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This is Brent of the Brookbush
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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