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This is Brent of the Brookbush Institute, and
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in this video we're bringing you another
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manual technique. Now if you're watching
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this video I'm assuming you're watching
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it for educational purposes, and that you
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are a licensed manual therapists
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following the laws regarding scope of
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practice in your state or region. That
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means athletic trainers, chiropractors,
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physical therapists, osteopaths, licensed
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massage therapists, you are likely in the
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clear to do these techniques. Personal
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trainers this probably does not fall
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within your scope of practice, although
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you might be able to use the palpation
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portion of this video, to aid in learning
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your functional anatomy in an
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educational setting supervised by a
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licensed manual therapists. Now before we
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place our hands on a patient or client
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it is important that we assess, and have
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a good rationale for doing so. And of
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course if we're going to assess, then we
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should be reassessing to ensure that the
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manual technique we're using is
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effective, and we have a good rationale
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for continuing to use that technique. In
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this we're going to go over static
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manual release of the splenii muscles,
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that's the splenius cervicis and the
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splenius capitis. I'm going to have my
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friend Melissa come out she's going to
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help me demonstrate. Now we're going to
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use the same four step process we've
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done in other static manual release
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videos. We're going to talk about how to
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palpate and differentiate the splenii
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from the other structures proximal
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to it on the posterior lateral neck.
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We're going to talk about any structures
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that might be proximal to the splenii
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muscles that we could insult or abrade
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with compression. We need to talk about
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trigger points a little bit because that
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will help the efficacy and accuracy of
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this technique, and we're going to talk
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about client and practitioner
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positioning, so that I am in a position that I
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can comfortably hold this technique. and
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my client can relax in the position
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they're in so that we can actually get a
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release. Now step number one of this
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technique is by far the hardest, it helps
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to know a little bit of functional
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Anatomy. We have to figure out how we're
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going to differentiate the splenii
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from the upper trapezius and the levator
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scapulae which it lies in between. Now it
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is important to be able to differentiate
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this structure because the upper trap,
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splenii, and levator scapulae don't all
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rotate the head in the same direction.
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So for example if I assessed Melissa she
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came in with some cervical dysfunction,
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maybe even some cervicogenic headache,
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and I noticed that she could not rotate
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her head completely in this direction, I
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need to know which of those muscles I
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should release on this side, and which I
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should release on this side. So let's
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talk about functional Anatomy a little
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bit. My splenii and this is splenius
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cervicis and splenius capitis together,
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originate from the spinous process
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of T6 up through the ligamentum nuchae to
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the spinous process of C3, and then they
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kind of run off in this direction,
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so from inferior medial to
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superior lateral, towards the mastoid
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process of the temporal bone, and you
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guys can feel that little bump that's
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behind your ear, that little point right
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that's where these fibers are
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heading to. You can imagine if I'm on
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this diagonal that when these muscles
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shorten, they'll create ipsilateral
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rotation. So the rotation the splenii
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muscles create matches the levator
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scapulae, but opposes the upper trapezius
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which rotates this way. So for example, if
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I had Melissa here and she had great
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rotation this way, we couldn't rotate
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this way very well, lets say she's stuck
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right there. What I would probably want
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to do is release levator scapulae and
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splenii on this side, but upper trapezius
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and deep extensors of the neck on this
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side. The more accurate I can be the
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better chance I have of getting good
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outcomes. So how do I get to this
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structure. Well we need to skip to step
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three real quick. Knowing where the
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common trigger points are, where we're
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likely to find those increases in tissue
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density is going to help. So trigger
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points are commonly just in line with
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the C7 spinous process, which is usually
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that most prominent spinous process of
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the base of the neck. So you guys can
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look for that and think
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ok, I got one trigger point that's going
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to be in here somewhere, and then the
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other one just happens to be in line
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with C2 which is the first spinous
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process I can feel underneath the head, It's
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nice and convenient so at least we have
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two nice landmarks we can kind of line
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up with. Now although I said that this
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this trigger point here which happens to
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be the trigger point for the splenius
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cervicis, is in line with the spinous
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process of C7 I can't just go ergh
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that's not going to work. It might leave a
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nice bruise but I'm probably not going
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to get to the splenii muscles, I
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actually need to get deep to the upper
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trapezius, and the only way I can do that is
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by finding the anterior border of the
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upper trapezius and falling off this way. So I
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don't know if you guys can kind of see
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my finger there fall off in front of the
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trapezius. Now we have to take another step
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here and get a little bit more technical
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and find the lamina trough, which is the
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trough between the transverse process and
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the spinous process here. So
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between the spinous process and the
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transverse process of a vertebra you
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have this little little divot, you guys
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can even kind of feel that if you
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kind of palpate in the neck here. The only
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difference is we need to find this
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trough while anterior to the trapezius, and
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heading down towards C7 spinous process.
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You guys got that,
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anterior to the trapezius, into the lamina
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trough, towards C7 spinous process
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and then we hit the levator scapulae,
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darn it, okay we're almost there. So
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what we're going to do is we're going to
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laterally flex, that's going to help
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soften up the upper trapezius a little bit,
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and then we're going to
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ipsilaterally rotate. And although this is
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going to shorten our tissues a little
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bit, for the splenius cervicis here it's
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going to allow me to get my thumb in
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between the upper trapezius and the levator
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scapulae which is just anterior, into
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that trough so that I can start doing my
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short stroke strumming perpendicular to
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the splenii fibers,which remember
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these fibers go up this way. So I'm
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actually going to be kind of doing
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these tiny little strums out this way in
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the trough with her head in this
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position, until I find the most dense
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fascicles. I'm going to look for a nice
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nodule once I find those fascicles and
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it's right there. All right and then I
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can use her head if I need to
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add a little tension to kind of
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stabilize that nodule, so I'm not playing
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the finger on top of the marble game, I
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can do that here. Now the other trigger
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point which is going to be our splenius
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capitis trigger point, all I need to do
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is start searching in through here and
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look for fibers that are heading from
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the spinous process out towards this
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mastoid process. The splenii
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muscles have a unique fiber direction which
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is kind of what I mentioned before, is
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why we need to be able to differentiate
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these tissues. They rotate differently
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than the deep extensors of the cervical
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spine underneath them. So i can have
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Melissa to do all sorts of things to
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help with my palpation, right like I can
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kind of get my fingers in the right
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place and I can go, hey do you mind
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rotating towards me against my thumb,
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right and then extend your head and turn
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lateraly towards me, and then if I
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do my my short strokes here, right so I'm
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going to come down this way, I can kind
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of see alright so I got her contracting
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the right muscle; can I get them, can I
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feel the ones that are going in the
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right direction heading in the right
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direction, and I can actually right here.
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And then once I find those tight
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fascicles is there any nodule or point
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of acute density that i can press on. Now
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a couple little things here guys; take
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your time, this isn't a race, nobody's
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expecting you to just put your finger
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right down on a trigger point in a
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muscle that's fairly deep and hard to
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palpate. That doesn't show
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proficiency to just kind of go aah, it
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shows maybe carelessness more than
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anything else. Your patient doesn't know
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whether this should take you 15 seconds
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to find, or three minutes to find. So if
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you know your functional Anatomy you can
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think of those fiber directions, you need
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your client you need to move your
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clients head around a little bit, you
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need to have them contract the muscle,
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that's all fine, that's all fine. Take
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your time. I'd rather you took three
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minutes to find the right point than to
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spend 15 seconds and be totally wrong,
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and not get any outcomes whatsoever. Now
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although we don't have too much issue
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here with sensitive structures, as long
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as you don't jab your finger up in
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towards the occiput that you kind of
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stay going posterior to anterior, you
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shouldn't run into any structures that
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are particularly sensitive to
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compression. You do have to be a little
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careful with the splenius cervicis point,
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because if you press down real hard, real
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fast, and you're not real careful, you
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could stretch the brachial plexus. So if
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you get any burning, searing, tingling
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they get that little jolt, right if they
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get any numbness, or funky pins and
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needles and their fingers, guys move, take
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your time, move your fingers around get
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off the brachial plexus. See if you can
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mess around with some
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ipsilateral flexion to get that brachial
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plexus out of the way, and still get to
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the muscle you're looking for. Now last
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we do need to talk a little bit about
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patient and client position. This is not
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a good idea all right, this is kind of
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weird, but I'm not I'm not just like
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palming people's foreheads and
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jabbing my thumbs in places where I
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can't see, especially because I can't see
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this trigger point here. This
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is all for you guys to be able to see a
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little bit of the anatomy, and how my
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hands are placed relative to some other
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structures. If I was going to do this in
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a seated position which you can, I would
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have Melissa swing her legs
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over the end of the table here and I
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would come sideways,and then I would
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probably use that that kind of quasi
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headlock position. I'll drop the table
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down here a little bit, but we talked
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about putting the forehead and the
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crease of your elbow on another one of
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our manual release techniques for the
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neck. If I do this, I can now move
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her head comfortably and she feels nice
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and stable. I can use my body against her
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shoulder, right like my rib cage and my
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torso here a little bit, and then I can
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take this thumb and get right where I
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need to get. This particular technique
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doesn't take a whole lot of pressure so
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you might be okay. It's not ideal body
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mechanics I can't really get my forearm
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perpendicular to, or parallel to the
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direction of force, but we're close to a
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good position here. I personally prefer
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to do this in supine, so i'm going to have Melissa
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swing all the way around here. I think
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supine is much more comfortable for both
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the patient and the client, and I think
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you guys will agree if I just slip this
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hand underneath the occiput, I now have
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total control of her head, and Melissa
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is very relaxed right now because we've
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done a lot of these videos and she
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trusts me, poor thing. She has had
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her neck worked on with me before.
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It might take a second to get your
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patients to completely relax, but you do
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have really nice control this way, and
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then I can take this hand and I'm going
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to use kind of this technique of
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reaching underneath her neck, and I can
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see her trap right here drop my hand ,and
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right anterior to it I'm going towards
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that laminar trough, and since I can feel
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C7 with these fingers, I can drop
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my thumb right down in that direction.
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Move her head however I need to, I can
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start doing my strumming out
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perpendicular to those fibers. Find the
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tightest fascicles, find my tight nodule, add
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a little tension so
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that I have that nodule pinned, and then
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wait for a release.
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And believe it or not the splenius
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capitis trigger point is even easier
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because all i have to do is move my
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fingers like this, right so i leave these
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digits kind of facing up, and i'm just
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going to use the weight of her head.
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I'm going tofind C2 which is
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that first by the spinous process I feel
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underneath her occiput. I'm
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going to look for the fibers that go in
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the right direction and I might have her
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like, okay can you rotate into this side
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here. I might have her rotate a little
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bit and then try to strum those fibers,
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find the most dense fibers, find the most
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dense nodule, and then once again just
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have her totally relax. The nice thing
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here is like my hand is curled, and then
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I just have the weight of her head hold
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for me until we get a release. Stay tuned for
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the close-up recap. So now for a close-up
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recap of the splenii static manual
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release. We're starting here with the
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splenius cervicis manual release. You can
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see my thumb is actually just anterior
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to the anterior border of the upper trap
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here, that my hand is wrapped underneath.
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I'm going to fall off the anterior
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border down into the lamina trough,
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which is the space between the
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transverse process and the spinous
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process on the posterior aspect of the
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cervical spine. I know that my common
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trigger point is down near the C7
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spinous process. So i can even palpate
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the C7 spinous process with these two
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fingers and give myself an idea of where
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that is, and then kind of push my fingers
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towards one another. But unfortunately
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the first thing I run into actually is
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my levator scapulae. So the way I get my
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levator scapulae out of the way is I do a
00:14:4500:14:47
little ipsilateral rotation, and
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although this takes some tension off my
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splenius cervicis, it's the only way
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for me to sink my finger down between my
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upper trap and levator scapulae. Once I've
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sunk my finger down in there I can then
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use my short strokes,
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kind of this lateral to medial stroke,
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and these are very short strokes
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just a couple fascicles at a time, to
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find anything to me that feels
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overactive, feels tauter than it should be.
00:15:2100:15:23
Once I find those taut
00:15:2300:15:26
fascicles I can kind of move inferior to
00:15:2600:15:29
superior, superior to inferior to try to
00:15:2900:15:33
find the densest nodule, and then i can
00:15:3300:15:36
actually once i've located that nodule
00:15:3600:15:39
go back into a little contralateral
00:15:3900:15:42
rotation, contralateral flexion to add
00:15:4200:15:43
some tension back in those tissues and
00:15:4300:15:44
help me pin that point of hyperactivity.
00:15:4800:15:51
Once I get a release, of course I can
00:15:5100:15:53
move on and of course this is the more
00:15:5300:15:57
complicated of the two release techniques
00:15:5700:16:00
for your splenii muscles. The
00:16:0000:16:03
splenius capitis muscle has a trigger
00:16:0300:16:05
point that's commonly at the level of
00:16:0500:16:08
your C2 spinous process, which your C2
00:16:0800:16:10
spinous process is the first spinous processs
00:16:1000:16:12
you feel underneath the occiput. So
00:16:1200:16:15
that's fairly simple, and we know
00:16:1500:16:18
that the splenii have this kind of
00:16:1800:16:20
unique fiber arrangement thats this way.
00:16:2000:16:24
So all we have to do is kind of go just to the
00:16:2400:16:29
side of C2 spinous process here, and look
00:16:2900:16:32
for fiber direction this way. Find her
00:16:3200:16:36
tightest fascicles by strumming this way,
00:16:3600:16:38
kind of from in the same direction that
00:16:3800:16:41
her shoulder to her ear would be.
00:16:4100:16:42
So we're strumming perpendicular
00:16:4200:16:46
to those fibers. Once we find them -find the
00:16:4600:16:48
tightest fibers that is, we can kind of go
00:16:4800:16:50
lateral to medial to see if there's a
00:16:5000:16:53
nodule and point of hyperactivity. And
00:16:5300:16:55
then I'm just using that kind of curved
00:16:5500:16:58
hand position and the weight of her head
00:16:5800:17:01
to do all the work, and once i get a
00:17:0100:17:05
release we're good to go and I would
00:17:0500:17:08
reassess. So there you have it knowing
00:17:0800:17:09
your functional Anatomy will definitely
00:17:0900:17:12
help your manual technique. It will help
00:17:1200:17:13
you differentiate structure so that you
00:17:1300:17:15
can place your hands where they need to
00:17:1500:17:17
As well as make you aware of these
00:17:1700:17:19
sensitive structures around the tissue
00:17:1900:17:21
that you're trying to target. Things like
00:17:2100:17:24
nerves, and lymph nodes, and arteries. Make
00:17:2400:17:25
sure that if you're going to place your
00:17:2500:17:27
hands on a patient that you have done an
00:17:2700:17:29
assessment, and have a good rationale for
00:17:2900:17:31
placing your hands on that patient. And
00:17:3100:17:33
if you're going to assess, make sure you
00:17:3300:17:35
reassess to ensure that your technique
00:17:3500:17:37
was effective and you have a good
00:17:3700:17:38
rationale for using that technique again.
00:17:3800:17:42
Now with manual therapy one-on-one live
00:17:4200:17:46
education is incredibly important. Please
00:17:4600:17:48
be looking for opportunities like
00:17:4800:17:51
workshops, and mentorships, and maybe even
00:17:5100:17:54
classes at your local university that
00:17:5400:17:57
can get you some one on one individual
00:17:5700:17:59
instruction. Or at least some live classroom
00:17:5900:18:03
instruction so you've had a chance to be
00:18:0300:18:06
critiqued and mentored, by somebody
00:18:0600:18:08
senior to you with some experience in
00:18:0800:18:11
manual therapy techniques. And before you
00:18:1100:18:15
bring this stuff back to your rehab,
00:18:1500:18:18
fitness, or performance setting, please
00:18:1800:18:20
practice on colleagues. There is no
00:18:2000:18:23
substitute for practice, and it is going
00:18:2300:18:27
to take a while to get accustomed to some
00:18:2700:18:29
of the techniques that we show in these
00:18:2900:18:31
manual technique videos. Don't expect to
00:18:3100:18:34
learn them in two, or three,. or even five
00:18:3400:18:37
minutes. You want to have hours of
00:18:3700:18:39
experience under your belt working on
00:18:3900:18:41
various different body sizes and shapes.
00:18:4100:18:44
So that when you do get that first
00:18:4400:18:46
paying client, first paying customer, and
00:18:4600:18:48
you're really trying to make a good
00:18:4800:18:51
positive impact, really trying to promote
00:18:5100:18:54
better outcomes, you feel comfortable
00:18:5400:18:56
with that technique. I look forward to
00:18:5600:18:58
hearing about your outcomes and hearing
00:18:5800:19:00
your questions in the comments section
00:19:0000:19:04
of this video, I'll talk with you soon.