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Rectus Femoris and Vastus Intermedius Static Manual Release
The Rectus Femoris and Vastus Intermedius Static Manual Release is a technique used to release tension in the quadriceps muscles. This technique is achieved by applying slow and gentle pressure to the desired region while the patient actively moves their leg through a full range of motion. This helps to break down scar tissue and fibrosis, resulting in improved range of motion and alleviating pain caused by muscular tension.
Transcript
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This is Brent of the Brookbush Institute.
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...blank
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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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surface,
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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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around,
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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
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