Name: Rectus Femoris and Vastus Intermedius Static Manual Release
Uploaded: 2023-04-26T01:00:51.000Z
Duration: 11 min 26 s

English captions

https://stream.mux.com/ROO00eIy9iiRoUn9AtoYx9Y401c2ZFrzAunYVmFfTVVmE.m3u8

Learn the proper technique for rectus femoris and vastus intermedius static manual release (a.k.a. soft tissue mobilization, ischemic compression, trigger point release) in this comprehensive step-by-step instructional video from the Brookbush Institute. This evidence-based course provides detailed guidance on assessment, positioning, tissue differentiation, and pressure application to release trigger points, decrease muscle overactivity, and restore optimal quadriceps function. Ideal for clinicians and movement professionals, including physical therapy students, massage therapists, athletic trainers, and chiropractors, seeking to enhance their manual therapy skills for knee health, rehabilitation, and performance.

Introduction to Manual Release Techniques for Quadriceps

Preparation and Positioning for Effective Trigger Point Release

Identifying and Targeting Trigger Points in Rectus Femoris

Dynamic Techniques for Releasing Vastus Intermedius Trigger Points

Hands-On Techniques: Applying Pressure and Maintaining Correct Positioning

Practical Applications and Patient Assessment for Muscle Dysfunction

Closing Remarks and Encouragement for Practicing Techniques

Rectus Femoris and Vastus Intermedius Static Manual Release

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

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Manual release techniques for the commonly overactive hip flexor muscles. Soft tissue release techniques for the psoas and iliacus (iliopsoas), rectus femoris, tensor fascia latae, anterior adductors (pectineus, gracilis, adductors brevis, adductor longus, and adductor magnus) and vastus lateralis. Advanced soft tissue, massage, trigger point palpation, and mobilization techniques to inhibit antagonists. The reliability and validity of manual release techniques for anterior pelvic tilt, excessive forward lean, asymmetrical weight shift, knee pain, hip pain, back pain, sacroiliac joint (SIJ) dysfunction, and lumbopelvic hip complex dysfunction.

Static Manual Release: Hip Flexors (for Lumbo Pelvic Hip Complex Dysfunction)

 is a superficial muscle that courses vertically down the anterior thigh from the anterior superior iliac spine (ASIS) to the medial tibia, and the 

 course vertically, originating deep to the 

 on the anterior inferior iliac spine (AIIS) and inserting into the patella tendon of the 

This technique is likely easiest to perform with the patient/client in supine, close to the side of the table, with the target leg abducted enough to allow the lower leg to hang off the table with 

The practitioner should be facing the patient with their thigh against the knee of the patient, so the practitioner may use their thigh to control the amount of knee flexion of the patient's target leg.

Start the palpation using a broad palpation (length of thumb and webspace) a few inches inferior to the ASIS and AIIS over the anterior thigh.

 can be differentiated from the quadriceps muscle by asking the client to flex their hip while flexing at the 

 flexion is is added to aid in reciprocally inhibiting the 

 . Asking the patient to perform this action repeatedly should help the practitioner feel the muscle contract, on and off, at some point along the practitioner's broad palpation.

 may be specifically differentiated by asking the patient to repeatedly internally rotate their tibia (without hip flexion); that is, turn the foot in as far as they can repeatedly.

Once the muscle has been located, the practitioner may preposition their hands to apply direct force to the target muscles using thumbs or fingers.

The inguinal lymph nodes, femoral artery and vein, femoral and saphenous nerve, and additional distributions of these vessels and nerves in the femoral triangle and adductor canal may be palpated during this technique if palpation strays medial of the rectus femoris. If a pulse is felt, or the patient complains of numbness, tingling, burning, or searing pain, or pain that is diffuse and uncomfortable and unlike trigger point pain, adjust hand placement laterally. Since the 

 is the lateral border of the femoral triangle, palpation of sensitive structures is likely a good indication that your palpation is not accurate.

 are either a few inches distal the ASIS or close to the middle of the length of the thigh.

 flexion is added to aid in reciprocally inhibiting the 

 . Asking the patient to perform this action repeatedly should help the practitioner feel the muscle contract, on and off, at a point along the practitioner's broad palpation.

Once the muscle has been located, the practitioner may preposition their hands to apply direct force to the target muscles using a "thumb over thumb" or "thumb in thenar crease" hand position.

 are vertically oriented, so lateral strokes should be used to identify taut bands.

Once a taut band is located, the length of the band is explored for a dense nodule and consistent pressure is applied.

Generally, compressive force is sufficient to pin dense nodules; however, a slight posterior to anterior force may be added.

Consistent pressure is held until the nodule softens under the practitioner's fingers, or tissue density/sensitivity is significantly reduced (generally 30 - 120 seconds).

Rectus Femoris and Vastus Intermedius Static Manual Release

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Vastus Lateralis Static Manual Release

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Anterior Adductors Static Manual Release

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Flexor Hallucis Longus and Flexor Digitorum Longus (FHL & FDL) Static Manual Release

Extensor Hallucis Longus and Extensor Digitorum Longus Static Manual Release (Soft Tissue Mobilization)

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