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This is Brent of the Brookbush Institute, and in this
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video we're going to go over a joint
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based manual therapy technique. If you're watching this video I'm assuming you're
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watching it for educational purposes, and that you are a licensed professional
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with joint based techniques within your scope; that means osteopath's, chiropractors,
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physical therapists, you're probably all in the clear. Physical therapy assistants,
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athletic trainers, massage therapist you need to check with your governing body
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in your state or region to see whether this is within your scope of practice.
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Personal trainers this is definitely not within your scope of practice. Of course
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all professions could use this video for purely educational purposes to help with
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learning biomechanics, anatomy and of course palpation. In this video we're
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going to do our superior to inferior, or cranial to caudal clavicle on sternum
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mobilization. So this are our caudal sternoclavicular mobilization, I'm going to
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have my friend Melissa come out and help me demonstrate. Now this is an
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interesting technique that I want you guys to keep in your back pocket, I find
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it very very helpful for those stubborn stiff shoulders where you can't quite
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figure out how to get that last five degrees of shoulder flexion, or five
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degrees of shoulder external rotation; and I know some of you guys are thinking
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well wait a second, how does the sternoclavicular joint contribute to
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shoulder range of motion? And this, this gets a little deep into biomechanics but
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we do have some research to suggest that those with shoulder impingement or
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shoulder dysfunction, do not get enough elevation and posterior rotation of the
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clavicle during elevation of the arm. So if we're not getting enough motion of
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the clavicle, we might want to start thinking towards well could we have
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stiffness in the SC and AC joint. Now in this video we're going to focus on an SC
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joint mobilization, so why would I go superior to inferior, well if I'm
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thinking about trying to get more elevation of the clavicle based on the
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way the clavicle is shaped being a saddle joint, we can presume that it
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follows concave on convex rules in the frontal plane right. So this joint wants
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to as the clavicle elevates, roll superiorly,
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which means we also need the glide inferiorly; hence why we come back to
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this superior to inferior glide that I want you guys to keep in the back of
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your brain, to try to help elevation of the clavicle, which just may help you get
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those extra few degrees with that stubborn stiff shoulder. So from here we
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kind of need to know how do we place our hands, how are we going to make this
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technique work, and that all starts with your knowledge of anatomy and and being
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able to palpate, and I would start with just palpate the clavicle, try to try to
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outline the clavicle. If you've never done that before, I mean we all know
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where our collarbones are that's fine, but start visualizing the shape of the
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clavicle and try to find the rounded end of the clavicle. One rounded end, the
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distal end would be the AC joint, but that proximal end is right where the
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sternoclavicular joint is, and if you keep exploring the border of that
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rounded proximal end you can actually feel like a depression, like a line
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between the flat sternum, in this case actually the manubrium which is the top
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of the sternum, and the rounded edge of the clavicle. And what I'm going to have
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you guys do is once you find that, without jabbing somebody in the neck
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which I know I jus jabbed Melissa in the neck there,
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but without jabbing her in the neck I want you guys just to take two fingers
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and put them right right over the joint line, we're going to use these as our
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feelers of joint glide. Once again it's one of those things
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where I just don't see taught often enough in joint mobilizations is if you have a
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free hand, if you have the opportunity to use your fingertips to feel a joint line,
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it's always a good idea to do so. It's going to help you determine when your
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first motion happened at the joint, and of course when the end of arthrokinematic
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motion or the end of glide happened as well. Now the way I'm going to mobilize
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this joint is a little different than this technique which I've seen
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traditionally in texts and and in some videos.
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This is pokey like you guys could just see Melissa's face kind of like uhh, and I think
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some clinicians are ok with with a little pokeyness sometimes if they have
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to, and and not that I want to say that there's a problem with that, but there is
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an alternative way to do this technique where you just don't need to be poking
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at somebody's bony sternoclavicular joint. Use these two fingers to feel the
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joint line, and then just use your your thenar eminence close to the joint line
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on the clavicle; and so if I do this you guys can see now notice I have my
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fingers pointed up here right ,like we don't want roaming fingers over
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somebody's chest no need to get yourself into trouble, but
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if I just put my thenar eminence nice and close to the joint line and I
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press in an inferior direction, I can immediately feel the clavicle move
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against my fingertips. No need to do this, nice broad surface area not pokey, and
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providing I don't let my hands slide down over the top of Melissa's neck like
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I'm going to choke, her like we definitely don't want anything like that.
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And if I just kind of keep right on top of the clavicle and I push that way, how
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does that feel? A lot better than this right. Okay yeah pokey, not pokey. A couple
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precautions before we get started with our protocol here guys, watch
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their sternocleidomastoid, keep in mind that your sternocleidomastoid like
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goes right over the top of your sternoclavicular joint. So if somebody
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starts tensing up and starts really guarding on you, you're not going to get
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a good mobilization. It's also going to make them feel a lot more uncomfortable
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because it's going to put a lot more tense muscle in your way which, we don't
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want anything bearing down on the neck. So fingertips here, thenar eminence here.
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I'm watching to make sure that her sternocleidomastoid aren't getting
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geared up, and then I'm just going to go okay where's my first resistance barrier,
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and it's right there, and then where is the end, is right there.
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I'm going to back off to 50%, and then I can either do my grade 3's by coming all
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the way back to the first resistance barrier, and doing like a larger
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amplitude mobilization here. Or I could do my grade 4, going all the way down
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arthrokinematic end range, back off 50% and stay right there at 50%, being a
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little bit more intense than our grade 3. Now one thing I do want you guys to
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notice is how straight this arm is, like I'm basically locked out here, and I'm
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using my my core muscles to push. So don't think because you're seated you're going
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to get away with like muscling this technique. You don't want to turn this
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into like a chest press, like this is not a good thing, notice all like I'm just like
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rocking her whole body anyway. What I really want to do is have my arms pretty
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much straight out, be straight on to the table with my feet, and then like I'm
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just using the weight of my trunk to push into Melissa's clavicle, Stay tuned
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for your close-up recap. To give you guys a different view of our superior to
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inferior sternoclavicular mobilization, the first thing we're going to do is
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palpate the clavicle right. So hopefully you guys can kind of see how I'm
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outlining the clavicular bone, and I actually want to follow the clavicular
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bone medially until I fall off the clavicular bone. I can feel this nice
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round bump here, and it approximates the rather flat manubrium which is the top
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of my sternum. So you guys can see here my fingers are on this flat sternum, and
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then if you watch me kind of go like this medial to lateral, you guys can see
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my fingers kind of bump up over the rounded edge of the clavicle. Now what I
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want to do is actually use my other hand to palpate the joint line. I'm going to
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palpate my joint line, and that's going to help me determine
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when my arthrokinematic motion starts with this mobilization, when I've had hit
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end range arthrokinematic motion, and I mentioned before I'm just going to use
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my thenar eminence here close to the joint, without being on top of Melissa's
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throat, and without having to be on top of my fingers because that's not going
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to be verycomfortable for me. So right here is probably good, and I can feel as
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soon as I push down, I can actually feel with these fingers that joints start to
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move. So there's my first resistance barrier just that easy, and then I can
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feel the end of arthrokinematic motion and then back off to 50%; and I can do
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either my grade 3s by starting at first resistance barrier and going to 50% in a
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larger amplitude, or I can stay at 50% in small amplitude and do my grade fours.
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Notice this is fairly comfortable for both Melissa and myself since I have my
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arms straight, and I'm just using my torso, my core muscles essentially to
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create the oscillatory motion. I'm not using my hand strength, I'm not using my
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arm strength, it's really just the weight of my torso leaning forward and a little
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core strength to create that oscillatory motion. Once I finish one to two
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oscillations per second and start to feel a decrease in arthrokinematic
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stiffness, I'll then go ahead and reassess. So there you have it assess,
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address, reassess. Make sure that every time you choose a joint based manual
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therapy technique it is based on an assessment, and that you return to that
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assessment after you've finished the intervention to see if it was effective
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for the individual, the patient or client that you had in front of you. Ensure that
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you continue to learn your Anatomy because your Anatomy is going to help
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you with your hand placement, with understanding what a joint can do, with
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understanding what you may gain from this particular technique. And of course
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practice, you have to practice these techniques hopefully not for the first
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time on a patient or client who just walked in the door. If you can, find a
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more senior instructor or a mentor to give you some really good hands-on
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instruction. Use your peers for some good feedback, and of course always look for
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live education to help with your manual therapy techniques. I know these videos
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make education very convenient, but there is no substitute for learning manual
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therapy in a live setting. I look forward to talking to you guys again