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This is Brent of the Brookbush Institute,
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and in this video we're going over
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static manual release of the tensor fasciae latae and gluteus minimus. I'm
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assuming that if you're watching this video you're watching it for educational
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purposes, and that you are a licensed manual therapist or student on your way
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to becoming a licensed manual therapist. Personal trainers this technique
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probably doesn't fall within your scope, although you could use the palpation
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portion of this video in an educational setting to help you learn your Anatomy.
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I'm going to have my friend Melissa come out, she's going to help me demonstrate
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this technique. Now all of these techniques follow a very similar
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protocol, over simplified that protocol would look something like palpate and
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compress. We're going to break it down a little further than that. We want to be
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able to palpate and differentiate these tissues from other muscles in the area.
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We do get bonus points for knowing our trigger points, so if you know where the
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common trigger points in the tensor fasciae latae are, the common trigger
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points in the gluteus minimus are, you will narrow your search field a bit and
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you won't have to search around quite so much to find those local points of
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overactivity. We do have to keep in the back of our head is there any tissues in
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this area that compression or abrasion might insult. So are there any nerves,
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lymph nodes, arteries. There are some nerves in this area but usually they're
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fairly small nerves, and if you happen to give somebody a tingling sensation or a
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burning sensation, it's pretty easy to get out of the way of those nerves by
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moving backward or forward. Last we have to figure out what position can we put
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Melissa in that will add some tension to this muscle. So we've pinned down those
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nodules, those trigger points, those locally overactive muscle fibers right.
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We also have to make sure she's comfortable and possibly most
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importantly, that we're comfortable that we're using our own body mechanics to
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apply pressure, so that we don't wear ourselves out over the course of one
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session or one day, one week or even one career. We don't want to be using so much
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of our hands that we only get a couple of these
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techniques before we're tired. Now let's start with our palpation and the anatomy
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involved in the tensor fasciae latae and gluteus minimus here. The first thing
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you're going to want to find is the top of the iliac crest here right. So the top
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of her pelvis, because I'm going to want to follow that to her ASIS, I'm going
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to go ahead and put the top of her pants over the top of her ASIS, so I know where
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that's located. I'm then going to go ahead and find her greater trochanter.
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We've actually put a little dot here on Melissa's pants right, so that we can
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mark the greater trochanter so that you guys can see it, if not in this view in
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the close-up recap. If I go from ASIS to greater trochanter, and then back up the
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mid-axillary line to the to the iliac crest here, in that triangle is my TFL,
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and right in the middle of that triangle is where the TFL trigger point usually
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is and we have that marked off. Now the gluteus minimus is just behind the TFL
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right, so the trigger point is also in the middle of that muscle,
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generally speaking falls just behind the mid-axillary line above the greater
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trochanter. So we're dealing in this little triangle right here below her
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pelvis and above her greater trochanter. Now to add some tension to this muscle
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I'm going to kind of use a modified Obers test right. I'm going to go ahead
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and bring her leg back, and if you watched the vastus lateralis video I
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talked about how we should put the vastus medialis on top of the calf,
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because what you don't want to end up with is kneecap on top of ankle because
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that hurts. When you start pressing, so we're going to take the meaty part of
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her of her quad here put it on the meaty part of her lower leg, so that when I
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start pressing, we're just compressing soft tissues we don't
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have any problems there. Now I'm going to palpate across these faacicles. This is
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a fan-shaped muscle right, a fan-shaped muscle whose fascicles run this way. So
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I'm going to palpate from anterior to posterior to find the tightest fascicles,
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and then I can start. Once I find some tight fascicles I can start moving a
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little bit more distal, or a little bit more proximal to find the tightest point
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within those fascicles, and then of course I'm just going to apply my
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pressure. I can use a thumb over thumb technique. I can use my pisiform over
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thumb technique. I can use my inner thenar groove over thumb technique here,
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and then you'll notice I have the table pretty low here with Melissa, so that I
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can just lean in until I get a little increase in tissue density here. I
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don't want to go further than that. I don't want pain. I don't want the tissues
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to all of a sudden guard on me because I'm pushing in so hard just right
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up until I hit some tissue resistance, how does that feel Melissa? Yeah that's,
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that's tender. This muscle definitely tends to get tender. A lot of people talk
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about IT band tightness and iliotibial band syndrome, and runners knee, guys your
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IT band is connective tissue it's not muscular tissue. Your IT band doesn't get
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tight, but your TFL will get over active and short and pull your IT band tight. so
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on a lot of these individuals what you'll find is they have very sensitive
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trigger points in their TFL, and releasing them usually does them some
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good. Sometimes you have to be a little gentler, so sometimes the 30 seconds to
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120 seconds static hold doesn't work out as well as maybe the five seconds on
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five seconds off, an increasing pressure a little bit each time.
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Trying to desensitize that area a little bit. Be gentle with people, you crush
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somebody right off the bat they might not come back, and if they don't come
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back you're not going to have a chance to fix their problem. Now after I get a
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release in the tensor fasciae latae I can just keep moving my thumb back, keep
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using that same anterior to posterior strum of her fascicles to find other
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tight fascicles. The gluteus minimus guys is basically the tensor fascia latae's
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nasty cousin. Both muscles do the same joint actions, both muscles are
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involved in the same dysfunctions. The only difference is the gluteus minimus,
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it does not have an attachment to the iliotibial band. Once I find some tight
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fascicles I'm going to narrow in by going proximal to distal, or distal to
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proximal to find the the tightest point within those fascicles.
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And again I'm going to apply my pressure, I could do the five-second holds on and
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off, increasing pressure each time if she was really sensitive. Or I could go in so
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I meet tissue resistance, hold for thirty seconds to a hundred and twenty seconds.
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Alright guys in the next video you'll see or in the next section, you're going
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to see us do a close up recap so you can see exactly where I'm putting my hands.
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Alright guys for the close-up recap let's start with palpation. The top of
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her iliac crest is right here alright. I'm going to put the front of her
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pants over the top of her ASIS, and then we'll kind of adjust here. Make sure our
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little markings there are over her greater trochanter. So we used this
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little beige button to mark the greater trochanter, ASIS, greater trochanter, up
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the mid-axillary line. In between this triangle right here is her tensor fasciaE
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latae, that nice fan-shaped muscle. And you can see we've marked off that trigger
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point which is basically in the middle of that muscle. You notice just posterior
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to that trigger point is another trigger point, marking this one representing the
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gluteus minimus which again falls behind the tensor fasciae latae, but doesn't
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have an attachment to the iliotibial band. So as far as my palpation I'm going
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to use those anterior to posterior kind of strumming, with a broad thumb
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here. Find the the most overactive fascicles there, and then move. In this
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case since I'm starting so proximal, I'm going to go ahead and keep moving distal
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until I find the tightest point, maybe even a little nodule within those
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fascicles that's where I'm going to apply my compression. I'm going to use my dummy
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thumb and then either my inner thenar groove here, or my pisiform to go ahead
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and apply pressure. I do find it helpful to add a little bit of a distal to
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proximal angle to this to help pin down that trigger point. I'm just going to go
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up to tissue resistance, and then hold it for 30 seconds to 120
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seconds. I did mention that this area does get very tender on people. You guys
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have heard of iliotibial band syndrome, runners knee, a lot of that comes from
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the tensor fasciae latae being overactive in those individuals and pulling on the
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iliotibial band, and it'll get it'll just get tender to the touch. So that five
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seconds on, five seconds off, five seconds on a little harder, five seconds off to
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help desensitize is sometimes a better way to start this technique. Then of
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course after I finished releasing this trigger point I can just keep going with
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my anterior to posterior strums, and I'll find my next trigger point in the
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gluteus minimus, and again just use my my pisiform over thumb grip here, apply
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pressure until I hit that first tissue resistance, and hold for 30 to
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120 seconds. So there you guys have it, ASIS, iliac crest, greater trochanter, TFL,
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gluteus minimus behind it, and trigger points right in the middle of those
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muscles. So there you guys go that was static manual release of the tensor
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fasciae latae and gluteus minimus. As I've said in all of our other manual
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release videos, make sure that by the time you put your hands on somebody you
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are 80% sure that those are muscles that need to be targeted with manual release
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techniques, and you should know that from your movement assessments. Manual
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release techniques by themselves make terrible assessments, be practising these
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techniques often, and if you can with your fellow professionals. The ability to
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practice with somebody who also does manual release techniques, to have these
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techniques done on you is learning that you are not going to get from this video,
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and no matter how well I speak, or how well we demonstrate this stuff on video,
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you need to have that practical application before you try this on
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our patients and clients. I hope you guys enjoyed this video. I hope you learned a
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lot from our video and this technique. I look forward to hearing about your
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outcomes.