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Sternoclavicular Superior to Inferior Manual Joint Mobilization

Sternoclavicular Superior to Inferior Manual Joint Mobilization is a physical therapy technique used to increase the range of motion of the sternoclavicular (SC) joint by applying a gentle, controlled, and sustained pressure to the area. This mobilization can help to reduce pain and improve function of the joint by increasing the joint capsule flexibility and restoring the mobility of the SC joint. This technique may be used to reduce pain from conditions such as arthritis, bursitis, and thor

Transcript

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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