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Sternocostal Joint Self-administered Mobilization

Sternocostal Joint Self-administered Mobilization is a technique used to reduce pain and improve range of motion in the cartilage connecting the sternum (breastbone) to the ribs. This mobilization can be done by oneself, without the help of a physical therapist or other health care provider. First, one should gently begin to press and move the sternum in an inward and outward motion, using the palms of the hands to press against the breastbone. Next, the

Transcript

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This is Brent of the Brookbush
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...blank
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Institute bringing you a new
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self-administered joint mobilization
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technique. In this video we're going to
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talk about sternocostal mobilizations,
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or mobilizations of these tiny little
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joints that you have just lateral to
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your sternum where your ribs interface.
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Some of you guys are thinking to
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yourself well why would I want to
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mobilize these tiny little joints. We
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have to think a little bit bigger
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picture for the broadest use of this
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technique, which is those individuals who
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have problems with thoracic mobility. So
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your thoracic spine controls your
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ribcage, and your ribcage attaches to
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your sternum anteriorly. Now if you've
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had long-standing thoracic mobility
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issues, it would actually make sense that
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we've had some sort of adaptive change
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in the mobility of these joints. Maybe an
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increase in stiffness that is preventing
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us from getting as much results as we
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could be getting from our thoracic
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mobility routine. There are some other
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issues where we may look at using this
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technique as well, for example those
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people who get a lot of trigger points
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through their pectoralis major. I would
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say it's worth a try to do this
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technique. I have noted clinically that
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there seems to be a relationship between
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sternocostal mobility and pectoralis
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major trigger points. There are also
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those individuals who feel like these
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joints need to pop, that's a potential
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symptom or a potential sign that this
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technique is also worth a try. Of course
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if you guys are dealing with pain, make
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sure you're either a licensed
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professional or you refer out to a
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licensed professional, to determine
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whether this technique would be
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appropriate. I'm going to have my friend
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Melissa come out, she's going to help me
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demonstrate this technique. Now let's go
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over our anatomy a little bit, like the
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practical part of this. You guys all know
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where your sternum is. Now this is her
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manubrium, the top of her sternum. I can
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actually just by putting the pads of my
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fingers down in the center of her
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sternum, I can actually feel her sternocostal
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joints at either side. So if you
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thought your sternum was that wide
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you're wrong, your sternum is actually
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fairly thin. These sternocostal joints
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are just lateral to the midline, so we're
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not going to be moving a whole lot when
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we do these mobilizations. We're going to
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be staying pretty center, which I know
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what some of you guys have already been
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thinking with this technique, is this
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safe for females to do, is this going to
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be uncomfortable for females to do, am I
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going to impinge, or bruise, or compress
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breast tissue. Chances are no, we're not
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moving very far and if somebody is
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really rolling over their chest they're
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going too far. Or they're using a
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foam well that's just too wide for their
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little person, but chances are they're
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rolling too far and as I show you this
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technique that'll make more sense. Now
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what we're going to do is we're going to
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adapt a manual therapy technique, which
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would be anterior to posterior
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mobilizations, where I would take maybe
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the ulnar border of my hand and put
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pressure down on those sternocostal
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joints anterior to posterior. Now
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obviously I can't do that with a foam roll
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I guess I could have somebody hug
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into themselves, but that's not going to
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work out too well. What we're going to do
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is we're going to start on the sternum
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which is essentially the ribs being
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unloaded, and then roll onto the ribs
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which is going to be an anterior to
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posterior force. We're then going to roll
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back and forth and that's going to
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create the oscillation that we'd
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normally use for mobilization. So
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Melissa's going to go chest down on this
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foam roll and the trigger point roll
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tends to work pretty well, being covered
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in a little bit of foam it definitely
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helps the sensitive area. She's going to
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start with her hands and maybe even
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elbows down to take off some of the
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weight, especially when she starts
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because this can be quite tender. If I
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needed to I could even use a towel
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underneath, to even further soften that
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down. We don't want to kill the person. We
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don't want them in so much pain just
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trying to do the technique that they're
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not going to comply, and do this with
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their home exercise program. Once she's
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found the center of her sternum I'm
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going to have her try one side at a time.
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I just want her to roll over one set of
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ribs, just barely over those bumps and
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then
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back, and then if she can get a little
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oscillation going, I'd have her do about
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15 maybe 30 seconds tops on each side.
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Good go ahead and switch sides.
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I'm going to have her get up and go back into Child's
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Pose. Nice and comfortable and then I go
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ahead and retest. Be very careful how
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much of this stuff you guys do, you don't
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want to take a mobilization from
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positive to irritating. Now there are
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several progressions to this
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mobilization to add force, that was our
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first progression. You may need to
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regress to something even softer. When
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Melissa and I were experimenting before
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we made this video, we actually used this
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very soft squishy ball, and honestly
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that's enough to load and unload the
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ribs for somebody who might be really
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really sensitive. Little tougher to roll
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back and forth but that's okay.
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Good go ahead and relax. The other thing
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we talked about is if you guys have any
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really soft foam rolls lying around, a
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good reason to keep some of those old
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beat-up spongy foam rolls, is a long foam
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roll can actually be less force because
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now Melissa can shift part of her body
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weight, onto her inner thigh on the side
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the she's is going to roll. So now
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she's getting like more or less the
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bottom half of her body supported by the
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length of the foam roll, and then she
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only has her upper body weighting down her
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ribs. But as Melissa is pretty tough and
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we've been working on this a little bit,
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let's go ahead and show you guys the
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progression. So those are some of the
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regressions, how would I progress this
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exercise, you want the trigger point roll
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back.
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So to increase the amount of weight
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we're using, we could just start by going
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from elbow and forearm down where we're
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nice and unweighted, to arms wide and now
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she can kind of roll back and forth this
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way. The next progressions we
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kind of start integrating this into our
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trapezius activation, or those prone ITY's.
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She goes on one side just over
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those sternocostal joints, and she
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goes down into her Cobra from floor and
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then pinches your shoulder blades. Not
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only is she unweighted herself by going
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from floor and up, floor and up, but her
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scapula having to retract and
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posteriorly tip, is also forcing
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mobilization of her rib cage which is
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going to have an effect on our sternocostal
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joints. And of course i can
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increase that posterior tipping and that
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retraction by going from Cobra to
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abduction, abduction with external
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rotation ideally. So now I'm kind of
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getting a little bit more bang for my
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buck if I'm writing out like an
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integrated warm-up, corrective exercise
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routine, home exercise program, where I'm
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trying to get a lot done in a few
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exercises or a short amount of time. I
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might be able to use this for trap
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activation knowing that I'm also getting
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some sternocostal mobility, if she's
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had a history of upper-body dysfunction.
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You can go ahead and relax.
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It has a tendency to be very tender. As
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they get off that foam roll I have found
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that going right into a child's pose
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helps. Sometimes you even get a little
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cavitation or mobilization of the
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thoracic spine going back into that
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lengthened position and having loosened
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up all of this tissue. This is once again
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a sensitive technique, you guys are going
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to have to use your best judgment. You
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guys are going to have to modify with
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towels and softer pieces of equipment
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and keep some old foam rolls around, but
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this is one of those techniques if it
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really is like a clinical gem. If you
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have that stiff thoracic spine that just
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doesn't seem to want to respond for you.
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You have somebody who's several years
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post sternotomy right,
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that bone is healed but all these joints
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are super stiff. Little stuff like this
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all the sudden might open some doors and
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get you a little further through your
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rehabilitation, or a little further into
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your intervention, or give you a little
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better mobility for your performance
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training, so that you can get better
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results than you've had before. I look
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forward to hearing how you guys use this
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technique, when you guys use this
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technique, and of course what results you