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Suboccipital Manual Static Release (Soft Tissue Mobilization)

Suboccipital Manual Static Release (Soft Tissue Mobilization) is a manual soft tissue therapy that involves static pressure from the practitioner being applied to specific areas of the upper neck, including the suboccipital muscles. This type of mobilization is often used to increase mobility, reduce pain, and improve range of motion. It involves gentle stretching to target the affected muscles and promote circulation to the area to help in the healing process. The practitioner utilizes a variety of hand pressures, such as

Transcript

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This is Brent of the Brookbush
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...blank
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Institute, in this video we're bringing
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you another manual technique. Now if
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you're watching this video I'm assuming
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you're watching it for educational
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purposes, and that you are a licensed
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manual therapists following the laws
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regarding scope of practice in your
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state or region. That means athletic
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trainers, chiropractors, physical
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therapists, osteopaths, licensed massage
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therapists, you are likely in the clear
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to do these techniques, personal trainers
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this probably does not fall within your
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scope of practice, although you might be
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able to use the palpation portion of
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this video to aid in learning your
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functional anatomy in an educational
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setting, supervised by a licensed manual
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therapist. Now before we place our hands
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on a patient or client, it is important
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that we assess and have a good rationale
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for doing so, and of course if we're
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going to assess then we should be
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reassessing to ensure that the manual
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technique we're using is effective, and
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we have a good rationale for continuing
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to use that technique. In this video
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we're going to go over static manual
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release of our suboccipital muscles,
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that's our rectus capitis posterior
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major, rectus capitis posterior minor, our
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obliquus capitis superior, or obliquus
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capitis inferior. If that wasn't enough
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of a mouthful I know a few of you are so
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familiar with your suboccipital muscles,
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you're wondering where the rectus
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capitis anterior and rectus capitis
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lateralis are, those muscles are too deep
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to actually be palpated and probably
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fall anterior to the axis of rotation
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for the upper cervical spine, making them
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deep cervical flexors. So our rectus
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capitis anterior, rectus capitis
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lateralis, we're going to go ahead and
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say that they're included in deep
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cervical flexor activation. What we're
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going to work on this video is release
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of the posterior suboccipital muscles.
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I'm going to have my friend Melissa come
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out, she's going to help me demonstrate
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this technique. Now she's going to start
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lying face down so I can kind of point
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out some landmarks although, we'll do
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this technique face up. I should mention
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right off the bat that it's probably not
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a reliable palpation, or it's not
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possible to reliably differentiate
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between the various suboccipital muscles.
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Unfortunately these muscles are very
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small they're kind of hidden away, and
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they're deep to two larger
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muscles of the neck, being the upper
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trapezius and splenii muscles. But if I
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think about my anatomy a little bit I
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think that we can set up some borders,
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especially with the obliquus muscles
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that will give us an idea of where we
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should put our thumbs to release these
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muscles as a group. So my obliquus
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capitis inferior goes from the spinous
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process of c2 to the transverse
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processes of C1. So C2 is the first
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spinous process you can feel underneath
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the skull. The transverse process of c1
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is just inferior posterior to the
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mastoid process, yes that that had point
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that the skull comes down to right here,
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right behind your ear, if you go just
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inferior and posterior to that, you can
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actually feel your transverse process
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sticking out, it definitely feels like
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bone and not soft tissue, you can't press
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all the way through it, you press through
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a little soft tissue where it is and all
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of a sudden boom you hit it a hard
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little point. So put your finger on that
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transverse processs, put the other finger
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on the spinous process of c2, that's
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going to be the inferior border of our
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suboccipital muscle. Now my obliquus
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capitis superior goes from transverse
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process of c1 to inferior nuchal line,
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that's our outer border, so we can
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honestly say just trans that transverse
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process we just found, if we just go just
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medial to that, that's going to be our
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outer border. Our superior border is
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going to be this inferior nuchal line,
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and you guys can feel that by just going
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just underneath the base of the skull
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here into the end of the soft tissues. I
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think you'll feel that ledge right where
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all of a sudden you can't, you palpate
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right into some pretty pretty dense
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tissues, that's going to be our
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suboccipitals. So we got our borders drawn
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out here, that's that's how we're going
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to palpate these muscles, before we go
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any further with this technique though
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I'm going to have Melissa flip over and
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be face up,
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because this isn't a very comfortable
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way to get a release to happen, there's
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an easier way to do this; which is, I can
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go just like this, I can do that curling
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of the fingers technique and let the
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weight of Melissa's head do all of the
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work. Not to mention I have a little bit
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more control over lateral flexion,
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flexion extension, which may help me when
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I start trying to palpate for dense
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fascicles. So I'm going to start with one
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side at a time, once again I'm going to
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find I'm going to find that transverse
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process of C1, i'm going to find C2, i'm
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going to let my fingers fall in, a little
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trick here you can use guys is if i go
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into a little bit of upper cervical
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flexion, which is going to be like a chin
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tuck, and it is probably helpful to think
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of like a chin tuck while retracting, and
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then i go into a little contralateral
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flexion, I've now lengthen those tissues
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quite a bit and then i can actually
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experiment with either contralateral
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rotation, or ipsilateral rotation to
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try to further allow me to find dense
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fascicles into an area that's actually
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not going to allow me to strum. I know in
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a lot of our other videos we've talked
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about strumming the fascicles to find
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the densest fascicle, and then moving
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around on that fascicle to find a nodule.
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In this case all we're going to do is
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sink our fingers down into that area i
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explained, which honestly is about a
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finger tips width we don't have much
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more room than that, and we're going to
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use this upper cervical flexion,
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contralateral flexion, and rotation to
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see if we can further stretch these
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fibers. Contralateral rotation making the
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majority of these fibers longer,
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everything except for the obliquus
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capitus superior, and I can find my
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fingers just sinking right into some
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pretty dense tissue up there, and then
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once I find the most dense or tender
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spot, I'm again just going to hold for 30
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to 60 seconds how's that feel? Good and
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then I can do the other side. Once again
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now this hand i'm using as a control, this
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hand i'm going to do that little curved
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position just laying Melissa's head right
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back over my fingers. I'm going to use a
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little upper cervical flexion,
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contralateral flexion to get my fingers
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in a little deeper, and then I can use
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rotation a little bit. Either
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contralateral rotation lengthen most of
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the suboccipital muscles, or ipsilateral
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rotation to lengthen the obliquus
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capitus superior. Once I find a nice and
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tender spot I'm going to hold that until
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I get a release, and then of course
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reassess.
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Stay tuned for the close-up recap. In
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our close-up recap of the suboccipital
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muscles, first step is we need to know
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where we're putting our fingers, which of
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course is going to be between that
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inferior nuchal line, and the line we
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created between the transverse process
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of C1, which is just underneath the
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mastoid process here, and the spinous
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process of C2. The lateral border we're
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going to say, of this place we're putting
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our fingers, we're going to say is the
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outside or the lateral edge of the
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transverse process, and then we're
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slipping our fingers just underneath the
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inferior nuchal line, which is
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essentially the base of the skull here.
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Now to get our fingers a little deeper
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and put some stretch on these
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suboccipital tissues, we can do a little
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upper cervical flexion, which is going to
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look a lot like retraction of the
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cervical spine and lateral flexion. And
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then from there we can even experiment
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with rotation. So if i do contralateral
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rotation that's going to lengthen the
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majority of the suboccipital
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muscles. If I need to shorten them a
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little bit and get a little bit more
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slack I can do ipsilateral rotation. The
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only suboccipital muscle that doesn't
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follow that rule of rotation is the
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obliquus capitis superior. Now step
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two, are there any tissues that could be
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damaged, or insulted, or maybe don't like
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compression. Well we do have to realize
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that the floor of the suboccipital
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muscles here, is the vertebral artery. So
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I would keep your VBI signs in mind. If
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you're in this position you can look
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straight into somebody's eyes and watch
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for things like nystagmus, if you have
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them just continue to talk to you, you
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can notice if there's any slurred speech,
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and of course if they feel like nausea,
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or any symptom that's just a little
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outside of the norm, I'd certainly be
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careful. I've never actually had those
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symptoms occur it's just an anatomical
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possibility.
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Step number three, finding our densest
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tissue guys, you're just going to go from
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lateral to medial. I don't think you're
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going to be able to feel fascicles like
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we have on other techniques. As I said to
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in the further shot it's probably not
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possible to differentiate or reliably
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differentiate the different suboccipital
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muscles, but I think just moving from the
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transverse process of C1 in towards the
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spinous process of C,2 underneath the
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inferior nuchal line looking for the
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densest tissue, and holding it until you
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get a release, is probably the most
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reliable technique we're going to be
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able to come up with, or the most reliable
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protocol we're going to be able to come
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up with. And of course patient position
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once again is just supine, and you notice
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like I get that nice natural curled hand
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position, I'm holding her head so I can
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control it real easy, and it's actually
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the weight of her head that's doing all
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the work i'm not like gripping her head,
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I'm just kind of curling my fingers, and
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letting my fingers sink in where I think
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she has a point of hyperactivity, or
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increased tissue density. So there you
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have it knowing your functional Anatomy
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will definitely help your manual
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technique. It'll help you differentiate
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structure so that you can place your
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hands where they need to be, as well as
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make you aware of these sensitive
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structures around the tissue that you're
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trying to target, things like nerves and
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lymph nodes, and arteries. Make sure that if
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you're going to place your hands on a
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patient that you have done an assessment
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and have a good rationale for placing
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your hands on that patient. And if you're
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going to assess, make sure you reassess
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to ensure that your technique was
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effective, and you have a good rationale
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for using that technique again. Now with
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manual therapy, one-on-one live education
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is incredibly important, please be
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looking for opportunities like workshops
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and mentorships, and maybe even classes at
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your local university that can get you
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some one on one individual instruction,
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or at least a live classroom instruction,
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so you've had a chance to be critiqued
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and mentored by somebody senior to you
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with some experience in manual therapy
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techniques.
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And before you bring this stuff back to
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your rehab fitness or performance
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setting please practice on colleagues,
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there is no substitute for practice, and
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it is going to take a while to get accustomed
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to some of the techniques that we
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show in these manual technique videos.
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Don't expect to learn them in two or
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three or even five minutes, you want to
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have hours of experience under your belt
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working on various different body sizes
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and shapes, so that when you do get that
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first paying client, first paying
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customer and you're really trying to
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make a good positive impact, really
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trying to promote better outcomes, you
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feel comfortable with that technique. I
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look forward to hearing about your
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outcomes and hearing your questions in
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the comments section of this video. I'll