Splenius Cervicis and Splenius Capitis Static Manual Release (Soft Tissue Mobilization)

Splenius Cervicis and Splenius Capitis Static Manual Release (Soft Tissue Mobilization) is a specific, manual technique used to help relieve tension and pain in the posterior neck and upper back. This type of therapy, using gentle pressure and manipulation of the soft tissues, can help to increase flexibility and reduce muscle tightness, improving joint range of motion in the upper spine. This essential treatment is safe and effective for reducing neck and back pain and can also help to

Transcript

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This is Brent of the Brookbush Institute, and
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...blank
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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
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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
00:14:5900:15:02
sunk my finger down in there I can then
00:15:0200:15:03
use my short strokes,
00:15:0300:15:07
kind of this lateral to medial stroke,
00:15:0700:15:09
and these are very short strokes
00:15:0900:15:13
just a couple fascicles at a time, to
00:15:1300:15:16
find anything to me that feels
00:15:1600:15:20
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
00:17:1500:17:15
be.
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.