0:04 This is Brenda the brook Bush Institute in this video. We're going 0:07 over manual therapy techniques specifically instrument assisted soft 0:10 tissue mobilization. Now, if you're watching this video, I'm assuming 0:13 that you are a licensed Medical Professional with instrument assisted 0:16 soft tissue mobilization within your scope 0:19 of practice. Now, there's some gray area here not every 0:22 state has legislation around these tools. If you're not sure 0:25 check, I would hate to see somebody getting in trouble because 0:28 they watch one of our videos and used 0:31 it on a patient or client when things did not fall 0:34 within their scope of practice act. Now these tools 0:37 just like all of our other techniques fall within 0:40 a model of practice and we are very 0:43 big on assess a dress reassess. So 0:47 even though these tools are specific to 0:50 perhaps fossil tissue. We're still 0:53 going to base their use on reliable assessments. 0:56 We're going to use these techniques 0:59 and then we're going to reassess and if they're not 1:02 effective we're not going to use them again for 1:04 particular patient or problem this video. 1:07 We're going to go over the thoracic infraspinatus and 1:10 posterior deltoid. Fascia with instrument assisted soft tissue mobilization. 1:13 I'm gonna have my friend that come out. She's going to help me demonstrate. 1:17 Now I'm going to show you guys this particular technique in a couple 1:20 positions because although prone is ideal. You 1:23 kind of need this setup to make 1:26 it work and what I mean by that is you kind of need these arm 1:29 cutouts. Can you back up just a little bit of it? There you go. You kind 1:32 of need these arm cutouts. You kind of need a headrest that 1:35 adjusts a little bit because remember we want to put some stretch in 1:38 these fossil tissues that we're gonna address with 1:41 these iastm techniques. If you don't have stretch it's 1:44 kind of like, 1:46 Scraping through mush, which doesn't work out very well. Now you'll notice 1:49 I had a vet take her arm out of her her strap 1:52 here so that I could get to the entirety of this 1:55 fascial sheath and I'm just gonna 1:58 go ahead and Tuck this strap underneath the bottom part 2:01 of a sports bra here. Now. The first thing we want to do is put 2:04 a little bit of this smart tools 2:07 cream on 2:10 of course, there's other creams and stuff out there guys. What 2:13 you're looking for is just some sort of of lotion or 2:16 oil that will give a little 2:19 protection to the skin a little lubrication to the skin so that we're not just exfoliating 2:22 the skin when we do this. 2:26 And sometimes I put it on a little bit with the tool other 2:29 times. I'll use my hands the nice thing 2:32 about using your hands as you get a little bit of your first contact with 2:35 the tissue and maybe a chance to do 2:38 a little bit of assessment manually and I 2:41 Can Tell She's definitely a little bit more. 2:44 Tense up in here, right? There's a little bit more tissue density 2:47 back here than there is in this area here. 2:50 Also, I'm noticing that there we go. 2:53 So I kind of flattened out her scapula there. That'll make this 2:56 a lot easier. 2:57 All right, once I feel like I have all that that lotion 3:00 rubbed in and if I had used Too Much, no big deal just wipe 3:03 the rest off the worst. You're gonna do is over lubricate. 3:06 Somebody's skin. I guess I don't know some people 3:09 get really bad out of shape about how much lotion to use. 3:14 All right. Now the next thing I want to do is those scanning Strokes 3:17 so I have this tool the the 3:20 shark. 3:21 Shark fin tool or shark tooth tool, I 3:24 guess depending on how you look at it. We could also use the scanner 3:27 tool it with that. 3:30 She's a smaller person. So this tool is 3:33 actually fairly large on her, but I could go through and 3:36 go from spinous process here. 3:40 and 3:42 then just pull all the way through and what 3:45 I'm noticing is where is there any 3:49 inconsistency in tissue quality 3:52 Right, so I noticed it was like all smooth and then 3:55 as I got in here. 3:57 Right, that was a little bit more bumpy. Like 4:00 I had a little bit more drag when I 4:03 went through that tissue. 4:04 And just like mowing the lawn. I'm gonna kind of go through and do the 4:07 next strip here. 4:09 Same thing. This is a little bit more bumpy. Definitely 4:12 a different tissue texture. 4:14 All right. Now I have a little bit more stuff in 4:17 here. 4:23 Same thing so I had this up in here now. I'm 4:26 getting this down here. I'm just taking a mental 4:29 note. Although I can see a little bit more redness in those areas, too. 4:34 I came through that way. Maybe I do a couple extra Strokes 4:37 all the way through the posterior delts since I haven't a good position for that, 4:40 too. 4:42 So this is just that continuity continuity between the thoracic fascia 4:46 infraspinatus fascia and deltoid fascia. 4:50 now once I kind of have my areas marked out that I I want 4:53 to go back over there their areas that we know we 4:56 have a little bit of abnormal tissue texture I start 4:59 thinking about 5:01 How am I going to disrupt that disorderly collagen 5:04 binding between layers and the way I'm going to 5:07 do that is just by literally stroking in 5:10 various directions. 5:12 Alright, so let's say here. For example, I might 5:15 start with 5:17 You know three to five down Strokes. 5:20 And then I'll go at an angle here. And in 5:23 this case. I just I'm holding one side of 5:26 it and then spinning around that side. I 5:29 tend to like to do those Strokes. They tend to work pretty well and 5:32 I can come sideways this way a little bit. 5:36 And then I'm gonna go ahead and spin this way. 5:39 Alright, so now I've gone down. 5:41 I've got four angles here. 5:44 Probably don't want to get much past 20 Strokes 5:47 total. 5:49 Now I would say 30 is definitely a lot of therapy for 5:52 one area. 5:55 Go down this way. 5:58 all right, and so that was probably about 6:01 16 to 20 strokes and I can see a 6:04 little bit of petechiae and that's all the therapy this 6:07 one area needs. Then the next thing I'm going to do is this area 6:10 in here? 6:11 And you guys don't have to use any one particular 6:14 tool the tool that you want to use is the one that fits the 6:17 area that you're working on. You can keep a little bit of 6:20 a 6:21 mental note on are you using double bevels like this tool or 6:24 single bevels, which is where only one side 6:27 has been shaved down generally single Bells tend to be sharper. 6:32 Sharper being also more intense. I'm going to 6:35 use the smaller tool for her over here on this infinatus fascia 6:39 area. And again, I'm just going to 6:41 a few Strokes in this diagonal 6:44 a few Strokes straight laterally 6:47 maybe I'll go in this diagonal next. 6:50 Maybe we'll go up a little bit. 6:55 Down a little bit. 6:58 across this way 7:02 I've mentioned this in other videos, but you know fascia doesn't 7:05 follow. 7:07 Muscle fibers as far as like the direction of collagen fibers 7:10 Bosch tends to be cross-hatched and 7:13 then the way they get bound down is with 7:16 fibers that are going in all directions. 7:19 So you don't need to potentially stroke All in One 7:22 Direction or all in another Direction. You're really just getting in 7:25 breaking up all of that binding in 7:28 as many directions as you can again, probably 15 7:31 to 30 Strokes on the high end 7:34 and then as soon as you start seeing redness and some tea 7:37 here, you're probably done. I wouldn't go past seeing petechiae 7:40 because the next step is usually bruising. Of course, 7:43 they can come in here maybe for here. I want to use the 7:46 concave surface for the deltoid so that 7:49 it fits a little bit better. 7:51 Try to get a few directions here. Obviously, the deltoids are 7:54 pretty small area. So it's a little harder. 7:57 to get multi-directional strokes in 8:03 Now I'd love to say that this is 8:06 usually the way I do this therapy in this prone 8:09 position where my patient is nice and relaxed. And 8:12 of course everything is nice and stretched out 8:15 and this is a really easy position for me to be in two because I 8:18 can use my body weight and what not to to add 8:21 pressure to these tools. The truth of the matter is usually I don't 8:24 have this table set up. 8:26 So the next easiest way to do this is I'm actually going to have a vet 8:29 set up and face away from me. 8:33 And then the way we get stretch on these tissues. 8:36 Is by having her cross this arm. 8:39 And she's going to use the other arm to support it kind of pulling down 8:42 and across so that the shoulder blade stays 8:45 down, but now you can see I have stretch on all these tissues. Of 8:48 course, I'm gonna get the table up nice and high for me since I 8:51 happen to be tall, but you kind of want your your patient right 8:54 in front of you. 8:55 So where this gets a little complicated is I 8:58 still want to do all those tissue strokes 9:01 and I'm going to have to more often than not do 9:04 those tissue Strokes with one hand while I 9:07 brace. 9:08 My patience, so I'm still I still would have 9:11 gone through all my scanning Strokes. 9:14 This way right and then I would have taken note 9:17 of those areas and then I still would have 9:20 done. 9:22 All my different directions Strokes. I'm just going to probably have to 9:25 use maybe some of the smaller tools if I can and 9:28 the person is strong. Okay, just try not to let me move you. 9:31 All right, I might be able to get away with stuff but I 9:34 can even feel that as I'm pushing into her. She's kind of 9:37 doing this thing, which makes it harder to be consistent. 9:41 Generally easier to grab a smaller tool brace 9:44 their shoulder and go through and do what 9:47 you need to do. 9:49 All right, and I can go through all those tissues now the couple of things we 9:52 didn't talk about. 9:53 Are going after trigger points. We know that rhomboid 9:56 sugar points along the vertebral border 10:00 of the scapula are very common. So 10:03 let's say I had a trigger point in there doing. 10:06 a little bit of 10:08 almost what I've been calling cross friction, although that's not 10:11 really fair because I really want to go in every direction. 10:14 I'm going to go around every direction around this trigger point 10:17 seems to help me with carryover whether that's 10:20 breaking down some of the 10:23 Scar Tissue that's created from 10:26 these dysfunctional mortal 10:29 Ed plates or whether it's just desensitization. It 10:32 does seem to help. 10:38 And so I can get in here and I'm seeing a little petechie eye come in 10:41 and right about the time I start seeing some petechiae. I know 10:44 I'm getting real close to the end because as I've mentioned 10:48 The next step after patikia is bruising and I've 10:51 mentioned this in a couple other videos. I don't find. 10:54 I haven't seen any evidence to make me think that the tiki I 10:57 are actually therapeutic. I think they're more coincidental like we're 11:00 breaking up some of the hypercapitalization that comes with 11:03 inflammation, but that breaking up doesn't actually 11:06 help us. It's just an indication that like, okay, maybe 11:09 we've done enough therapy there. 11:11 All right. The other thing we want to potentially do is 11:14 something that I think is very functional and a 11:17 great technique to use with these iastm techniques 11:20 and especially smart tools man. They do a great 11:23 job of teaching these techniques is these pin and stretch 11:26 so the way I would do pin and stretch on the rhomboids is 11:29 I would have 11:31 that start with her arms straight out here. 11:34 I would pin the tissue. 11:36 And then what I would ask her to do is go ahead 11:39 and take this arm grab your elbow. 11:41 And pull your arm across your chest. 11:44 Right. And so now she's gonna stretch all the way out. And 11:47 of course the next step for intensity would 11:50 be for me to add over pressure. I might just start with her doing a couple of herself. 11:56 Good and then we can take it up one more Notch with intensity 11:59 by me having her pin the tissue having her 12:02 come across apply some over pressure as I'm 12:05 pulling the tool through. 12:08 the 12:10 abnormal fossil tissue that we've been trying to treat now 12:13 that's a very intense technique. You're only going to get two 12:16 to maybe five Strokes out of that total before you 12:19 probably need to call it quits on that. I can 12:22 do the same thing for the infraspinatus fascia, right? I 12:25 can kind of adjust here on her arm. If I need to to kind 12:28 of feel where that tension is pin the tissue again, right 12:31 have her polar our arm across her chest. 12:35 Good. 12:36 Good stuff, right and then of course I could 12:39 do it again have an ad over pressure this time maybe. 12:42 All right, let's do really that's one this one good. 12:45 Good. All right, and then maybe last one? 12:48 Go ahead pull through. 12:52 And depending on who the client is who I'm working with. I might 12:55 not add over pressure. 12:57 I might start with active with overpressure and 13:00 pulling through the tissue if this is somebody I've been working with on a regular basis. 13:04 All right. So once again guys this is probably the 13:07 position you're gonna have to get used to we'll show this position again in 13:10 the close-up recap just so you can see me 13:13 go through this technique in a 13:16 seated position if you can do it supine that 13:19 is probably better always start with 13:22 your scanning Strokes after scanning go ahead 13:25 and break up any of that. 13:28 abnormal tissue that you feel 13:30 After that, you could go after your trigger points 13:33 and then I always recommend adding at least 13:36 a couple of the pin and stretch Strokes at the 13:39 end just because of how wonderfully functional they 13:42 are for returning some of that gliding back 13:45 and that tissue Mobility stay tuned 13:48 for the close-up recap. Okay, guys, we're doing our close-up recap of 13:51 the thoracic fascia, the infraspinatus fascia 13:55 and the posterior deltoid. Fascia. The first thing I'm going 13:58 to do is add a little smart tools cream here. 14:02 alright 14:03 want to get that skin lubricated so that we don't 14:06 abrade the skin as we're trying to 14:09 do our fossil techniques. Remember you do have to you have 14:12 to push down hard enough on the skin. 14:14 that it 14:16 Actually gets down to those fossil layers. We 14:19 want to be. 14:20 Kind of right into the top layer of muscle. 14:23 So we're getting 14:24 good pull through good Shear Force through our 14:27 superficial fascia layers. 14:29 Now the first thing we always start with is our scanning Strokes. 14:33 So I can start right at the spinous process. 14:37 Right just like so 30 degrees and kind 14:40 of pull through. 14:42 I'll hit the scapula here. And as 14:45 long as I'm not pushing down too hard, right, I'm just 14:48 down to the the muscle layer as long as I'm not pushing 14:51 down too hard. I can keep right on going through this 14:54 continuous fossil sheath. 14:56 you guys can see here this 14:58 Is from the previous video we just did of the cervical fascia. 15:03 But I'm trying to take no. 15:06 Of any weird areas and you guys can almost 15:09 see like there's like a lot of resistance right 15:12 through here. 15:14 All right some in through here. 15:23 And then just kind of going through those different techniques have been 15:26 talking about now that we've done our scanning Strokes. I know 15:29 that this and maybe this is my areas of 15:32 dysfunction. I'm going to do those multi-directional Strokes to 15:35 break up any 15:37 fossil sheath binding 15:39 and we can use a bunch of different tools. We could potentially use 15:42 the battering tool. 15:44 Alright, so maybe I want to go sideways. 15:47 And then do my swiping strokes this way. 15:51 My swiping strokes this way actually feel like I mean 15:54 just a little bit more lotion there. 15:56 You feel that burn on the skin a little bit. 15:59 Yeah, guys you're better off with too much lotion than too little too much 16:02 lotion will just kind of build up on the end of your tool like that 16:05 too little and like it almost burns the skin. 16:09 All right, so 16:12 and we're gonna do some swipey strokes this way. 16:15 swipey strokes this way 16:18 if you want to come up this way a little bit remember fascia 16:21 does not follow the direction of the muscle fibers 16:24 underneath it. We just want to go in a lot 16:27 of different directions and try to break up any 16:31 discontinuous or disorganized 16:36 Collagen fibers right what really works well is to 16:39 find a tool that you can hold with one hand so that I 16:42 can use this other hand. 16:43 To brace so that's torso unstabilize a little 16:46 bit. Now. The other part I want to do is here. 16:48 right 16:49 So again, I'm just going to do my swipes sideways swipes. 16:55 All right, change it in my hand go this way swipe. 17:03 You guys can see I do 15 to 25 Strokes maybe 17:06 up to 30 Strokes if I think. 17:10 A vet's tissue can handle it and I got something I'm trying to work out. 17:13 You know, but you can see it there. I got a little bit of 17:16 petechia, right? That's probably a good sign that okay, you've 17:19 done enough therapy. 17:20 Anything more than that, you're gonna start getting bruising. So the 17:23 next thing I can go after is of course those trigger 17:26 points we've been talking about and I know trigger points is a 17:29 muscular phenomenon, but 17:31 If I've been doing my static manual release techniques or 17:34 my foam roll techniques to work on her upper body 17:37 dysfunction. I might want to help carry over a little bit by going through. 17:42 and 17:45 breaking up any scar tissue that might be laid down. Maybe it's 17:48 nothing more than desensitization. 17:51 of these dysfunctional motor end plates 17:55 But it definitely seems to help carry over a little 17:58 bit. 18:05 again, I'm just 18:07 you know with all these techniques like you guys can use any stroke you 18:10 want just and and hand positions 18:13 like you need to find something. That's comfortable. I'm really just trying to 18:16 get to a you know, 20 to 45 degree 18:19 angle get down to the level of the muscle tissue and 18:22 just create some sheer. 18:24 That's really all this is. 18:27 And I think people make out instrument assisted soft 18:30 tissue mobilization to be this really complicated technique 18:33 and it's really not that complicated. 18:38 Try not to bang your tools together. That's that's not a good thing. You'll 18:41 create a little divots in the tools and whatever but 18:44 the next thing we're going to do is that pin and stretch technique, which I think is great 18:47 for functional though. It is very intense. So we're only going to get two to 18:50 five swipes here and what I would have a 18:53 vet do in this case. 18:55 Let's say I want to pull this tissue, right? And this is 18:58 the tissue. I want to work on like right where we had that a dysfunction 19:01 here. I'm going to go ahead and have you reach your arm out. 19:05 A little bit more towards the wall there. 19:07 Okay, so a little bit more outward. 19:09 Nope, sorry, not that way that way. 19:12 There we go. I'm gonna pin the tissue this way good have her 19:15 reach across her chest. 19:18 There we go. You guys can almost see I'll try to get 19:21 my hand on the way the next one. 19:23 Let's try let's try this way. So you guys can see. Okay good. 19:27 I'll go like this and she can pull all that 19:30 tissue through. 19:31 Good, and then that's actually adding some overpressure 19:34 with her ever other hand because she's done this before. All right, 19:37 and if I really wanted to get intense I could 19:40 actually pull through as she's pulling through. 19:43 Right. So like we could start reach for the wall for me that. 19:47 Good and I'm gonna pull through with you good and 19:50 that would be really intense and guys, honestly that five Strokes 19:53 that I just did would probably be as much as 19:56 I would do in any one area and you can see she already 19:59 has some petite here. This was from a previous video, but 20:02 this petite I hear like this is pretty 20:05 normal. 20:07 For instrument assisted soft tissue mobilization, especially 20:10 in the upper body. That's a little bit more sensitive and tends 20:13 to create petechiae a little easier the 20:16 videos. I see where people are completely flared 20:19 up, right they have particular like 20:22 this, but just every totally unnecessary. There 20:25 is never a reason to be that 20:29 Aggressive with somebody I've never seen better outcomes with 20:32 it than what I get from just this alone and the 20:35 bruising itself can obviously be painful and 20:38 I think that's something to consider. The last thing we want to 20:41 do is add painful stimulus to something that 20:44 we're trying to correct. So guys take it easy. Do these 20:47 techniques make sure you're assessing using the 20:50 technique and reassessing to see if you got any change in Mobility. You can 20:53 do your functional tests as well and and try this 20:56 maybe you're working on the overhead squat did this and you can 20:59 use like arms fell forward as a as a sign 21:02 on whether or not you actually got a 21:05 An outcome, but keep that stuff in mind 21:08 keep outcome driven. If you have any questions leave them 21:11 in the comments box below. So there you have it instrument assisted soft 21:14 tissue mobilization, make sure to assess. 21:17 Address using the intervention and then 21:20 of course reassess and if you get the 21:23 chance these videos are not a replacement 21:26 for live education. Of course, 21:29 if you get the chance, you should take live workshops or 21:32 find a mentor who's experienced using these 21:35 tools or maybe a friend that wants to 21:38 learn them too. So at least you can practice on each other and give 21:41 each other some tactile feedback of what you feel 21:44 how you felt the next day what results you 21:47 felt that you got. 21:49 I hope you guys enjoyed this video. Please. Feel free to leave your questions 21:52 below.
