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Scalene Static Manual Release (Soft Tissue Mobilization)
Scalene Static Manual Release (SSMR) is a safe, effective, and non-invasive soft tissue mobilization technique used to reduce pain and restore optimal range of motion. It uses sustained, low-pressure application to a single area of the body to increase flexibility and reduce any associated inflammation or irritation. This type of treatment is beneficial for chronic myofascial problems, trigger point related pain, and active or post-injury conditions. SSMR also provides a beneficial “
Transcript
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This is Brent of the Brookbush
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...blank
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Institute in this video we're bringing
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you another manual technique now if
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you're watching this video I'm assuming
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you're watching it for educational
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purposes and that you are a licensed
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manual therapists following the laws
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regarding scope of practice in your
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state or region that means athletic
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trainers chiropractors physical
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therapists osteopath licensed massage
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therapists you are likely in the clear
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to do these techniques personal trainers
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this probably does not fall within your
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scope of practice although you might be
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able to use the palpation portion of
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this video to aid in learning your
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functional anatomy in an educational
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setting supervised by a licensed manual
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therapists now before we place our hands
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on a patient or client it is important
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that we assess and have a good rationale
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for doing so and of course if we're
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going to assess then we should be
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reassessing to ensure that the manual
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technique we're using is effective and
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we have a good rationale for continuing
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to use that technique in this video
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we're going to go over static manual
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release of the scalenes that's the
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anterior middle and posterior scalenes
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I'm have my friend Melissa come out she's going
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to help me demonstrate now we're going
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to use the same four step process we've
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used for all of our static manual
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release videos in this case I want to
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start with step 4 and talk about patient
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or client position notice that I had
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Melissa come out and laid down
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immediately I have seen texts and videos
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that refer to scalene release in the
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seated position it's hard for me to
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believe that it would be easy to
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palpate or release these muscles in a
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seated position where the scalenes as
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well as the other lateral stabilizers of
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the cervical spine are going to have to
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remain somewhat active to stabilize the
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cervical spine in the head against the
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force of gravity if you have somebody
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laid down all this stuff relaxes which
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means now we can get our fingers in here
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so we can actually find the scalenes and
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get a good release now trying to
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differentiate the scalenes is not easy I
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see a lot of people just kind of going
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at the side of the neck and I feel like
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they're almost just hoping that the
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scalenes are in there but there's some
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other stuff in there too that we've
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already talked about some other videos
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like the levator scapula and the
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splenius cervicus so we need to figure
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out how are we going to differentiate
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these tissues
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well first let's start with identifying
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where the posterior cervical triangle is
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because I know that my scalenes are in
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there the posterior cervical triangle
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refers to a triangle that has the SCM as
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its anterior border so more so go ahead
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you lift your head so you guys have
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somebody turn their head away and then
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lift up towards the ceiling their SCM
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pops right out that's easy to find
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all right I'm to make sure I can feel
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that border I have it identified I know
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where it is and then this mass right
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here is your upper trap that's the
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posterior border and then the bottom of
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this triangle is actually just kind of a
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top of the shoulder girdle here so
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inside there is my scalenes all right
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first step done next is going to take a
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little functional anatomy knowledge so I
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know that my scalenes anterior middle
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and posterior come off the transverse
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processes of my cervical spine the
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transverse processes are not something
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that you want to jab at but you can
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palpate by gently kind of letting your
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fingers to press into the side of the
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neck and looking for what feels like
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bony spines almost okay they're kind of
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spiny don't press real hard but you'll
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notice that they definitely feel
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different than soft tissue transverse
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processes feel like they're not going
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anywhere no matter how hard you press
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soft tissue obviously you can kind of
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kind of almost feel like you're going to
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push through once you find those
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transverse processes we now have a good
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idea of where the origin
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of these muscles are the insertion is in
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the first and second rib now if you've
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never felt the first and second rib
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these aren't your first and second ribs and
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I know that seems a little
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counterintuitive but generally speaking
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the first two ribs underneath the
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clavicle or your third and fourth rib
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your first and second rib almost exists
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behind the clavicle they're much smaller
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right they almost exist in this space
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here just above the lungs really so how
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do I figure out where those first and
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second ribs are well the easiest thing
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to do is probably
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fine c7 spinous process that's the
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biggest spinous process at the bottom of
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the base of your neck right here all
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right so if I find that on Melissa and
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then I fall off laterally now what
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you're probably going to have to do is
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flex the neck towards the side your
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palpating so that the trap will calm
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down once again you'll feel something
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that is definitely not soft tissue
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that's definitely a bone right there and
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sure enough right there I'm going to go
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ahead and move this so they can scream
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now I wouldn't have to move her strap
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for any therapeutic reason i can i can
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get at her neck without moving that but i
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want you guys to be able to see kind of
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where my hand is if i push down right
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there that's definitely bone well
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that's my first rib that's my first
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rib and then if I know where c7 is I
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could go to t1 and try to see if I can
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palpate the second rib a little harder
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palpation there guys it's almost easier
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to just kind of step off inside the AC
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joint here right into a clavicle or
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acromion shelf if I get in there and
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kind of feel the second rib that is one
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of those points where it's really
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helpful to have some live education or a
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mentor or kind of demonstrate those two
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techniques because it's not easy to find
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those in the soft tissue here guys but
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with a little bit of patience and maybe
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a colleague who is little patient with
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you I think you guys will find them at
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the very least you know that there's
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this bony floor to this area right here
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at the top of the shoulder girdle that
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your scalenes attach to from the
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transverse processes and so hopefully
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you guys can kind of summarize that i'm
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looking for something inside of this
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posterior cervical triangle that goes
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from the bony spikes on the side of the
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cervical spine to the bony floor at the
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top of my shoulder girdle now
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going back to the bony spikes if i start
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up closer to her head and I go anterior
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to posterior kind of over but not into
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those bony spikes I should start to be
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able to identify some very vertically
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aligned fascicles and my scalenes are very
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vertical muscles based on what I just
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told you they attached to being the
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first and second rib and the transverse
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processes something like my levator
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scapula which also attaches to the
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transverse processes is going to have a
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little bit more of an angle going
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towards posterior if you're still having
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a hard time identifying these fascicles
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what you could do is use your two
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fingers right to palpate in this
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posterior cervical triangle but then
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have your client like push into that
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same palm a little bit with some lateral
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flexion right that'll get a bunch of
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stuff really active including the SCM on
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what you palpated earlier but then if
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they go into just a little bit of
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flexion which is lifting their head off
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the table you definitely would inhibit
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the levator scapula so now you know that
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as long as your posterior the scalene
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our posterior the sternocleidomastoid
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you're in the posterior cervical
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triangle and you're feeling vertical
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bands that's definitely your anterior
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and middle scalene all right so now that
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we found the anterior middle scalene we
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do have to talk for a second step number
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two which is what structures are around
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these structures that I could insullt abrade
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injure with compression we have
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the carotid artery let's let's stay away
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from the carotid artery we don't need
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anybody passing out on us I think you
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will find that if you gently apply
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pressure rather than just aggressively
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going in that you would find a pulse well
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before you would ever occlude an artery
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and there's nothing
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on the feeling a pulse but it is a good
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sign that you should probably press
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somewhere else remember that the carotid
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artery isn't very thick all you have to
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do is move a few millimeters in any
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direction and I think you'll be able to
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change your finger angle to still get it
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the same fascicles without occluding
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that artery the other thing you might
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want to stay away from is there are
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little beads in here which are lymph
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nodes you don't want to like take one of
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those beads thinking it's a trigger
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point and press it up against the
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transverse process thats a very bad idea we
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don't want to try to crush lymph nodes
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is going to cause inflammation could
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cause some symptoms but we don't want to
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deal with last your brachial plexus
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actually pierces between your anterior
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middle scalene and that's its normal
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course it comes out those nerve roots
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right and they all those various nerve
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roots combine to become the brachial
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plexus and it comes out between the
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anterior middle scalene goes underneath
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the clavicle and underneath the
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pectoralis minor and then feeds all the
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nerves to the arm right we don't want to
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push on the brachial plexus because a we
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can cause some nerve symptoms we don't
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want to cause tingling we don't want to
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cause something that's going to almost
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look like a radiculopathy we don't want
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to cause numbness or that nerve pain we
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don't want to push down on the brachial
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plexus and create that searing burning
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stretch i'm sure some of you have felt
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when you stretch a nerve we want to stay
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away from all that so if your client
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complains of any of those symptoms once
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again all you got to do is move a couple
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millimeters in any direction maybe
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change the angle of your thumb and you
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should still be able to get those same
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tissues so I know this is a lot of
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information guys which is why I'm glad
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this is on video you can put it on
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repeat a couple times but let's review
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you have posterior cervical triangle we
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know it's in there if I want to
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differentiate my anterior middle
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scalenes for my levator scapula which is
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probably the only other issue we have or
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maybe the the splenius cervicus I can
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use a little bit of lateral flexion and
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then flexion off the table to make sure
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I start there
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once I found those vertical fibers to
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find the densest fascicles and to
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find these trigger points tender points
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points of acute hyperactivity I'm going
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to do my anterior to posterior strumming
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since these are vertical fibers as I
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move from inferior or superior to
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inferior and our common trigger points
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are actually much closer to the ribs so I
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think what you guys will find is nine
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times out of ten rather than there being
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trigger points up in the middle of the
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neck they're much closer to the base of
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the neck and so I can actually feel here in
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Melissa that the tightest fascicles
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are right about there I don't feel a pulse
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any nerveyness you know nerveyness no little
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lymph node type feeling beads all right
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and then I can feel that it's a little
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denser there it gives me a little nodule
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all right so I can hold that for my 30
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seconds to 2 minutes until i get a
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nice release guys an important thing
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to keep in mind here is I'm not pressing
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lateral to medial I'm actually pressing
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I have a little lateral to medial angle
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but I'm mostly pressing superior to
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inferior and so I'm pressing towards the
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rib the reason why that's important is
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pressing into the transverse processes
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is going to be painful and I think as
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soon as we stimulate pain once again it
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becomes very hard to get a release I know
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that this is not comfortable for Melissa
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but there's a difference between this
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and pinchy pain which just does not feel
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good now to find the posterior scalenes
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all you have to do is keep all that
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anterior to posterior strumming in mind
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but then think okay my posterior scalene
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goes from c6 c7 transverse processes
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down to my second rib so it's almost
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like that splenius cervicus pocket that we
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talked about in the splenius cervicus
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release video but rather than go towards
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the laminar trough back this way and
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towards the
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is process I'm going to go kind of out
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this way towards the second rib and the
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fibers are looking for are much more
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vertical this is good technique to pick up
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because posterior scalenes tend to get
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very overactive and I can just do the
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same thing again if I need it to if I
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needed to try to differentiate for
00:13:2100:13:24
example the posterior scalene from the
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anterior and middle scalene I could go
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lateral flexion into my palm so mostly
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pressing into the arm i'm using for
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release and then if she extends back into
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the table boom right all of a sudden her
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anterior middle scalenes calm way down
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and her posterior scalenes
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fire up just like with all your
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techniques guys take your time this is
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not a race your patient has no idea what
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you're doing your patient has no idea
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how long this is supposed to take I know
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you want to get a lot of work done but I
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used to hate when my mother said this
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but I'm going to tell it to you guys the
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quickest way to get anything done is to
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do it the right way the first time man I
00:14:0400:14:06
used to hate that but now it makes so
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much sense so take your time use lateral
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flexion use flexion and extension to
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help you differentiate tissues if you
00:14:1500:14:17
have to use the SCM technique of
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contralateral rotation an flexion to
00:14:1900:14:23
find the SCM great that's fine if you
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have to sit there and find c7 to find
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the first rib because you've never felt
00:14:2800:14:31
that before fine somebody has Anatomy
00:14:3100:14:32
that's a little different than you're
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used to somebody's a little maybe a
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bigger person or a more muscular person
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or much more slight than you're used to
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dealing with all these little cues
00:14:4100:14:42
knowing your functional anatomy and
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taking your time with your palpation
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will be your savior you can still get to
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all of these tissues just about anybody
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and you should be able to get to them
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comfortably without causing discomfort
00:14:5500:14:57
from impending a nerve or whatever just
00:14:5700:15:00
simply by keeping your functional
00:15:0000:15:01
anatomy in mind
00:15:0100:15:04
stay tuned for the close-up recap and
00:15:0400:15:06
this close-up recap of our scalene
00:15:0600:15:08
static manual release we're going to
00:15:0800:15:11
start by outlining that posterior
00:15:1100:15:14
cervical triangle most of you would lift
00:15:1400:15:15
your head real quick you guys can see
00:15:1500:15:19
there's SCM ok so this mass right here
00:15:1900:15:22
is the upper trap so we know we're going
00:15:2200:15:25
right in between the two in here this
00:15:2500:15:29
being the floor of that triangle now the
00:15:2900:15:30
first thing I'm going to look for is
00:15:3000:15:33
those transverse processes because what
00:15:3300:15:36
I don't want to end up on is end up back
00:15:3600:15:38
here where it's more likely that i'm
00:15:3800:15:40
going to release my levator scapula and
00:15:4000:15:43
splenii I want to find the origin of
00:15:4300:15:47
these muscles so that I can start doing
00:15:4700:15:52
my anterior to posterior strokes towards
00:15:5200:15:55
their insertion down on the first and
00:15:5500:15:58
second rib now if I'm having problems
00:15:5800:16:01
finding those muscles like they're not
00:16:0100:16:03
popping into my fingers I'm not feeling
00:16:0300:16:05
the strands or I think by chance I'm on
00:16:0500:16:08
either the levator scapulae or splenii I
00:16:0800:16:11
could have Melissa go ahead and kind of
00:16:1100:16:14
push into my hand here a little bit with
00:16:1400:16:16
lateral flexion and although the SCM
00:16:1600:16:19
puffs up pretty quick I know where I
00:16:1900:16:21
know thats my SCM if I have her then
00:16:2100:16:24
go into a little bit of flexion I know
00:16:2400:16:28
that the muscles behind my SCM that are
00:16:2800:16:30
puffed up from lateral flexion and
00:16:3000:16:33
flexion are my anterior and middle
00:16:3300:16:37
scalenes disflexion inhibits my
00:16:3700:16:40
levator scapula and splenii muscles
00:16:4000:16:43
so right there go ahead and relax Melissa
00:16:4300:16:47
right there I know I'm on nothing but
00:16:4700:16:49
scalene of course I can do my anterior
00:16:4900:16:52
posterior strokes here looking for the
00:16:5200:16:55
dentist fascicles once I find them I'm
00:16:5500:16:57
going to go ahead apply pressure now
00:16:5700:16:58
of course since I'm in the area of the
00:16:5800:17:01
neck I am keeping in mind do I feel a
00:17:0100:17:04
pulse am I getting any nerve symptoms
00:17:0400:17:07
does Melissa have any tingling or numbness
00:17:0700:17:11
does she have that searing stretchy pain
00:17:1100:17:13
of stretching a nerve am i on a lymph
00:17:1300:17:16
node does it feel like a like I have
00:17:1600:17:18
a little lima bean underneath my finger
00:17:1800:17:21
remember these densities inside muscle
00:17:2100:17:23
just feel like an increase in tissue
00:17:2300:17:25
density and might feel a little ball
00:17:2500:17:30
like but it's more just denser parts of
00:17:3000:17:32
the same structure that you're feeling
00:17:3200:17:35
now to find the posterior scalene is a
00:17:3500:17:38
little tricky I suggest going anterior
00:17:3800:17:41
middle scalenes first and then what you
00:17:4100:17:45
can do is ensure that you're down low
00:17:4500:17:51
enough that your lateral to c6 and c7
00:17:5100:17:53
right because that's where your
00:17:5300:17:57
posterior scalene in our originates and
00:17:5700:18:00
then you can have your patient do
00:18:0000:18:02
lateral flexion into your hand again and
00:18:0200:18:05
extend back into the table and you'll
00:18:0500:18:08
feel those fibers pop out all right so
00:18:0800:18:12
if you know you're pretty close to
00:18:1200:18:15
anterior middle scalene come back on to
00:18:1500:18:18
where you think posterior scalene may
00:18:1800:18:21
be and then you confirm by doing lateral
00:18:2100:18:24
flexion and extension you're probably in
00:18:2400:18:27
good shape go ahead and relax and then
00:18:2700:18:29
posterior scalene definitely gets
00:18:2900:18:32
tight on a lot of people the common
00:18:3200:18:34
trigger points for all of these muscles
00:18:3400:18:37
guys are very close to the first and
00:18:3700:18:39
second ribs so right about where my
00:18:3900:18:41
thumb is that right at the base of the
00:18:4100:18:43
neck there is a common trigger point for
00:18:4300:18:45
anterior scalene that's up a little
00:18:4500:18:47
higher about midway up the neck but
00:18:4700:18:50
again these are all far more common down
00:18:5000:18:54
here and as I suggested in our further
00:18:5400:18:58
away shot supine is probably the best
00:18:5800:19:01
way to get this technique done this
00:19:0100:19:04
isn't uncomfortable for me I can get my
00:19:0400:19:07
arm behind my direction of pressure
00:19:0700:19:09
which is going to be down towards the
00:19:0900:19:11
rib right not into the transverse
00:19:1100:19:12
process
00:19:1200:19:15
down towards the rib and of course my my
00:19:1500:19:17
patient here is very comfortable as
00:19:1700:19:20
shes just lying with her head supported
00:19:2000:19:21
so there you have it knowing your
00:19:2100:19:23
functional Anatomy will definitely help
00:19:2300:19:25
your manual technique it'll help you
00:19:2500:19:27
differentiate structures so when you can
00:19:2700:19:28
place your hands where they need to be
00:19:2800:19:30
as well as make you aware of these
00:19:3000:19:33
sensitive structures around the tissue
00:19:3300:19:35
that you're trying to target things like
00:19:3500:19:37
nerves and lymph nodes and arteries make
00:19:3700:19:39
sure that if you're going to place your
00:19:3900:19:40
hands on a patient that you have done an
00:19:4000:19:42
assessment and have a good rationale for
00:19:4200:19:44
placing your hands on that patient and
00:19:4400:19:46
if you're going to assess make sure you
00:19:4600:19:48
reassess to ensure that your technique
00:19:4800:19:50
was effective and you have a good
00:19:5000:19:52
rationale for using that technique again
00:19:5200:19:56
now with manual therapy one-on-one live
00:19:5600:19:59
education is incredibly important please
00:19:5900:20:01
be looking for opportunities like
00:20:0100:20:04
workshops and mentorship and maybe even
00:20:0400:20:07
classes at your local university that
00:20:0700:20:10
can get you some one on one individual
00:20:1000:20:13
instruction or at least a live classroom
00:20:1300:20:16
instruction so you've had a chance to be
00:20:1600:20:20
critiqued and mentored by somebody
00:20:2000:20:22
senior to you with some experience in
00:20:2200:20:25
manual therapy techniques and before you
00:20:2500:20:28
bring the stuff back to your rehab
00:20:2800:20:31
fitness or performance setting please
00:20:3100:20:34
practice on colleagues there is no
00:20:3400:20:37
substitute for practice and it is going
00:20:3700:20:41
to take a while to get accustomed to some
00:20:4100:20:42
of the techniques that we show in these
00:20:4200:20:45
manual technique videos don't expect to
00:20:4500:20:48
learn them in two or three or even five
00:20:4800:20:50
minutes you want to have hours of
00:20:5000:20:52
experience under your belt working on
00:20:5200:20:55
various different body sizes and shapes
00:20:5500:20:57
so that when you do get that first
00:20:5700:21:00
paying client first paying customer and
00:21:0000:21:01
you're really trying to make a good
00:21:0100:21:05
positive impact really trying to promote
00:21:0500:21:08
better outcomes you feel comfortable
00:21:0800:21:10
with that technique I look forward to
00:21:1000:21:12
hearing about your outcomes and hearing
00:21:1200:21:14
your questions in the comments section
00:21:1400:21:18
of this video I'll talk with you soon
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