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Scalene Static Manual Release (Soft Tissue Mobilization)

This soft tissue mobilization video guides viewers through the basics of scalene static manual release. Learn effective techniques, indications, and contraindications for treatment success.

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Transcript

00:04 - 00:05This is Brent of the Brookbush
00:05 - 00:07Institute in this video we're bringing
00:07 - 00:08you another manual technique now if
00:08 - 00:10you're watching this video I'm assuming
00:10 - 00:11you're watching it for educational
00:11 - 00:13purposes and that you are a licensed
00:13 - 00:15manual therapists following the laws
00:15 - 00:17regarding scope of practice in your
00:17 - 00:19state or region that means athletic
00:19 - 00:21trainers chiropractors physical
00:21 - 00:23therapists osteopath 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 - 00:43therapists 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 - 00:52going to assess then we should be
00:52 - 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 - 01:04release of the scalenes that's the
01:04 - 01:05anterior middle and posterior scalenes
01:05 - 01:07I'm have my friend Melissa come out she's going
01:07 - 01:09to help me demonstrate now we're going
01:09 - 01:11to use the same four step process we've
01:11 - 01:12used for all of our static manual
01:12 - 01:14release videos in this case I want to
01:14 - 01:17start with step 4 and talk about patient
01:17 - 01:19or client position notice that I had
01:19 - 01:20Melissa come out and laid down
01:20 - 01:24immediately I have seen texts and videos
01:24 - 01:26that refer to scalene release in the
01:26 - 01:29seated position it's hard for me to
01:29 - 01:30believe that it would be easy to
01:30 - 01:34palpate or release these muscles in a
01:34 - 01:36seated position where the scalenes as
01:36 - 01:38well as the other lateral stabilizers of
01:38 - 01:40the cervical spine are going to have to
01:40 - 01:43remain somewhat active to stabilize the
01:43 - 01:45cervical spine in the head against the
01:45 - 01:47force of gravity if you have somebody
01:47 - 01:49laid down all this stuff relaxes which
01:49 - 01:51means now we can get our fingers in here
01:51 - 01:54so we can actually find the scalenes and
01:54 - 01:56get a good release now trying to
01:56 - 01:59differentiate the scalenes is not easy I
01:59 - 02:02see a lot of people just kind of going
02:02 - 02:03at the side of the neck and I feel like
02:03 - 02:05they're almost just hoping that the
02:05 - 02:07scalenes are in there but there's some
02:07 - 02:08other stuff in there too that we've
02:08 - 02:10already talked about some other videos
02:10 - 02:12like the levator scapula and the
02:12 - 02:15splenius cervicus so we need to figure
02:15 - 02:16out how are we going to differentiate
02:16 - 02:17these tissues
02:17 - 02:19well first let's start with identifying
02:19 - 02:22where the posterior cervical triangle is
02:22 - 02:24because I know that my scalenes are in
02:24 - 02:26there the posterior cervical triangle
02:26 - 02:30refers to a triangle that has the SCM as
02:30 - 02:32its anterior border so more so go ahead
02:32 - 02:34you lift your head so you guys have
02:34 - 02:35somebody turn their head away and then
02:35 - 02:37lift up towards the ceiling their SCM
02:37 - 02:39pops right out that's easy to find
02:39 - 02:41all right I'm to make sure I can feel
02:41 - 02:44that border I have it identified I know
02:44 - 02:46where it is and then this mass right
02:46 - 02:48here is your upper trap that's the
02:48 - 02:52posterior border and then the bottom of
02:52 - 02:53this triangle is actually just kind of a
02:53 - 02:55top of the shoulder girdle here so
02:55 - 02:59inside there is my scalenes all right
02:59 - 03:03first step done next is going to take a
03:03 - 03:05little functional anatomy knowledge so I
03:05 - 03:08know that my scalenes anterior middle
03:08 - 03:11and posterior come off the transverse
03:11 - 03:14processes of my cervical spine the
03:14 - 03:15transverse processes are not something
03:15 - 03:17that you want to jab at but you can
03:17 - 03:22palpate by gently kind of letting your
03:22 - 03:24fingers to press into the side of the
03:24 - 03:28neck and looking for what feels like
03:28 - 03:32bony spines almost okay they're kind of
03:32 - 03:35spiny don't press real hard but you'll
03:35 - 03:36notice that they definitely feel
03:36 - 03:39different than soft tissue transverse
03:39 - 03:41processes feel like they're not going
03:41 - 03:42anywhere no matter how hard you press
03:42 - 03:44soft tissue obviously you can kind of
03:44 - 03:47kind of almost feel like you're going to
03:47 - 03:49push through once you find those
03:49 - 03:52transverse processes we now have a good
03:52 - 03:56idea of where the origin
03:56 - 03:58of these muscles are the insertion is in
03:58 - 04:00the first and second rib now if you've
04:00 - 04:02never felt the first and second rib
04:02 - 04:05these aren't your first and second ribs and
04:05 - 04:06I know that seems a little
04:06 - 04:08counterintuitive but generally speaking
04:08 - 04:09the first two ribs underneath the
04:09 - 04:11clavicle or your third and fourth rib
04:11 - 04:14your first and second rib almost exists
04:14 - 04:16behind the clavicle they're much smaller
04:16 - 04:19right they almost exist in this space
04:19 - 04:23here just above the lungs really so how
04:23 - 04:25do I figure out where those first and
04:25 - 04:27second ribs are well the easiest thing
04:27 - 04:29to do is probably
04:29 - 04:33fine c7 spinous process that's the
04:33 - 04:37biggest spinous process at the bottom of
04:37 - 04:39the base of your neck right here all
04:39 - 04:41right so if I find that on Melissa and
04:41 - 04:44then I fall off laterally now what
04:44 - 04:46you're probably going to have to do is
04:46 - 04:49flex the neck towards the side your
04:49 - 04:51palpating so that the trap will calm
04:51 - 04:54down once again you'll feel something
04:54 - 04:55that is definitely not soft tissue
04:55 - 04:58that's definitely a bone right there and
04:58 - 05:01sure enough right there I'm going to go
05:01 - 05:03ahead and move this so they can scream
05:03 - 05:05now I wouldn't have to move her strap
05:05 - 05:07for any therapeutic reason i can i can
05:07 - 05:09get at her neck without moving that but i
05:09 - 05:11want you guys to be able to see kind of
05:11 - 05:13where my hand is if i push down right
05:13 - 05:15there that's definitely bone well
05:15 - 05:17that's my first rib that's my first
05:17 - 05:19rib and then if I know where c7 is I
05:19 - 05:21could go to t1 and try to see if I can
05:21 - 05:24palpate the second rib a little harder
05:24 - 05:28palpation there guys it's almost easier
05:28 - 05:33to just kind of step off inside the AC
05:33 - 05:35joint here right into a clavicle or
05:35 - 05:37acromion shelf if I get in there and
05:37 - 05:42kind of feel the second rib that is one
05:42 - 05:43of those points where it's really
05:43 - 05:45helpful to have some live education or a
05:45 - 05:47mentor or kind of demonstrate those two
05:47 - 05:49techniques because it's not easy to find
05:49 - 05:51those in the soft tissue here guys but
05:51 - 05:55with a little bit of patience and maybe
05:55 - 05:57a colleague who is little patient with
05:57 - 05:59you I think you guys will find them at
05:59 - 06:00the very least you know that there's
06:00 - 06:04this bony floor to this area right here
06:04 - 06:07at the top of the shoulder girdle that
06:07 - 06:12your scalenes attach to from the
06:12 - 06:15transverse processes and so hopefully
06:15 - 06:17you guys can kind of summarize that i'm
06:17 - 06:20looking for something inside of this
06:20 - 06:22posterior cervical triangle that goes
06:22 - 06:24from the bony spikes on the side of the
06:24 - 06:28cervical spine to the bony floor at the
06:28 - 06:31top of my shoulder girdle now
06:31 - 06:34going back to the bony spikes if i start
06:34 - 06:39up closer to her head and I go anterior
06:39 - 06:45to posterior kind of over but not into
06:45 - 06:49those bony spikes I should start to be
06:49 - 06:52able to identify some very vertically
06:52 - 06:55aligned fascicles and my scalenes are very
06:55 - 06:57vertical muscles based on what I just
06:57 - 06:59told you they attached to being the
06:59 - 07:01first and second rib and the transverse
07:01 - 07:03processes something like my levator
07:03 - 07:05scapula which also attaches to the
07:05 - 07:07transverse processes is going to have a
07:07 - 07:09little bit more of an angle going
07:09 - 07:12towards posterior if you're still having
07:12 - 07:14a hard time identifying these fascicles
07:14 - 07:16what you could do is use your two
07:16 - 07:20fingers right to palpate in this
07:20 - 07:22posterior cervical triangle but then
07:22 - 07:25have your client like push into that
07:25 - 07:26same palm a little bit with some lateral
07:26 - 07:29flexion right that'll get a bunch of
07:29 - 07:31stuff really active including the SCM on
07:31 - 07:34what you palpated earlier but then if
07:34 - 07:36they go into just a little bit of
07:36 - 07:38flexion which is lifting their head off
07:38 - 07:42the table you definitely would inhibit
07:42 - 07:45the levator scapula so now you know that
07:45 - 07:48as long as your posterior the scalene
07:48 - 07:50our posterior the sternocleidomastoid
07:50 - 07:54you're in the posterior cervical
07:54 - 07:56triangle and you're feeling vertical
07:56 - 07:59bands that's definitely your anterior
07:59 - 08:02and middle scalene all right so now that
08:02 - 08:04we found the anterior middle scalene we
08:04 - 08:07do have to talk for a second step number
08:07 - 08:10two which is what structures are around
08:10 - 08:15these structures that I could insullt abrade
08:15 - 08:17injure with compression we have
08:17 - 08:19the carotid artery let's let's stay away
08:19 - 08:20from the carotid artery we don't need
08:20 - 08:23anybody passing out on us I think you
08:23 - 08:26will find that if you gently apply
08:26 - 08:28pressure rather than just aggressively
08:28 - 08:31going in that you would find a pulse well
08:31 - 08:34before you would ever occlude an artery
08:34 - 08:35and there's nothing
08:35 - 08:37on the feeling a pulse but it is a good
08:37 - 08:39sign that you should probably press
08:39 - 08:41somewhere else remember that the carotid
08:41 - 08:44artery isn't very thick all you have to
08:44 - 08:45do is move a few millimeters in any
08:45 - 08:47direction and I think you'll be able to
08:47 - 08:49change your finger angle to still get it
08:49 - 08:51the same fascicles without occluding
08:51 - 08:53that artery the other thing you might
08:53 - 08:55want to stay away from is there are
08:55 - 08:58little beads in here which are lymph
08:58 - 09:00nodes you don't want to like take one of
09:00 - 09:01those beads thinking it's a trigger
09:01 - 09:03point and press it up against the
09:03 - 09:06transverse process thats a very bad idea we
09:06 - 09:08don't want to try to crush lymph nodes
09:08 - 09:09is going to cause inflammation could
09:09 - 09:10cause some symptoms but we don't want to
09:10 - 09:15deal with last your brachial plexus
09:15 - 09:18actually pierces between your anterior
09:18 - 09:19middle scalene and that's its normal
09:19 - 09:22course it comes out those nerve roots
09:22 - 09:26right and they all those various nerve
09:26 - 09:28roots combine to become the brachial
09:28 - 09:29plexus and it comes out between the
09:29 - 09:31anterior middle scalene goes underneath
09:31 - 09:32the clavicle and underneath the
09:32 - 09:34pectoralis minor and then feeds all the
09:34 - 09:37nerves to the arm right we don't want to
09:37 - 09:39push on the brachial plexus because a we
09:39 - 09:42can cause some nerve symptoms we don't
09:42 - 09:44want to cause tingling we don't want to
09:44 - 09:45cause something that's going to almost
09:45 - 09:47look like a radiculopathy we don't want
09:47 - 09:52to cause numbness or that nerve pain we
09:52 - 09:55don't want to push down on the brachial
09:55 - 09:58plexus and create that searing burning
09:58 - 09:59stretch i'm sure some of you have felt
09:59 - 10:01when you stretch a nerve we want to stay
10:01 - 10:03away from all that so if your client
10:03 - 10:05complains of any of those symptoms once
10:05 - 10:08again all you got to do is move a couple
10:08 - 10:09millimeters in any direction maybe
10:09 - 10:11change the angle of your thumb and you
10:11 - 10:15should still be able to get those same
10:15 - 10:16tissues so I know this is a lot of
10:16 - 10:18information guys which is why I'm glad
10:18 - 10:20this is on video you can put it on
10:20 - 10:22repeat a couple times but let's review
10:22 - 10:26you have posterior cervical triangle we
10:26 - 10:28know it's in there if I want to
10:28 - 10:30differentiate my anterior middle
10:30 - 10:33scalenes for my levator scapula which is
10:33 - 10:36probably the only other issue we have or
10:36 - 10:39maybe the the splenius cervicus I can
10:39 - 10:41use a little bit of lateral flexion and
10:41 - 10:43then flexion off the table to make sure
10:43 - 10:45I start there
10:45 - 10:48once I found those vertical fibers to
10:48 - 10:51find the densest fascicles and to
10:51 - 10:53find these trigger points tender points
10:53 - 10:56points of acute hyperactivity I'm going
10:56 - 10:58to do my anterior to posterior strumming
10:58 - 11:01since these are vertical fibers as I
11:01 - 11:03move from inferior or superior to
11:03 - 11:06inferior and our common trigger points
11:06 - 11:10are actually much closer to the ribs so I
11:10 - 11:12think what you guys will find is nine
11:12 - 11:14times out of ten rather than there being
11:14 - 11:15trigger points up in the middle of the
11:15 - 11:19neck they're much closer to the base of
11:19 - 11:22the neck and so I can actually feel here in
11:22 - 11:25Melissa that the tightest fascicles
11:25 - 11:28are right about there I don't feel a pulse
11:28 - 11:31any nerveyness you know nerveyness no little
11:31 - 11:35lymph node type feeling beads all right
11:35 - 11:37and then I can feel that it's a little
11:37 - 11:39denser there it gives me a little nodule
11:39 - 11:43all right so I can hold that for my 30
11:43 - 11:45seconds to 2 minutes until i get a
11:45 - 11:48nice release guys an important thing
11:48 - 11:50to keep in mind here is I'm not pressing
11:50 - 11:53lateral to medial I'm actually pressing
11:53 - 11:57I have a little lateral to medial angle
11:57 - 12:00but I'm mostly pressing superior to
12:00 - 12:03inferior and so I'm pressing towards the
12:03 - 12:04rib the reason why that's important is
12:04 - 12:06pressing into the transverse processes
12:06 - 12:10is going to be painful and I think as
12:10 - 12:12soon as we stimulate pain once again it
12:12 - 12:14becomes very hard to get a release I know
12:14 - 12:16that this is not comfortable for Melissa
12:16 - 12:18but there's a difference between this
12:18 - 12:21and pinchy pain which just does not feel
12:21 - 12:25good now to find the posterior scalenes
12:25 - 12:29all you have to do is keep all that
12:29 - 12:31anterior to posterior strumming in mind
12:31 - 12:35but then think okay my posterior scalene
12:35 - 12:39goes from c6 c7 transverse processes
12:39 - 12:41down to my second rib so it's almost
12:41 - 12:48like that splenius cervicus pocket that we
12:48 - 12:49talked about in the splenius cervicus
12:49 - 12:53release video but rather than go towards
12:53 - 12:56the laminar trough back this way and
12:56 - 12:57towards the
12:57 - 13:00is process I'm going to go kind of out
13:00 - 13:04this way towards the second rib and the
13:04 - 13:06fibers are looking for are much more
13:06 - 13:10vertical this is good technique to pick up
13:10 - 13:12because posterior scalenes tend to get
13:12 - 13:16very overactive and I can just do the
13:16 - 13:20same thing again if I need it to if I
13:20 - 13:21needed to try to differentiate for
13:21 - 13:24example the posterior scalene from the
13:24 - 13:26anterior and middle scalene I could go
13:26 - 13:29lateral flexion into my palm so mostly
13:29 - 13:31pressing into the arm i'm using for
13:31 - 13:33release and then if she extends back into
13:33 - 13:36the table boom right all of a sudden her
13:36 - 13:38anterior middle scalenes calm way down
13:38 - 13:41and her posterior scalenes
13:41 - 13:43fire up just like with all your
13:43 - 13:46techniques guys take your time this is
13:46 - 13:49not a race your patient has no idea what
13:49 - 13:51you're doing your patient has no idea
13:51 - 13:53how long this is supposed to take I know
13:53 - 13:56you want to get a lot of work done but I
13:56 - 13:58used to hate when my mother said this
13:58 - 13:59but I'm going to tell it to you guys the
13:59 - 14:01quickest way to get anything done is to
14:01 - 14:04do it the right way the first time man I
14:04 - 14:06used to hate that but now it makes so
14:06 - 14:10much sense so take your time use lateral
14:10 - 14:12flexion use flexion and extension to
14:12 - 14:15help you differentiate tissues if you
14:15 - 14:17have to use the SCM technique of
14:17 - 14:19contralateral rotation an flexion to
14:19 - 14:23find the SCM great that's fine if you
14:23 - 14:26have to sit there and find c7 to find
14:26 - 14:28the first rib because you've never felt
14:28 - 14:31that before fine somebody has Anatomy
14:31 - 14:32that's a little different than you're
14:32 - 14:34used to somebody's a little maybe a
14:34 - 14:37bigger person or a more muscular person
14:37 - 14:39or much more slight than you're used to
14:39 - 14:41dealing with all these little cues
14:41 - 14:42knowing your functional anatomy and
14:42 - 14:44taking your time with your palpation
14:44 - 14:47will be your savior you can still get to
14:47 - 14:50all of these tissues just about anybody
14:50 - 14:52and you should be able to get to them
14:52 - 14:55comfortably without causing discomfort
14:55 - 14:57from impending a nerve or whatever just
14:57 - 15:00simply by keeping your functional
15:00 - 15:01anatomy in mind
15:01 - 15:04stay tuned for the close-up recap and
15:04 - 15:06this close-up recap of our scalene
15:06 - 15:08static manual release we're going to
15:08 - 15:11start by outlining that posterior
15:11 - 15:14cervical triangle most of you would lift
15:14 - 15:15your head real quick you guys can see
15:15 - 15:19there's SCM ok so this mass right here
15:19 - 15:22is the upper trap so we know we're going
15:22 - 15:25right in between the two in here this
15:25 - 15:29being the floor of that triangle now the
15:29 - 15:30first thing I'm going to look for is
15:30 - 15:33those transverse processes because what
15:33 - 15:36I don't want to end up on is end up back
15:36 - 15:38here where it's more likely that i'm
15:38 - 15:40going to release my levator scapula and
15:40 - 15:43splenii I want to find the origin of
15:43 - 15:47these muscles so that I can start doing
15:47 - 15:52my anterior to posterior strokes towards
15:52 - 15:55their insertion down on the first and
15:55 - 15:58second rib now if I'm having problems
15:58 - 16:01finding those muscles like they're not
16:01 - 16:03popping into my fingers I'm not feeling
16:03 - 16:05the strands or I think by chance I'm on
16:05 - 16:08either the levator scapulae or splenii I
16:08 - 16:11could have Melissa go ahead and kind of
16:11 - 16:14push into my hand here a little bit with
16:14 - 16:16lateral flexion and although the SCM
16:16 - 16:19puffs up pretty quick I know where I
16:19 - 16:21know thats my SCM if I have her then
16:21 - 16:24go into a little bit of flexion I know
16:24 - 16:28that the muscles behind my SCM that are
16:28 - 16:30puffed up from lateral flexion and
16:30 - 16:33flexion are my anterior and middle
16:33 - 16:37scalenes disflexion inhibits my
16:37 - 16:40levator scapula and splenii muscles
16:40 - 16:43so right there go ahead and relax Melissa
16:43 - 16:47right there I know I'm on nothing but
16:47 - 16:49scalene of course I can do my anterior
16:49 - 16:52posterior strokes here looking for the
16:52 - 16:55dentist fascicles once I find them I'm
16:55 - 16:57going to go ahead apply pressure now
16:57 - 16:58of course since I'm in the area of the
16:58 - 17:01neck I am keeping in mind do I feel a
17:01 - 17:04pulse am I getting any nerve symptoms
17:04 - 17:07does Melissa have any tingling or numbness
17:07 - 17:11does she have that searing stretchy pain
17:11 - 17:13of stretching a nerve am i on a lymph
17:13 - 17:16node does it feel like a like I have
17:16 - 17:18a little lima bean underneath my finger
17:18 - 17:21remember these densities inside muscle
17:21 - 17:23just feel like an increase in tissue
17:23 - 17:25density and might feel a little ball
17:25 - 17:30like but it's more just denser parts of
17:30 - 17:32the same structure that you're feeling
17:32 - 17:35now to find the posterior scalene is a
17:35 - 17:38little tricky I suggest going anterior
17:38 - 17:41middle scalenes first and then what you
17:41 - 17:45can do is ensure that you're down low
17:45 - 17:51enough that your lateral to c6 and c7
17:51 - 17:53right because that's where your
17:53 - 17:57posterior scalene in our originates and
17:57 - 18:00then you can have your patient do
18:00 - 18:02lateral flexion into your hand again and
18:02 - 18:05extend back into the table and you'll
18:05 - 18:08feel those fibers pop out all right so
18:08 - 18:12if you know you're pretty close to
18:12 - 18:15anterior middle scalene come back on to
18:15 - 18:18where you think posterior scalene may
18:18 - 18:21be and then you confirm by doing lateral
18:21 - 18:24flexion and extension you're probably in
18:24 - 18:27good shape go ahead and relax and then
18:27 - 18:29posterior scalene definitely gets
18:29 - 18:32tight on a lot of people the common
18:32 - 18:34trigger points for all of these muscles
18:34 - 18:37guys are very close to the first and
18:37 - 18:39second ribs so right about where my
18:39 - 18:41thumb is that right at the base of the
18:41 - 18:43neck there is a common trigger point for
18:43 - 18:45anterior scalene that's up a little
18:45 - 18:47higher about midway up the neck but
18:47 - 18:50again these are all far more common down
18:50 - 18:54here and as I suggested in our further
18:54 - 18:58away shot supine is probably the best
18:58 - 19:01way to get this technique done this
19:01 - 19:04isn't uncomfortable for me I can get my
19:04 - 19:07arm behind my direction of pressure
19:07 - 19:09which is going to be down towards the
19:09 - 19:11rib right not into the transverse
19:11 - 19:12process
19:12 - 19:15down towards the rib and of course my my
19:15 - 19:17patient here is very comfortable as
19:17 - 19:20shes just lying with her head supported
19:20 - 19:21so there you have it knowing your
19:21 - 19:23functional Anatomy will definitely help
19:23 - 19:25your manual technique it'll help you
19:25 - 19:27differentiate structures so when you can
19:27 - 19:28place your hands where they need to be
19:28 - 19:30as well as make you aware of these
19:30 - 19:33sensitive structures around the tissue
19:33 - 19:35that you're trying to target things like
19:35 - 19:37nerves and lymph nodes and arteries make
19:37 - 19:39sure that if you're going to place your
19:39 - 19:40hands on a patient that you have done an
19:40 - 19:42assessment and have a good rationale for
19:42 - 19:44placing your hands on that patient and
19:44 - 19:46if you're going to assess make sure you
19:46 - 19:48reassess to ensure that your technique
19:48 - 19:50was effective and you have a good
19:50 - 19:52rationale for using that technique again
19:52 - 19:56now with manual therapy one-on-one live
19:56 - 19:59education is incredibly important please
19:59 - 20:01be looking for opportunities like
20:01 - 20:04workshops and mentorship and maybe even
20:04 - 20:07classes at your local university that
20:07 - 20:10can get you some one on one individual
20:10 - 20:13instruction or at least a live classroom
20:13 - 20:16instruction so you've had a chance to be
20:16 - 20:20critiqued and mentored by somebody
20:20 - 20:22senior to you with some experience in
20:22 - 20:25manual therapy techniques and before you
20:25 - 20:28bring the stuff back to your rehab
20:28 - 20:31fitness or performance setting please
20:31 - 20:34practice on colleagues there is no
20:34 - 20:37substitute for practice and it is going
20:37 - 20:41to take a while to get accustomed to some
20:41 - 20:42of the techniques that we show in these
20:42 - 20:45manual technique videos don't expect to
20:45 - 20:48learn them in two or three or even five
20:48 - 20:50minutes you want to have hours of
20:50 - 20:52experience under your belt working on
20:52 - 20:55various different body sizes and shapes
20:55 - 20:57so that when you do get that first
20:57 - 21:00paying client first paying customer and
21:00 - 21:01you're really trying to make a good
21:01 - 21:05positive impact really trying to promote
21:05 - 21:08better outcomes you feel comfortable
21:08 - 21:10with that technique I look forward to
21:10 - 21:12hearing about your outcomes and hearing
21:12 - 21:14your questions in the comments section
21:14 - 21:18of this video I'll talk with you soon
21:25 - 21:27you

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