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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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manual static release of the rectus
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femoris and vastus intermedius, those
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middle quadriceps muscles. If you're
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watching this video, I'm going to assume
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you're watching it for educational
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purposes and are a licensed manual
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therapist. That's physical therapists,
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ATC's, chiropractors, massage therapists...
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and you are following the laws dictating
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your scope in your state. If you're not
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sure what those laws are, or whether
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you're allowed to perform manual release
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techniques, please look those up before
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trying these out on patients or clients.
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I'm going to have my friend Melissa come
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out, she's going to help me demonstrate
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this technique. The only rough little
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thing you need to know about rectus
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femoris or vastus intermedius static
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release technique, is the position to put
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your patient or client in. If you try to
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pin down trigger points, pin down
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hypertonic nodules, or pin down adhesions in
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this position you're going to have a
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hard time. The muscles are going to feel like
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mush. You're going to play that 'finger
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tip on top of a marble' game, where it just
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keeps shooting out. What you need to
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do, is have your client or patient go
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crooked on the table. Hang their lower
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leg off the table, and you're going
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to use your thigh, just like
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you used your thigh to control plantar
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flexion or dorsiflexion on some of those
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lower leg release techniques that we did.
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Once we get here, you will see that
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I've marked off the rectus femoris
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trigger point here, and the vastus
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intermedius trigger point. Those are
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the common trigger points. Once again,
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trigger points are very related to
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motor points, or where the nerve
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innervates the muscle. We think this
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is where the the most dysfunction
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happens, especially in those overactive
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muscles. Once I know kind-of where these
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trigger points are, what I'm going to do
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is use a thumb. A nice, broad
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to track over these fascicles,
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perpendicular to them, because what I
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want to do is find the densest
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fascicles in this muscle. Once I find
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some dense fascicles, I'm then going to
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move proximal and distal, remember that
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the rectus femoris originates in
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the AIIS, so that's up pretty
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high. I want to make sure that when I do
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my tracking here, my searching for a
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tight nodule, I go from origin, down.
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I find my tight nodule right
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there, and then what I'm going to do is,
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once again, I'm going to use a broad
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surface here to block that that trigger
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point, make sure I pin it down with a
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little distal to proximal force, and
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anterior to posterior force. Then I
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can even help to center and
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stabilize that trigger point by pulling
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these fascicles taut, by giving just a
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little pressure into knee flexion.
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Again, broad surface over that
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nodule, little distal proximal force,
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and anterior to posterior force, as I
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push a little bit in the knee flexion.
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I'm then going to use this groove right
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here in my hand over my thumb to apply
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pressure. Once I apply some pressure, I'm
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going to go right into where I feel a
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little give back in that tissue density.
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I don't need to go too far. I don't need
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to try to kill Melissa with pain. Just
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right up to where the tissue starts
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giving back a little bit, and then I'm
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going to hold patiently while it lets go.
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Usually this takes 15 to 30 seconds.
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I think Melissa can start feeling it right
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about now, I can actually start to feel
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the tissue melt underneath my thumb.
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Melissa will probably feel a little
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reduction in the discomfort. Once I'm
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done with that trigger point,
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let's go a little lower. Let's look
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for these trigger points, and maybe
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vastus intermedius. Notice I take
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some of the pressure off the leg, and I
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started doing these perpendicular kind
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of strokes with my thumb, strumming over
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those fascicles, looking for the tightest
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fascicles. I found one here. Now, it's
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about finding the knot that's pulling
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those fascicles tight. With the
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quads, it's going to take a fair amount
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of searching. This is a lot of muscle,
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these fascicles are very long, and there are a
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ton of them, so be patient with yourself.
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This isn't a race. It's not a game to see
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who can get the quickest release.
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Accuracy is far more important, so take
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your time finding the most dense
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fascicles. I found that
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nodule right there, I'm going to use that
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nice, broad, thumb stroke to create
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distal to proximal, and anterior to
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posterior force, as I stabilize that
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trigger point a little bit
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underneath my finger, by placing her knee
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a little bit more into flexion. Then,
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this will be my dummy hand. No
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pressure on this hand, I'll use this hand
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with my shoulders over my hands, to
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create the pressure. Just one quick note,
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before we go into our close-up
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review... Notice that my hands are
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palpation hand on the outside, dummy hand
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on the inside, and if I flip my hands
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and I go after that rectus femoris
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trigger point, I think you're going
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to see where this hand is going to end
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up, and that's just not necessary or
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appropriate. Don't get yourself into
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trouble. This is your
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close-up recap. Notice that I have the
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rectus femoris and vastus intermedius
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trigger points marked. Try to memorize
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where those positions are. Notice
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the rectus femoris is fairly high. This
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is the anterior inferior iliac spine
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behind this soft tissue. The rectus
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femoris, goes all the way down to the
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knee, but this trigger point is really
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high. I'm going to use the same technique
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I always do of palpating across those
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fascicles, until I find the fascicles
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that have an increase in tissue density or an increase in tension. Once
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I find them, I'm going to go ahead
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and track that fascicle approximately
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all the way up to the AIIS in this case,
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and down until I find that little
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nodule or knot that I think is pulling
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the whole thing tight. Notice that I have
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Melissa kind of hanging this leg off, and
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I have her whole body crooked on the
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table so that she's aligned with this
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leg. The reason I have this is so that I
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can once again center that trigger point,
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make sure it's stable for me to press
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into by just adding a little tension,
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pushing her into knee flexion, so now I
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can use my nice broad thumb stroke here
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do a little distal to proximal force, and
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then use this hand again right over my
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thumb, right there in between my
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fenar eminences, press until I get a
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little pushback from that tissue density,
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and hold it 5, 10, 15 seconds. It'll start
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to melt away, and it'll probably
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completely disappear in 30 to 60 seconds.
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It does take a little practice, learning
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how much tension you should put into the
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system, because if you push too hard and
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constant pain, the muscle will kick
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back against you and you'll never get
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release. If you don't put enough, you
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probably don't stimulate enough receptor
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activity to get autogenic inhibition.
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Once I get a release here, of course, I
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can move on to vastus intermedius which,
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notice, vastus intermedius is much more
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in the center of the length of the leg.
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Again, I'm going to palpate across, find
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those dense fascicles, find the knot
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that's contributing to that density, and
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once I've got it, a little pressure
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into knee flexion with my thigh.
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That will help tense this line, center
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that trigger point, and then I can put
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some pressure over it. Like I
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said before, you're going right up
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against that tissue density, where it
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starts to really increase on you,
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and then you're just going to hold that
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spot. Please pay careful attention.
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Notice that my dummy thumb is on my
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outside hand, not my inside hand. You
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can imagine that if I started tracking
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proximally, I'm going to get my hands in
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a position that is not appropriate.
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Once again, dummy thumb on me on the
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outside hand, and then you're going to
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put pressure with your inside hand. So there
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you go. Vastus intermedius and
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rectus femoris static manual release
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techniques. Keep in mind if you're doing
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palpation and manual release, you should
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be 75-80% sure you
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have a solid hypothesis that's
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based on assessment, you believe those
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muscles are overactive. If we were
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talking about me, and I was going after
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the rectus femoris specifically, I
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probably saw something like an anterior
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pelvic tilt, or an excessive forward lean.
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Maybe the knees bow out on an overhead squat
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assessment. In goniometry, the rectus
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femoris can restrict both internal and
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external rotation of the hip. Maybe we
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did that muscle length test, the Ely's
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test, which is specific to rectus
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femoris extensibility.
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Once you guys have a good hypothesis,
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definitely don't be afraid to try rectus
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femoris and vastus intermedius release. I
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think you'll get great results if these
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muscles are involved in the dysfunction
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or pathology that you're working with.
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Make sure to try these techniques on
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colleagues and friends so that you get
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good practice and good confidence
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skills before you start placing your
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hands on patients and clients where a
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mistake could cost you not only outcomes,
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but maybe a client or patient. I look
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forward to hearing how this technique
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added to your repertoire improves your
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outcomes and improves the performance of
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your clients. Please feel free to write
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questions down in the comments boxes