 7:44 or an advanced technique. I 7:47 literally just found a tool. 7:49 With a surface that matched the 7:52 surface. I was trying to go over. 7:54 And since when I scanned all of her change 7:57 and tissue texture or the abnormal texture 8:00 texture was all in here. It was worth me trying to go over 8:03 this area. 8:06 Now once I've done my disruption of fibers now, obviously I can only 8:09 go in two directions here. Once I've thought about disruption of 8:12 that collagen Matrix between fossil layers. 8:15 The next thing I might want to go after is trigger 8:18 points, so I have noticed that if 8:21 I kind of do like a 8:24 Cross friction around trigger points the 8:27 idea being that we're affecting any 8:30 scar tissue or extra connective tissue that's 8:33 been laid down around that dysfunctional motor 8:36 end plate. I do see a little bit of a 8:39 better carryover from some of my trigger point therapy 8:42 stuff like static release techniques or foam 8:45 rolling. So imagine if we had a trigger 8:48 point here at the just just 8:51 lateral to her sternum, which is a very common place 8:54 for pectoral trigger points. What I might do is just 8:57 kind of go 9:01 all the way around 9:03 just kind of breaking stuff up. 9:14 and once I've got all the way around 9:16 You know, maybe 12 to 20 Strokes. 9:21 I'll call it a day. She's already starting to get pretty red there. Now the 9:24 last thing you might want to do, right? So we did the disruption 9:27 in many directions. We did 9:30 kind of the Cross friction in all 9:33 directions around our our trigger points is now 9:36 we can do that like pin and stretch more active 9:39 IAS TM technique. 9:43 So actually you know what? I'm gonna 9:46 stick with this short this shark tool. What I'm gonna have her do is I'm gonna 9:49 I'm gonna take her arm like this. 9:52 I'm gonna place. 9:54 The tool right at my 30 degree angle. 9:57 This is gonna pin my tissue. 9:59 Right, and now what I can do. 10:02 Is pull her arm? 10:04 through that pen tissue 10:06 So this is just like the pin and stretch technique you 10:09 guys have done manually. We're just doing them with the tool, which is 10:12 probably affecting just The Superficial layers a 10:15 little bit more. 10:16 I can stay real passive with a static tool. 10:24 Maybe the next thing I can do. 10:27 Is have her actively pull back? 10:30 Right, so pull down towards the table. Actually. There you go, and 10:33 then I can use overpressure. 10:36 Like it's a little bit more intense. 10:38 And then maybe the most intense thing I can do. 10:41 I'm gonna readjust here because I've beaten that tissue up a little 10:44 bit. Maybe the most intense thing I can do is as she's 10:47 pulling back. I'm gonna apply over pressure and I'm 10:50 gonna pull the tool. 10:53 Through the tissue a little bit. 10:55 So that's getting real intense. 11:01 Good. 11:02 All right guys, so there you guys have it. 11:05 Some important things to remember one. These are 11:08 superficial. 11:09 techniques, I don't see a reason to 11:12 believe that iastm is gonna affect like the the 11:17 pectoralis minor fosh or the clavicular fossa 11:20 that are deeper layers. I don't think it's gonna work that well 11:23 so you don't have to attack people with these tools 11:26 we get things very superficial her position 11:29 is probably the most important thing to remember which was supine we 11:32 put her hand up overhead which just made everything 11:35 real easy to access and put a little stretch on these tissues and then 11:38 guys this little trick with their hands, especially if 11:41 you're a guy dealing with the opposite sex, don't 11:44 forget about that stuff. It'll make things a lot more comfortable for 11:47 you. And then and of course, we don't want little stuff like 11:50 that getting in the way of great physical therapy. 11:53 We did scanning. 11:55 With the scan we were looking for abnormal. 11:58 Tissue texture once I found where 12:01 that abnormal tissue texture was. I did all of my 12:05 cross 12:06 in different direction 12:08 strokes and and guys just do whatever 12:11 is comfortable. I kind of generally use like a 12:14 sweeping stroke in all directions because it's 12:17 comfortable for me if you'd rather use both hands. 12:20 Just put the tool at a 30 degree angle and use both 12:23 hands going through all directions find the stuff 12:26 that's comfortable find the tool that fits after I did 12:29 that. I went after a trigger point here that we found in her her pectoralis major 12:32 and I'm just noticed a little bit better carryover when 12:35 I use iastm those trigger points tend to calm 12:38 down a little faster from session to session and then the last thing we 12:41 did which is great for function, but definitely more 12:44 intense was the pin and stretch 12:47 techniques guys. Stay tuned for the close-up recap. All 12:50 right guys for the close-up recap. Just wanted to go through each of 12:53 The Strokes here on our pectoral 12:56 Foss a little bit of our anterior deltoid. 12:59 Fascia. Of course, I'm going to use a little bit of this smart tools 13:02 cream. 13:04 You just need something to lubricate the skin. 13:08 right 13:09 We can use our hands a little bit, you know 13:12 be careful notice. I have a vet using the same hand 13:15 position as the last video to make sure 13:18 that we don't accidentally bump sensitive areas. 13:24 Go ahead and pull your hand. There we go. That's good. 13:27 cool 13:29 Great. All right. Now of course, we're gonna start with those scanning Strokes. 13:32 So I'm just gonna actually you guys 13:35 can kind of see how this is the scanning tool and Tiny event 13:39 here. She is kind of a small person like this just 13:42 doesn't gonna work. 13:43 So we'll go with a different tool. 13:46 All right, sometimes we just have to do what works as opposed to what's optimal. So 13:49 we'll scan with our shark fin tool. 13:52 And I'll come through here. 13:55 And I'll notice a little bit as function right there. All right, 13:58 and then I can come back through this way. 14:02 And same thing. I noticed this function here. I notice like 14:05 sorry this functions maybe a two general 14:08 word. What I notice is an inconsistency in the tissue. It's 14:11 a little bumpier here than it is down here. 14:14 And I just want to make sure I get a good scan of all the 14:17 tissue. 14:21 So all this in here is where we 14:24 have the issues. 14:26 So what we're going to do, of course is do our multi-directional Strokes now, so 14:29 I'm going to come through here and maybe I 14:33 Do some of these kind of 14:36 swiping Strokes that I use quiet often because they're just easy 14:39 on the hands. 14:41 Right notice. I'm just 20 to 45 degree angle. I've 14:44 pushed down right down to the muscle tissue and I'm 14:47 just creating a Shear force with all of that. Fascia. 14:51 This way and although this way. 14:54 This is a pretty sensitive area. So, you know 14:57 be intentional don't take your time. 15:05 remember hand position and strokes like 15:08 we're just trying to go in a lot of different directions. 15:14 this way 15:16 try one handed this way. Maybe that'll work 15:19 a little bit better for me. 15:20 That does seem to work pretty good. And then I'm 15:23 gonna come down this way. 15:25 Same thing. I just want to address all of this tissue where 15:28 I felt a little bit of tissue dysfunction. 15:31 As many directions as I can get. 15:36 She's not developing petite Kia on this side and the other side. She 15:39 definitely had some fatigue. I think I need just a little bit of lotion. 15:44 Alright, the other thing I like to do with this area. 15:49 and again guys better off with too much lower than too little too 15:52 little ocean and like burns the skin like a 15:56 bit of a rug burn almost 16:03 worse that's gonna happen is you'll just get a little build up on the tissue if you use are 16:06 on the tool if you use too much. 16:08 All right, so that 16:11 other technique I like to do to 16:14 break up these dysfunctional. 16:16 layers is this tool like a 16:19 tool with a curve in it works real good for that lateral border 16:22 of the PEC so we can try to 16:25 kind of frame 16:28 the lateral border and you can see that's cringing 16:31 a little bit which is some of the stuff is 16:34 pretty uncomfortable. You just want to be intentional and get 16:37 it done. 16:40 See she's developing just a little bit of tiki up in here. 16:46 Now the other things we can do is go after those trigger points. 16:50 So if I had a trigger point here? 16:53 And we have come through try to break up as much as I can. 17:00 And once again, you don't have to use this tool. 17:07 Maybe you want to use the edge of this tool. 17:11 It's going to be a little bit more intense though because of how small the surface 17:14 area of this tool is. 17:18 Definitely got a vet cringing a little bit. 17:21 All right, so breaking that up might help our carry over a little bit on our 17:24 trigger point techniques. 17:26 And then the last thing we're going to do again is pin and stretch. 17:30 So I'm going to use my broader tool here. 17:34 At the same way, I would to do my disruptive Strokes. 17:39 and only 17:41 what I want to do now. 17:43 Is I'm gonna start here with her arm 17:46 up pin the tissue and then pull 17:49 down and through. 17:55 pin the tissue 17:57 pull down and through 17:59 I might even be able to try a couple different angles. 18:02 Pull down and through and then of course we can we've talked 18:05 about how to increase the intensity a little bit we can go active have 18:08 her polar arm down towards the table. I 18:11 can add a little overpressure. I know you guys can't see that now, but you can see that 18:14 in the other take and then of course if I want to get really intense I 18:17 could have her polar arm down to the table do over 18:20 pressure as I'm pulling the tool through 18:23 and you can even see an event's face that is 18:26 definitely an intense technique. Once again, you 18:29 guys are only doing two to five repetitions of those pin and 18:32 stretch techniques in any one area because they are so intense 18:35 because if you have any questions, please leave them in the comments box 18:38 below. I hope this video helped give you some 18:41 confidence to start using these instrument assists itself tissue mobilization techniques. 18:44 So there you have it instrument assisted soft tissue 18:47 mobilization, make sure to assess 18:50 Address using the intervention and then 18:53 of course reassess and if you get the chance 18:56 these videos are not a replacement 18:59 for live education. Of course, if 19:02 you get the chance, you should take live workshops or find 19:05 a mentor who's experienced using these tools or 19:08 maybe a friend that wants to learn them 19:11 too. So at least you can practice on each other and give each 19:14 other some tactile feedback of what you feel how you 19:17 felt the next day what results you felt that 19:20 you got. 19:21 I hope you guys enjoyed this video. Please. Feel free to leave 19:24 your questions below.
