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This is Brent of the Brookbush
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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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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.