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