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Rhomboid Static Manual Release (Soft Tissue Mobilization)

This dynamic video teaches how to properly execute a rhomboid static manual release to improve mobility in soft tissue areas. Learn how to properly mobilize this critical area of your body.

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Transcript

00:04 - 00:05This is Brent of the Brookbush
00:05 - 00:07Institute, and in this video we're bringing
00:07 - 00:08you another manual technique. Now if
00:08 - 00:09you're watching this video I'm assuming
00:09 - 00:11you're watching it for educational
00:11 - 00:13purposes, and that you are a licensed
00:13 - 00:15manual therapist following the laws
00:15 - 00:17regarding scope of practice in your
00:17 - 00:19state or region. That means athletic
00:19 - 00:20trainers, chiropractors, physical
00:20 - 00:23therapists, osteopaths, licensed massage
00:23 - 00:25therapists, you are likely in the clear
00:25 - 00:28to do these techniques, personal trainers
00:28 - 00:30this probably does not fall within your
00:30 - 00:31scope of practice; although you might be
00:31 - 00:33able to use the palpation portion of
00:33 - 00:35this video to aid in learning your
00:35 - 00:38functional anatomy, in an educational
00:38 - 00:41setting supervised by a licensed manual
00:41 - 00:43therapist. Now before we place our hands
00:43 - 00:45on a patient or client it is important
00:45 - 00:48that we assess and have a good rationale
00:48 - 00:50for doing so, and of course if we're
00:50 - 00:53going to assess then we should be
00:53 - 00:55reassessing to ensure that the manual
00:55 - 00:57technique we're using is effective, and
00:57 - 00:59we have a good rationale for continuing
00:59 - 01:01to use that technique. In this video
01:01 - 01:02we're going to go over static manual
01:02 - 01:03release of the rhomboids. I'm going to
01:03 - 01:04have my friend Melissa step out and help
01:04 - 01:07me demonstrate. Now this technique uses
01:07 - 01:08the same protocol we've used for all of
01:08 - 01:10our static manual release techniques,
01:10 - 01:11that basically comes down to palpate and
01:11 - 01:13compress, although we are going to get a
01:13 - 01:15little bit more detailed, talk about how
01:15 - 01:17to differentiate the rhomboids from the
01:17 - 01:18other tissues in the area. We're going to
01:18 - 01:20talk about where our common trigger
01:20 - 01:22points are, we're going to talk about
01:22 - 01:24what other tissues in the area maybe
01:24 - 01:27are contraindicated to press on, and then
01:27 - 01:28of course the last thing we're going to
01:28 - 01:30talk about is patient and client
01:30 - 01:33position and your position, so that you
01:33 - 01:34have great technique.
01:34 - 01:37Now the rhomboids are deceptively
01:37 - 01:40difficult to get a good release on. iIt's
01:40 - 01:42a fairly thin muscle, we don't have those
01:42 - 01:45big thick fibrous bands to find, that gives
01:45 - 01:47us really good indication of like a
01:47 - 01:50fiber direction; and there are a couple
01:50 - 01:51of other muscles in the area, not to
01:51 - 01:53mention the rib cage right underneath it.
01:53 - 01:55So let's talk about how to differentiate
01:55 - 01:57this tissue. The thing to start with
01:57 - 01:59would be your origins and insertions to
01:59 - 02:02set up some borders for the area that
02:02 - 02:04you should be in. The origin of your
02:04 - 02:07rhomboids major and minor goes from C7
02:07 - 02:11to T5, and then the insertion is the
02:11 - 02:13vertebral border of your scapula which
02:13 - 02:15is fairly easy to palpate there. So if
02:15 - 02:17you find these things
02:17 - 02:22roughly C7 to T5 to the vertebral border,
02:22 - 02:26and you draw a little box around that
02:26 - 02:30you get this little twisted square, also
02:30 - 02:33known as a rhomboid, which is where the
02:33 - 02:35rhomboid muscle gets its name from.
02:35 - 02:37We know that this is the area we
02:37 - 02:39should be palpating in, so what other
02:39 - 02:41tissues are there that maybe we need to
02:41 - 02:43differentiate? Well, I happen to know that
02:43 - 02:47our traps lie on top of our rhomboids, so
02:47 - 02:49our lower trap and middle traps
02:49 - 02:51specifically, we need to kind of figure
02:51 - 02:52out how are we going to differentiate
02:52 - 02:55between lower trap and rhomboid. Well
02:55 - 02:57being that my rhomboid goes in this
02:57 - 02:58direction we would expect more of a
02:58 - 03:01horizontal fiber direction. My lower trap
03:01 - 03:04goes from the spine of the scapula, the
03:04 - 03:05medial portion of the spine of my
03:05 - 03:08scapula, all the way down to T12. So we
03:08 - 03:11get this somewhat oblique but mostly
03:11 - 03:14vertical fiber direction, and what the
03:14 - 03:15lower traps actually feel like is a
03:15 - 03:19somewhat triangular shaped vertical
03:19 - 03:22column of muscle, being that those fibers
03:22 - 03:24are vertical it makes it very easy to
03:24 - 03:26differentiate that from what would be
03:26 - 03:30horizontal fibers of the rhomboids. Now
03:30 - 03:32the middle traps do have that horizontal
03:32 - 03:35fiber direction, but if we follow them
03:35 - 03:38they don't go into the vertebral border
03:38 - 03:41of the scapula they continue on to the
03:41 - 03:44spine of the scapula, not to mention the
03:44 - 03:46middle traps are much much thicker than
03:46 - 03:48the rhomboids. So after you've done this
03:48 - 03:49a few times you've learned how to
03:49 - 03:51identify the rhomboids, you know how to
03:51 - 03:53identify the mid traps, you're going to
03:53 - 03:55know when you're on the trapezius muscle
03:55 - 03:56in general just because it's a much much
03:56 - 03:59thicker muscle. Now the only other muscle
03:59 - 04:02that's in that area is the serratus
04:02 - 04:04posterior superior which is deep to the
04:04 - 04:08rhomboids, very thin, not generally
04:08 - 04:10something we think about palpating,
04:10 - 04:12something we think about having trigger
04:12 - 04:14points. I would imagine if we were trying
04:14 - 04:15to go after it, it would have something
04:15 - 04:18to do with CT junction dysfunction, maybe
04:18 - 04:20breathing dysfunction, maybe some
04:20 - 04:22sort of assessed dysfunction of the upper
04:22 - 04:26ribs. If we're trying to palpate the
04:26 - 04:29rhomboids, my guess is we had more of the
04:29 - 04:32thoracic or scapular dyskinesis
04:32 - 04:33that we're worried about. I think it's
04:33 - 04:39actually fairly uncommon for us to go
04:39 - 04:40after the rhomboids, when the serratus
04:40 - 04:42posterior superior was involved, or vice
04:42 - 04:43versa.
04:43 - 04:45I think that muscle for the most part is
04:45 - 04:46not something that we're going to have
04:46 - 04:47to worry about, and when we talk about
04:47 - 04:49step 2 - where are the common trigger points,
04:49 - 04:50we're going to find out that our hands
04:50 - 04:52are actually going to be even further
04:52 - 04:55from the serratus posterior superior. So
04:55 - 04:58the trigger points here, that's getting
04:58 - 05:01into step 2, are all along the vertebral
05:01 - 05:04border of the rhomboids. This is a really
05:04 - 05:06important fact because this is what's
05:06 - 05:09going to save us when we try to locate
05:09 - 05:13these hypertonic fascicles within the
05:13 - 05:15rhomboids, because if you try to
05:15 - 05:18feel here, like let's say you just start
05:18 - 05:21trying to feel in that rhomboid area for
05:21 - 05:23horizontal fibers, I don't think you're
05:23 - 05:25going to find much. There's like there's
05:25 - 05:28not these differentiated fascicles in
05:28 - 05:29here and unfortunately we have the
05:29 - 05:32ribcage which has these little bumps in
05:32 - 05:36it, which make it a little hard to figure
05:36 - 05:38out whether you're just feeling bumps on
05:38 - 05:40the ribcage, or you're actually feeling
05:40 - 05:42some fascicles on the rhomboid. You can
05:42 - 05:44even end up just feeling this flat mush
05:44 - 05:49over the ribcage until you get down into
05:49 - 05:51the vertebral border here, and at the
05:51 - 05:54vertebral border you can feel a little
05:54 - 05:58bit of thickness as the rhomboid turns
05:58 - 06:02into these tendinous fibers
06:02 - 06:05that invest into that vertebral border.
06:05 - 06:07In fact we're going to make this even
06:07 - 06:08easier for ourselves, we're going to go
06:08 - 06:10ahead and ask Melissa to put her hands
06:10 - 06:13up over her head. If she didn't have a
06:13 - 06:15face cut out in this table we could
06:15 - 06:16actually have her put her hands
06:16 - 06:18underneath her forehead which sometimes
06:18 - 06:20it's just more comfortable, now I've
06:20 - 06:22lengthened out these rhomboid fibers
06:22 - 06:24even further. That's going to add a
06:24 - 06:28little tension, maybe make it easier for
06:28 - 06:30me to feel the horizontally oriented
06:30 - 06:33fibers. It's also going to help me with
06:33 - 06:36that finger on a marble game right, we
06:36 - 06:37don't want to play that, we don't want to
06:37 - 06:39play that game where we keep trying to
06:39 - 06:41hit trigger points but they keep sliding
06:41 - 06:42out from underneath our fingers. We can
06:42 - 06:42use
06:42 - 06:44this increase in length, increase in
06:44 - 06:45tension on the rhomboids to help
06:45 - 06:48stabilize that trigger point. I think
06:48 - 06:49once you get somebody in this position
06:49 - 06:52and you start strumming perpendicular to
06:52 - 06:54those fibers right up against the
06:54 - 06:57vertebral border, now you start feeling
06:57 - 07:00some fascicles. But it's really not until
07:00 - 07:03we get into this position and feel very
07:03 - 07:05specific to about where these trigger
07:05 - 07:08points are along the vertebral border
07:08 - 07:10that we can feel anything, and I want you
07:10 - 07:12guys to experiment with this, experiment
07:12 - 07:15with hand down and then hand up and I
07:15 - 07:16think you'll see what I'm talking about.
07:16 - 07:19Now before we take this to the actual
07:19 - 07:22technique and getting a good release
07:22 - 07:24here, is there anything contraindicated,
07:24 - 07:26is there anything that I shouldn't put
07:26 - 07:27pressure on, is there anything that's
07:27 - 07:30sensitive in this area -the answer is no
07:30 - 07:33not really. You always run the risk of, or
07:33 - 07:35the chance of over stretching like a
07:35 - 07:37sensory nerve or something, like
07:37 - 07:39something that gives us some
07:39 - 07:43sensation in the skin and that would
07:43 - 07:47give us some sort of like sharp twinge
07:47 - 07:49of pain, like it's that burning searing
07:49 - 07:50pain I know we've all felt when somebody
07:50 - 07:52like stretches our skin the wrong way
07:52 - 07:54and you like it that little that little
07:54 - 07:57zap, but even that's fairly uncommon in
07:57 - 07:58this area. I don't think it's something
07:58 - 07:59that you're going to have to worry about.
07:59 - 08:02So this is probably the best position
08:02 - 08:05for the patient, before I go through this
08:05 - 08:09technique also notice that I am working
08:09 - 08:11on the rhomboid that's farthest from me,
08:11 - 08:13and they're the reason for that has to
08:13 - 08:15do with how we're going to pin the
08:15 - 08:16tissues. If I were to try to do the
08:16 - 08:19rhomboid closest to me I end up kind of
08:19 - 08:21like this trying to push down towards my
08:21 - 08:24thigh, which this type of force just
08:24 - 08:26isn't a real easy force to apply. I'd
08:26 - 08:29much rather be pushing across my body be
08:29 - 08:31able to walk out my arms and just lean.
08:31 - 08:34So this is the patient position I know
08:34 - 08:36it was a long explanation to try to get
08:36 - 08:37to where we're going to be, and the
08:37 - 08:40technique isn't that difficult. All I'm
08:40 - 08:43going to do is take a thumb, strum
08:43 - 08:46perpendicular to what would be the
08:46 - 08:47direction of the fibers at this point,
08:47 - 08:51which is going to be parallel to the
08:51 - 08:54vertebral border of my scapula. Once I
08:54 - 08:56find something that feels like an
08:56 - 08:58increase in tissue density, I'm then
08:58 - 09:01going to go a little bit along the
09:01 - 09:04length of the fiber and see if I can
09:04 - 09:08identify a nodule of tightness. Once
09:08 - 09:09again those nodules are going to be
09:09 - 09:12pretty close to the vertebral border. I
09:12 - 09:14don't know if you guys can see the X's
09:14 - 09:15where I actually marked off the trigger
09:15 - 09:16point parts, but when we get into the
09:16 - 09:18close-up recap I know you will.
09:18 - 09:21Once I've not only identified the tight
09:21 - 09:23fascicles but I've done my palpation
09:23 - 09:25along the length of those fascicles to
09:25 - 09:27find the tight nodule, now what I'm going
09:27 - 09:29to try to do to pin it -is actually push
09:29 - 09:33into the vertebral border of the scapula.
09:33 - 09:36I find that that is easiest and what
09:36 - 09:37I'll usually do is since I was just
09:37 - 09:39strumming this way, I'll use my thumb to
09:39 - 09:42kind of block this way and then I'll put
09:42 - 09:46my thumb right in between my thenar eminence
09:46 - 09:50there, just like so walk out my arms, and
09:50 - 09:54press in. How does that feel? Okay a
09:54 - 09:57little tender I'm sure, I'm sure this is
09:57 - 10:01just a little bit of tenderness here, and
10:01 - 10:03of course after I get one release let's
10:03 - 10:05say after 30 seconds to two minutes of
10:05 - 10:07holding, that's not a tremendous amount
10:07 - 10:10of pressure. I just have to press up to
10:10 - 10:13the point of the tissue giving me some
10:13 - 10:16resistance back, I don't have to like try
10:16 - 10:18to push my thumb all the way down
10:18 - 10:22underneath her scapula per se. I just
10:22 - 10:24wait for a release then I can do the
10:24 - 10:28same thing, perpendicular strums try to
10:28 - 10:32feel for an increase in tissue density,
10:32 - 10:37increase in tissue tightness, right about
10:37 - 10:39there I'm feeling some tight fascicles,
10:39 - 10:41and then I can move along the length of
10:41 - 10:42the fascicles
10:42 - 10:46to find a tight nodule, and then again
10:46 - 10:48I'm going to make sure I can get some
10:48 - 10:50pressure on that nodule and I find that
10:50 - 10:53going in kind of this direction rather
10:53 - 10:54than like let's say straight down, if
10:54 - 10:56you did go straight down it just hurts a
10:56 - 10:57little bit, you just end up pushing into
10:57 - 10:59the rib cage. So if I go this way a
10:59 - 11:03little bit -this direction, I can hold,
11:03 - 11:05get a good release,
11:05 - 11:08and on my bottom hand as soon as this
11:08 - 11:09hand puts pressure becomes the dummy
11:09 - 11:12thumb, I'm not using my hand strength I'm
11:12 - 11:14just using my bodyweight to get a good
11:14 - 11:19release. Now the only tricky point is
11:19 - 11:23this rhomboid minor trigger point in
11:23 - 11:25this position doesn't quite work, because
11:25 - 11:26unfortunately when we
11:26 - 11:28upwardly rotated the scapula
11:28 - 11:31the superior angle ends up
11:31 - 11:34retracting a little bit. So we need to
11:34 - 11:35lengthen out these rhomboid minor
11:35 - 11:37trigger points. I think the easiest way
11:37 - 11:39to do that is to actually have Melissa
11:39 - 11:42put her hands underneath her ASIS,
11:42 - 11:44alright so I know you guys have seen
11:44 - 11:47this position before and then I might
11:47 - 11:50even try to protract her a little bit
11:50 - 11:53further, abduct her scapula as far as I
11:53 - 11:56possibly can and then I'm just going to
11:56 - 11:59go ahead and palpate that superior
11:59 - 12:02portion of her rhomboids right up
12:02 - 12:05against the superior third of the
12:05 - 12:09vertebral border of her scapula.
12:09 - 12:12Doing my perpendicular strokes, now I'm
12:12 - 12:15doing my along the fiber to find the
12:15 - 12:20nodule, found it -make sure I can apply
12:20 - 12:22some pressure right without losing it,
12:22 - 12:24it's not trying to shoot out from under
12:24 - 12:27my finger. I'm going to use my hand
12:27 - 12:29here putting my thumb right in the
12:29 - 12:32middle of my palm and just leaning, and
12:32 - 12:34that's it. This is a real easy technique
12:34 - 12:37for me, for Melissa it might not
12:37 - 12:39feel that easy up front, we're going to
12:39 - 12:41get a little bit of tenderness at first,
12:41 - 12:43but then it's going to let go and of
12:43 - 12:45course for example if she had something
12:45 - 12:49like downwardly rotated scapula as part
12:49 - 12:51of like some upper-body dysfunction and
12:51 - 12:53shoulder impingement syndrome, hopefully
12:53 - 12:55this would give her better outcomes
12:55 - 12:57after we finished this technique. Stay
12:57 - 12:59tuned for the close-up recap. The
12:59 - 13:01close-up recap, step one we have to be
13:01 - 13:04able to palpate, differentiate this
13:04 - 13:05muscle from the other muscles in the
13:05 - 13:08area. I already have Melissa's arms up so
13:08 - 13:10we pulled the vertebral border of the
13:10 - 13:12scapula away from the other tissues we
13:12 - 13:16would be concerned about confusing
13:16 - 13:18ourselves with, being like the lower trap
13:18 - 13:21column over here, you know we have the
13:21 - 13:23mid traps that they're way up here,
13:23 - 13:25and then our serratus posterior superior
13:25 - 13:28would be somewhere in here. The vertebral
13:28 - 13:30border of the scapula is, I'm trying to
13:30 - 13:32palpate this for you guys and kind of
13:32 - 13:34show you, you see that crease I just
13:34 - 13:37created in our skin, that crease is the
13:37 - 13:40vertebral border of our scapula, and
13:40 - 13:43you'll notice that these are the common
13:43 - 13:45trigger point sites for the rhomboids
13:45 - 13:48which are all along that vertebral
13:48 - 13:50border. So well now all we have to do is
13:50 - 13:54do our strokes perpendicular to the
13:54 - 13:57fiber direction, all right so we're going
13:57 - 14:01to come through here like this, and not
14:01 - 14:05surprisingly as I do these perpendicular
14:05 - 14:07strokes, I'm finding that I have these
14:07 - 14:10dense fascicles, this increase in tissue
14:10 - 14:13density, this tightness occurring right
14:13 - 14:15around these X's, especially this X on
14:15 - 14:20her, maybe a little bit here too. So once
14:20 - 14:23I find that increase in tissue density
14:23 - 14:25then I'm going to search it this way
14:25 - 14:29right, make sure that I'm right on the
14:29 - 14:32tightest nodule and then I'm going to
14:32 - 14:35try to make sure I have that trigger
14:35 - 14:38point anchored, so that it's not moving
14:38 - 14:40out from under my thumb, and then once I
14:40 - 14:42have it nice and anchored I'm going to
14:42 - 14:44go ahead and put my palm over the top of
14:44 - 14:49that thumb, and I can do this with each
14:49 - 14:52of the dense fascicles, or each of the
14:52 - 14:56tight nodules in the rhomboids here, hold
14:56 - 14:59for 30 seconds to two minutes. The only
14:59 - 15:00one that's a little different is the
15:00 - 15:01rhomboid minor, i'm going to have
15:01 - 15:04Melissa move her arm down so she has
15:04 - 15:08her hands underneath her ASIS, and then
15:08 - 15:09I'm going to make sure she's abducted,
15:09 - 15:11her scapula is abducted as far as
15:11 - 15:13possible, she's protracted as far as
15:13 - 15:13possible,
15:13 - 15:18and then I'll look at the upper rhomboid
15:18 - 15:20fibers, and once again doing my
15:20 - 15:22perpendicular strokes once I find the
15:22 - 15:23tight fascicles,
15:23 - 15:26going along the length of the fiber and
15:26 - 15:30then anchoring that dense nodule, and
15:30 - 15:32putting my palm over the top of it;
15:32 - 15:36to apply that static pressure for 30
15:36 - 15:39seconds to two minutes. So there you have
15:39 - 15:41it, knowing your functional anatomy will
15:41 - 15:43definitely help your manual technique.
15:43 - 15:45It'll help you differentiate structure
15:45 - 15:46so that you can place your hands where
15:46 - 15:48they need to be, as well as make you
15:48 - 15:50aware of these sensitive structures
15:50 - 15:52around the tissue that you're trying to
15:52 - 15:54target. Things like nerves and lymph
15:54 - 15:57nodes, and arteries. Make sure that if
15:57 - 15:58you're going to place your hands on a
15:58 - 15:59patient that you have done an assessment
15:59 - 16:02and have a good rationale for placing
16:02 - 16:03your hands on that patient, and if you're
16:03 - 16:05going to assess, make sure you reassess
16:05 - 16:07to ensure that your technique was
16:07 - 16:09effective and you have a good rationale
16:09 - 16:11for using that technique again. Now with
16:11 - 16:15manual therapy, one-on-one live education
16:15 - 16:18is incredibly important. Please be
16:18 - 16:21looking for opportunities like workshops
16:21 - 16:24and mentorships, and maybe even classes
16:24 - 16:26at your local university that can get
16:26 - 16:29you some one-on-one individual
16:29 - 16:31instruction, or at least some live
16:31 - 16:33classroom instruction so you've had a
16:33 - 16:38chance to be critiqued and mentored by
16:38 - 16:40somebody senior to you with some
16:40 - 16:42experience in manual therapy techniques,
16:42 - 16:45and before you bring this stuff back to
16:45 - 16:48your rehab, fitness, or performance
16:48 - 16:52setting, please practice on colleagues.
16:52 - 16:55There is no substitute for practice and
16:55 - 16:57it is going to take a while to get
16:57 - 17:00accustomed to some of the techniques
17:00 - 17:02that we show in these manual technique
17:02 - 17:04videos. Don't expect to learn them in two
17:04 - 17:07or three or even five minutes. You want
17:07 - 17:10to have hours of experience under your
17:10 - 17:12belt working on various different body
17:12 - 17:15sizes and shapes. So that when you do get
17:15 - 17:17that first paying client, first paying
17:17 - 17:19customer, then you're really trying to
17:19 - 17:22make a good positive impact, really
17:22 - 17:26trying to promote better outcomes, you
17:26 - 17:28feel comfortable with that technique. I
17:28 - 17:29look forward to hearing about your
17:29 - 17:32outcomes and hearing your questions in
17:32 - 17:34the comments section of this video. I'll
17:34 - 17:37talk with you soon.
17:43 - 17:45you

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