Posterior Deltoid Manual Static Release
Posterior deltoid manual static release is a manual therapy technique used to reduce tension and improve mobility in the shoulder joint. It is designed to target the back of the shoulder, commonly known as the posterior deltoid, by using static pressure and gentle manual movements. The technique combines stretching and soft tissue massage to target any scar tissue, knots, and other muscle restrictions. This type of release can help to restore range of motion, reduce pain and stiffness, and improve overall shoulder health
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 doing
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static manual release of the posterior
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deltoid. If you're watching this video,
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I'm assuming you're watching it for
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educational purposes and that you are a
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licensed manual therapist. That is, the
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laws around the scope of practice in your
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state allow you to do manual techniques.
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If you're unsure what those laws are,
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please look them up. I'm assuming
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chiropractors, athletic trainers, physical
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therapists, massage therapists, osteopaths,
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you're all in the clear. Personal
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trainers, this probably does not fall
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within your scope, although you could use
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the palpation portion of this video in
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an educational setting to help you with
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your anatomy. I'm going to have my friend,
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Crystal, come out and she's going to help me
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demonstrate the technique. Now, before I
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put my hands on Crystal, I want to be
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very certain that this, or at least
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fairly certain that this technique is
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going to either improve her symptoms or
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improve her performance. The only way to
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get there is with assessment. Posterior
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delt is a little weird. We think
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about most of the time people get too
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internally rotated. We think of the
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posterior delt as long, but due to some
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more complex human movement science
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issues, this muscle tends to become long
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and overactive, synergistically dominant
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for an underactive infraspinatus and
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teres minor. So, we do have good reason to
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do this technique if things like arms
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fall on the overhead squat assessment or
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a lack of internal rotation in goniometry
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pop up during our assessment
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and evaluation. Now, all of our manual
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techniques follow a very similar and
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fairly simple protocol, especially if you
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know your anatomy. We're going to palpate
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and compress. We get bonus points for
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knowing where our trigger points are to
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help us aim our hands, aim our fingers
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to the tightest points within that
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muscle. We want to know if there's any
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other structures that could be insulted
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or injured by compression in the same
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area. In this case, not really. Potentially there's
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the axillary nerve if we really, really
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pressed hard with somebody with a little
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bit of out of the ordinary anatomy. But,
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again,
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the axillary nerve at this point would be very,
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very thin. You just move a millimeter or
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two in either direction and you'd be off
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that. And, of course, we want to think
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about body position, which I'll get to
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here in a second. So, you guys know where
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your palpating. We're just literally
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doing the posterior one-third of the
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deltoid. That's going to be our
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palpation area. So, on Crystal, here,
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because she's got nice, defined, strong
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deltoids, you can actually see the shape
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of her deltoid, and you can think there's
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the back third. Even on somebody who's a
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little larger, a little less fit, has some
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more adipose tissue, I'm pretty sure you
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guys will be able to palpate through
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that tissue and feel this upside down
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triangle shaped muscle, and maybe even
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feel this border where the the triceps
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begins. This is usually a pretty good
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border on most people. If you get a
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chance, you might start by practicing on
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somebody a little leaner- faculty,
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professors, teachers out there. I
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definitely suggest when you can finding
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a nice, lean, fit person to start these
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techniques with, because I think the
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better visual model up here we can get,
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the easier these techniques become on
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those individuals who are a little less
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fit or are a little larger. Alright, so
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now that we're on the posterior third,
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we know that the fiber direction is
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this way, so what I'm going to do is
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strum this way to find those denser
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fascicles, those fascicles that are a
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little more active than the rest. I
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feel right here, these are some nice
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dense fascicles. Now what I'm going to do
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is I'm going to move from distal to
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proximal to see if those fascicles are
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related to an overactive point or nodule. I'm
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going to find a nice nodule right there,
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and then all I'm going to do is press
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into the tissue until that first
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resistance, not even first resistance, but
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that that point where the the muscle
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starts increasing in tension. Alright, so
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I've talked about how if you press in,
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you start getting a little
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tissue tension, a little bit of tissue
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tension, and all of a sudden it increases
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pretty rapidly. I'm going to go right up
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to that point. I don't really want to try
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to push through the tissue tension. Once
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I get there, I'm going to hold for 30 to
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120 seconds. Any sort of nervy feeling
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like burning, tingling? No, so chances are
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we're not on a nerve. It just feels tender,
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right? Is it starting to go away? It's
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starting to go away. You guys will
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notice, right where my thumb ended up you
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see that little X. That is the common
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point of the trigger point. If you can't
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see it now, you'll see it in our close-up
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recap. Now, the one thing I'm not doing
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very well here, guys, is showing you what
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my body position should be. My patient or
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client's body position is lying on a
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table, fairly comfortable, fairly
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comfortable position. I do find that
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most therapists I talk to, they're really
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good with keeping their clients and
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patients comfortable. They're definitely
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caring people who want to make sure
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that their patient is as relaxed as can
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be and is going to stay with this
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process. What they're terrible at is
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watching their own posture, which has a
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lot more to do with the longevity of
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their career and is probably just as, if
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not more, important. We want you to be
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able to help a lot of people throughout
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a long career. So how would I
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particularly position myself? Number one,
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I wouldn't release the posterior delt on
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the opposite side of the body. I would
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stand next to the side that I wanted to
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release. What I'm going to do with
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Crystal, here, is I'm going to use my
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lumbrical grip, that kind of crab claw
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grip, right over the top of her
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elbow and forearm. This actually gives me
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good control over her forearm with my
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fingers, as well as control of internal
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rotation, external rotation, adduction,
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abduction, flexion, extension, like I have
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total control over her shoulder. Alright,
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so once I get this position here, I'm
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going to take this hand and I'm going to use
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that lumbrical grip again. I'm going to
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use my four fingers to help keep her
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scapula in a neutral
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position, and then I'm going to
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use my thumb straight down over the top
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of the tissue. I know you guys can't
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quite see that. You'll see it in the
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close-up recap though. I'm going to use
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my thumb straight down over the top of
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the tissue so that I
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can use this hand to pull a little bit
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into adduction and internal rotation.
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That'll tense up those tissues a little
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bit. And then, I'm coming at an oblique
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angle to pin down that tender nodule,
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because what I don't want to do is start
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playing that game of trying to put my
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finger on top of a marble. You know, it's
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like put your finger on top of the marble and it spits
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out this way, and you put- right? So what
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we're going to do is we're going to use
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the fascicles themselves to kind of
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pull long, so that will help center
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that marble. And then, rather than come at
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it like this, I'm going to kind of come
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this way at the marble so that it stays
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pinned down. And so, here, here, and I can do my
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strumming from this position, and then
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once I find those fascicles and I find
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that nice tight point, I can straighten
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my body out. I can add a little tension
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here and I'm just going to wait for that
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nodule either to melt away underneath my
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finger, to notice that the tissue isn't
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giving me much tension back anymore, or
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what I might even notice, since I kind of
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have her pulled into horizontal
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adduction and internal rotation here, is
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her arm starts to give way a little bit.
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That would be a good indication that
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those fibers have started to tone down
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and relax. Next, we'll show you our
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close-up recap. Now, for a close-up recap.
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You guys can see I have that lumbrical
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grip over Crystal's elbow here and a
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little bit over her proximal forearm. I
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can control her forearm with my fingers.
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I can control internal and external
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rotation or horizontal adduction
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horizontal abduction, which is going
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to come in handy for increasing or
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decreasing the tension in her posterior
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deltoid. You can see her posterior
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deltoids here. You can see this line, right
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here, where triceps come off. This,
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right here, is our posterior delt.
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I got that trigger point, that common
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trigger point for the posterior deltoid
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marked off. Now what I'm going to do is
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I'm going to take my other hand, and it's
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also going to be in a lumbrical grip,
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because I'm going to use these four
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fingers to control her scapula so she
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doesn't get all up into elevation and
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upward rotation. I can kind of pin
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that down. But then, I'm also going to use
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my thumb in this direction, because this
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distal to proximal force along with a
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little force from superficial to deep is
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going to help me pin any trigger point
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or nodule of overactivity. I'm going
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to want to do my strumming this way,
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since the posterior deltoid fibers run
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this way. And again, I can just kind of
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move my thumb back and forth looking for
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the tightest fascicles. And I notice
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right here, nice tight fascicles. And then,
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I can move from distal to proximal over
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that nice tight fascicle until I see if
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there is a nodule or some little point
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of increased density. I found it right
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there, right about where I have that
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trigger point marked off. Now I'm
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going to go ahead and
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add some compressive force right up to
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the point where I get some good tissue
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resistance, not past it. I think you guys
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will find that you push into soft tissue
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and it's pretty soft, and then all of a
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sudden you get a big increase in tissue
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resistance. You're just going up to that
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point, not past it, and then I'm going to
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go ahead and hold if I want. I can add
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some tension this way by adding a little
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horizontal adduction and internal
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rotation to either help me pin the
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tissue by kind of pulling these fibers
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this way so that we don't get as much
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play this way, or maybe I feel like I
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don't have enough tissue
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resistance, so I can pull this way.
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I'll hold that until I either feel that
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density melt underneath my fingers,
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Crystal tells me that she's no longer
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feeling anything
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from that pressure, or all of a sudden
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her shoulder starts giving way into
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internal rotation or horizontal
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adduction. So there you have it, static
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manual release of the posterior deltoid.
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Make sure before you attempt this
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technique that you practice it on
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friends, colleagues, with a mentor. Maybe
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even take a live workshop on manual
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release techniques and then come back to
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this video for review. If you're going to
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put your hands on somebody, ensure that
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you have a good working hypothesis that
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this technique is going to either reduce
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symptoms or improve performance. The
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only way to get there is assessment. I
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hope you guys have enjoyed this video. I
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look forward to seeing your questions.
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Please leave them in the comments box
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below. I'll talk with you soon.
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