0:04 This is Brent of the Brookbush Institute in this video we're going to go over 0:07 manipulations or high-velocity thrust techniques. I assume that if you're 0:11 watching this video you're watching it for educational purposes and that you 0:14 are a licensed professional with high velocity thrust or manipulation 0:18 techniques in your scope of practice. If you are not sure check with your state 0:24 board. Most physical therapists, chiropractors and osteopaths you're in 0:28 the clear. I believe that ATC's you can't do manipulations in the United States, 0:33 although other countries again check your scope. Of course massage therapists 0:38 and personal trainers these are generally not within your scope, of 0:41 course you could continue to watch these videos just for educational purposes, 0:47 learn a little Anatomy, learn a little biomechanics. If you're going to do these 0:51 techniques please make sure that you have a good rationale for putting your 0:56 hands on a patient, this should be based on assessment, and if you're going to 1:00 assess I'm hoping that you'll assess, use these interventions and reassess to 1:06 ensure that you're getting the result that you're looking for and have good 1:09 reason to continue using this technique. In this video we're going to go over radial 1:13 head manipulations. I'm going to have my friend Yvette come out, she's going to help 1:15 me demonstrate. Now remember if we're doing manipulations we're doing them to 1:18 increase joint mobility based on not just subjective symptoms, but some 1:22 objective tests as well. So I might do some passive accessory motion 1:26 but also maybe some elbow flexion extension, maybe some pronation 1:31 supination goniometery so I have something to use for reassessment after 1:35 this technique. Now I have seen a couple of different techniques for the radial 1:40 head, and supposedly one of them's for the proximal radioulnar joint, the other 1:45 ones for radial humeral joint, and the only consensus I have to tell you 1:50 is they probably both do both. I think sometimes when we get a little too 1:55 detailed about our biomechanics we actually lose a little bit of our 1:59 accuracy. So what I'm going to tell you is try both of these techniques, they 2:04 both probably work fairly well, and a lot of it probably depends on what you get 2:09 comfortable with. You might find that you get a lock position in one and not in 2:13 the other. You might find that it depends on which patient you have, 2:17 whether you can find locked position. So they both have a few things in common, 2:23 number one, all of them involve this underhand grip of the distal humerus 2:28 with palpation of the radial head. Now if you've never palpated the radial 2:35 head what you could do is just reach on either side of the brachial radialis 2:39 real close to the elbow, and start pronating and supinating the wrist, and 2:44 you'll actually get to a point where you feel the radius go out until 2:50 like a disc shape, and you can feel it spin underneath your fingers. So once, 2:56 once you have that thing spinning under your fingers right, now I want you 3:01 to stick your thumb right there, alright so your thumb is going to be applying 3:07 this type of force that is the big manipulative motion. Now the question is 3:16 how do we get lock out? Lock out comes in one of two forms, you either see 3:23 people do a lot of supination, or you see people do pronation. I really think if 3:32 you get to the end of either one you end up locking out this joint. 3:36 Alright so either here or here. So now we got that, we'll start with this one. All 3:43 right this one I find tends to be a little bit more general elbow because 3:46 you get so much of this snapping going on without as much radial head 3:53 motion. But once you get here now the force is going to be kind of into 3:59 extension while I press posterior to anterior with my thumb, and it's going to be 4:04 a little varus force too, which is the equivalent of me trying to take her arm 4:10 and break it this way. I'm not going break your arm I promise. Okay so just a 4:15 little bit of force this way, we're just kind of like as we're pushing into 4:18 extension we're kind of pushing this way with extension. So I said 4:25 it's extension with a little bit of this way, and I'm going to go ahead and finish 4:29 out with supination while keeping this thumb really rigid. So the first thing 4:34 I'm going to do, is as I do this combination of techniques I got to find my lock, 4:40 there we go we're getting there we're building off all that tension. All 4:44 right you can tell Yvette love's manipulations, she's been so kind to 4:48 volunteer for these videos, and then once I get there, that's it, it's just a little 4:54 whip. All right sorry I did it to you twice. All right so there you have 4:59 it. Now we didn't get a cavitation there, but don't forget that with manipulations 5:03 the success comes from doing the manipulation not from hearing a sound. I 5:08 would reassess and see what this did to her concordance sign, what it did to her 5:14 continuous interval measures like goniometry and see if I got a 5:18 successful manipulation before I just sit there and keep yanking on her arm. 5:21 Could I have missed, absolutely. I'm far from perfect when it comes to these 5:25 techniques, but you don't want to just keep grinding away at a technique 5:29 assuming that you missed because you might have been very successful and now 5:32 you're just flaring things up. Now the other technique all I'm going to do is use 5:37 a little bit of wrist flexion, you don't have to do this, but just a little bit of 5:41 wrist flexion this is kind of like a modification of what's called the Mills 5:44 manipulation. It's still the same position here, I'm still kind of bringing into 5:51 that same bit of varus force, so the bendiness, and this is actually the 5:59 technique I prefer because I tend and find it a lot easier to get a lock 6:03 position here, and I find that I don't have to get all the way into elbow 6:07 extension, which on a humeral joint or a humeroulnar joint extension can 6:15 be a little painful at the end range. Instead I can get locked out 6:19 short of full extension and then once I'm there and I get all of it, and you 6:24 you can see in Yvette's face we're there. All right and then it's just 6:28 a whip, and we actually got a nice little cavitation on that one. All right good 6:33 stuff. So the one I prefer again is just a modification that Mills technique, 6:38 just a little bit of wrist flexion so you can just grab the hand like 6:41 this, we're going to pronate all the way, and then I'm pressing up with 6:47 this hand as I apply a posterior to anterior force this way, and then it's 6:53 just a little whip right, and I'm not just so you are clear, I'm not 6:58 pulling her all the way into elbow extension, we were actually short 7:01 of elbow extension, and I think if you practice this a little bit slowly 7:04 first, you will feel that if you twist all the way this way and push up a 7:11 little this way, you actually hit lock before you hit full elbow extension 7:15 if you were to let this relax. All right if you have any questions on this 7:19 technique, it is tricky. It takes some practice, the lock position is 7:25 deceptively hard to find on this particular technique, but practice with 7:30 with some friends and some colleagues, and then maybe find some patients who 7:36 aren't elbow patients to start. So what I mean by that is you know this could have 7:41 a positive effect on an upper-extremity issue that's mostly shoulder, but you 7:45 know you manipulated their elbow because you think it might help, 7:49 this is a little trick I am teaching you, as in don't start practising on elbow 7:54 patients, practice on patients that elbow manipulation might help some other 7:58 symptoms somewhere else. If you have any other questions leave them in the 8:02 comments box below. a couple of points to recap, knowing your anatomy and knowing 8:07 your biomechanics will certainly help you choose the right technique for the 8:11 right patient. if you're unsure whether manipulations are appropriate due to 8:15 their higher intensity it's okay to do mobilizations, most research points to 8:21 manipulations being slightly more effective, but mobilizations being very 8:25 effective, and of course we have those videos for you if you want to start with 8:29 those less intense techniques. Make sure that if you are doing any technique that it 8:35 is based on assessment, and of course that you're reassessing ensuring that 8:38 the technique is effective for the patient that you're working on, and when 8:42 it comes to all manual techniques, manipulations maybe more than any other, 8:46 look for opportunities to get live education. Although I know videos are 8:52 convenient and I'm happy to have these up for you to watch, it would be so 8:57 much more helpful to use those videos as a recap of one-on-one attention with 9:04 somebody who's experienced with manipulation techniques. At the very 9:09 least grab a colleague, grab a friend and start practising these before you bring 9:15 them into clinic and start using them on patients and clients. I hope you enjoyed 9:20 this video, if you have any questions please leave them in the comments box 9:23 below.
