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Upper Trapezius Static Manual Release (Soft Tissue Mobilization)

Upper trapezius disengagement and stretching techniques helping to reduce neck pain. Learn how to do a Static Manual Release (Soft Tissue Mobilization) for relief and improved mobility.

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00:04 - 00:05This is Brent of the Brookbush Institute and
00:05 - 00:07in this video we're bringing you another
00:07 - 00:08manual technique. Now if you're watching
00:08 - 00:10this video, I'm assuming you're watching
00:10 - 00:12it for educational purposes and that you
00:12 - 00:14are a licensed manual therapist,
00:14 - 00:16following the laws regarding scope of
00:16 - 00:18practice in your state or region. That
00:18 - 00:20means, athletic trainers, chiropractors
00:20 - 00:23physical therapists, osteopaths, licensed
00:23 - 00:25massage therapists, you are likely in the
00:25 - 00:27clear to do these techniques.
00:27 - 00:29Personal trainers, this probably does not fall
00:29 - 00:31within your scope of practice, although
00:31 - 00:32you might be able to use the palpation
00:32 - 00:35portion of this video to aid in learning
00:35 - 00:38your functional anatomy in an
00:38 - 00:40educational setting supervised by a
00:40 - 00:42licensed manual therapist. Now, before we
00:42 - 00:44place our hands on a patient or client,
00:44 - 00:47it is important that we assess and have
00:47 - 00:50a good rationale for doing so. And, of
00:50 - 00:52course, if we're going to assess, then we
00:52 - 00:54should be reassessing to ensure that the
00:54 - 00:56manual technique we're using is
00:56 - 00:58effective and we have a good rationale
00:58 - 01:00for continuing to use that technique. In
01:00 - 01:01this video, we're going to go over static
01:01 - 01:02manual release of the upper trapezius.
01:02 - 01:04I'm going to have my friend Melissa come
01:04 - 01:05out, she's going to help me
01:05 - 01:08demonstrate. All of our manual release
01:08 - 01:10techniques follow a very similar
01:10 - 01:11protocol. Step one is to be able to
01:11 - 01:13differentiate the target tissue from the
01:13 - 01:16other tissues around it. Step two is to
01:16 - 01:17think about any tissues that might be
01:17 - 01:20injured or insulted by compression that
01:20 - 01:23are around the target tissue. Step three is
01:23 - 01:25we get a little extra bonus for knowing
01:25 - 01:27our trigger point sites that will help
01:27 - 01:29with our accuracy of our palpation and
01:29 - 01:30for finding the points that we need to
01:30 - 01:32release. And step 4 is thinking about
01:32 - 01:36patient and practitioner position so
01:36 - 01:38that you're in a good position to be
01:38 - 01:41able to hold the release technique long
01:41 - 01:43enough to actually get the desired
01:43 - 01:45result. Palpation of the upper
01:45 - 01:46trapezius, if you know your functional
01:46 - 01:49anatomy, is not that challenging.
01:49 - 01:51The upper trapezius is a very
01:51 - 01:54superficial, flat muscle that runs along
01:54 - 01:56the whole posterior and lateral aspect
01:56 - 01:58of the neck into the spine of the
01:58 - 02:00scapula and all the way down onto the
02:00 - 02:04acromion shelf. Essentially this, well
02:04 - 02:05what you're seeing is skin, but just
02:05 - 02:07underneath the skin, is the upper
02:07 - 02:09trapezius. If you want to get a little
02:09 - 02:11bit more detailed, you can feel
02:11 - 02:13through here and you'll notice this bony
02:13 - 02:16ridge that goes all the way to the shelf
02:16 - 02:17of her shoulder.
02:17 - 02:18When I talk about the shelf of the
02:18 - 02:19shoulder, I'm talking about that bony
02:19 - 02:20shelf where you don't have any muscle,
02:20 - 02:22regardless of how big your deltoids are,
02:22 - 02:24this is your acromion shelf and then
02:24 - 02:26this right here is the spine of your
02:26 - 02:29scapula. I can palpate in
02:29 - 02:32through here fairly superficially, follow
02:32 - 02:34that all the way up into the neck and if
02:34 - 02:39I let myself fall off
02:39 - 02:41this meat on the side of the neck here, I
02:41 - 02:47get an idea of how thick and how
02:47 - 02:49the fibers course for the upper
02:49 - 02:52trapezius. You can feel how flat
02:52 - 02:55this muscle is, unlike the levator
02:55 - 02:57scapulae, which we talked about a
02:57 - 02:59different video, that's very ropey and
02:59 - 03:03bundley. This muscle has a density
03:03 - 03:08but no "ropiness" to it, for lack of a
03:08 - 03:12better term. Once I have a good idea of
03:12 - 03:18how my upper trap feels, I need to start
03:18 - 03:20thinking about, well, is there anything
03:20 - 03:21else in here that I should worry about
03:21 - 03:23before I start strumming these fibers.
03:23 - 03:27And the answer is yes, we do have one
03:27 - 03:29potential issue and that's if I get
03:29 - 03:32really, really anterior on the upper
03:32 - 03:35trapezius, I start to fall right along
03:35 - 03:37those transverse processes of the
03:37 - 03:39cervical spine, which means I have just
03:39 - 03:41a little bit of concern where if I press
03:41 - 03:45down really, really hard, I could stretch
03:45 - 03:47the brachial plexus and that could be
03:47 - 03:49problematic. It's going to be very
03:49 - 03:51uncomfortable for the patient or client,
03:51 - 03:53number one. It might give them burning or
03:53 - 03:55tingling or a numbing sensation in their
03:55 - 03:57hands and if they are somebody who has
03:57 - 03:59had a history of radiculopathy, you could
03:59 - 04:00flare them up a little bit, but let's be
04:00 - 04:03careful. Let's make sure that we stay a
04:03 - 04:06little bit more posterior and that we
04:06 - 04:09don't search from the anterior aspect of
04:09 - 04:13the neck. And then make sure when we're
04:13 - 04:14pressing we do keep in the back of our
04:14 - 04:16head that hey this is a superficial
04:16 - 04:18muscle, I don't need to sit here and
04:18 - 04:20drive down with all the force I have or
04:20 - 04:22sink and elbow down into the neck.
04:22 - 04:24My thumbs and a little bit of
04:24 - 04:26pressure is going to be fine.
04:26 - 04:29Considering the direction of these
04:29 - 04:31fibers, I'm going to assume that the
04:31 - 04:34direction goes from the spinous process,
04:34 - 04:36ligamentus nuchae and external
04:36 - 04:38occipital protuberance, which is the
04:38 - 04:41origin of the trap, straight down to the
04:41 - 04:44spine of the scapula here. To strum those
04:44 - 04:46fibers I'm going to need to go this way.
04:46 - 04:49Either from superior-lateral
04:49 - 04:57to inferior-medial or from inferior-medial to superior-lateral. Remember
04:57 - 04:59I told you that you get bonus points for
04:59 - 05:01knowing where the trigger point is? The
05:01 - 05:02trigger point on the upper trap is
05:02 - 05:08almost right down in the middle of this
05:08 - 05:11meat here. I know you can walk
05:11 - 05:12up to somebody and what I'm
05:12 - 05:13talking about, where you got this
05:13 - 05:16little triangular section of
05:16 - 05:18muscles right here on the side of the
05:18 - 05:20neck. Right down in the middle of
05:20 - 05:23that tends to be the common sight for
05:23 - 05:24the trigger point in the upper trapezius.
05:24 - 05:27If you start palpating across this way
05:27 - 05:30and looking for the most dense fascicles,
05:30 - 05:32we'll assume those are the most
05:32 - 05:35overactive fascicles and then you can
05:35 - 05:38start moving from distal to proximal
05:38 - 05:43towards the neck to find any nodule, any
05:43 - 05:45acute point of increased tissue
05:45 - 05:48density and I feel one right there. How's that feel?
05:48 - 05:51A little more tender than the rest
05:51 - 05:53of it right? This is where I
05:53 - 05:55would hold my technique.
05:55 - 05:57Now we run into the little problem of,
05:57 - 06:00would I actually set myself up, my patient
06:00 - 06:03and myself like this? Probably not. This
06:03 - 06:05is not very comfortable for either one
06:05 - 06:07of us. I'm having to do this
06:07 - 06:11thing to see the trap at all, I have
06:11 - 06:13my patient facing into
06:13 - 06:16my neck and chin and this isn't a great
06:16 - 06:20way for me to get any leverage on the
06:20 - 06:22traps themselves, so holding this
06:22 - 06:23technique is going to wear my hands out.
06:23 - 06:26What I'm going to have Melissa do is
06:26 - 06:28go ahead and put her arm back in
06:28 - 06:30the sleeve of her shirt. We only had it
06:30 - 06:32out for the benefit of you and
06:32 - 06:34being able to see some of the bony
06:34 - 06:38landmarks. Flip around. Much like the
06:38 - 06:40levator scapulae, I don't have a problem
06:40 - 06:43palpating or releasing the upper
06:43 - 06:45trapezius through thin gym clothing or
06:45 - 06:46even a t-shirt. There's no
06:46 - 06:48reason to have to move around
06:48 - 06:49clothing and I think with a little
06:49 - 06:51practice you will be able to feel
06:51 - 06:54the landmarks enough that you won't need
06:54 - 06:57a visual reference on the skin,
06:57 - 07:00per se. This isn't a terrible
07:00 - 07:03way to do it, not my favorite way, in
07:03 - 07:06seated. You're definitely better off
07:06 - 07:08posterior to the patient than you are in
07:08 - 07:11front of the patient. You can do
07:11 - 07:16the palm the head thing or the headlock
07:16 - 07:18thing, although this is going to get a
07:18 - 07:21little trickier with the traps because
07:21 - 07:23the way to stretch the traps, and again
07:23 - 07:25we're going to add lengthening to these
07:25 - 07:28tissues to try to pin down our
07:28 - 07:31overactive nodule, we want to
07:31 - 07:32pull it from either side
07:32 - 07:34so that when we press down on it, it
07:34 - 07:36doesn't do that flop around thing.
07:36 - 07:37We have a little support from
07:37 - 07:41either side. With the upper trap, well the
07:41 - 07:43levator scapulae went this way, which
07:43 - 07:44is nice because it just falls
07:44 - 07:46into our arm. With upper trap, we need
07:46 - 07:49to go this way. If you can get
07:49 - 07:51your hand on somebody's head, it makes it
07:51 - 07:55a lot easier. The headlock
07:55 - 07:57technique we talked about before, ends up
07:57 - 08:01putting you with hands crossed, which
08:01 - 08:05isn't going to be real easy. I can go
08:05 - 08:08into contralateral flexion, a little bit
08:08 - 08:10of flexion and then it's
08:10 - 08:13ipsilateral rotation and then I can use this
08:13 - 08:16hand, to once again, strum in this
08:16 - 08:20diagonal. Superior-lateral to
08:20 - 08:24inferior-medial. This way,
08:24 - 08:27find those tight fascicles, find the tightest
08:27 - 08:28nodule and boom and you can see
08:28 - 08:31Melissa's face change and that's the
08:31 - 08:34tender point. Not a terrible way to
08:34 - 08:36do this technique, but I'm really not
08:36 - 08:37taking advantage
08:37 - 08:41of any sort of leverage. I can definitely
08:41 - 08:44control Melissa's head and I can get
08:44 - 08:46enough pressure in this position, but I
08:46 - 08:48prefer something that didn't require so
08:48 - 08:51much hand strength for me and maybe
08:51 - 08:53stabilized Melissa a little bit
08:53 - 08:55more. What we're going to do is go ahead
08:55 - 08:58and do this in supine.
09:07 - 09:09Bring the table up just a little bit
09:09 - 09:13so the table is it about the same height
09:13 - 09:16as my elbows. I can then use this hand
09:16 - 09:19underneath the occiput and what I'm
09:19 - 09:21going to do is pull her head
09:21 - 09:25this way so that as I pull her
09:25 - 09:28head, she's rotated in the same direction.
09:28 - 09:30This would be levator scapulae,
09:30 - 09:32letting her fall off this way,
09:32 - 09:33that would lengthen those tissues
09:33 - 09:35because those tissues connected to the
09:35 - 09:37transverse process.
09:37 - 09:39Since these tissues
09:39 - 09:43connect into the spinous process, I want
09:43 - 09:46to pull the spinous process away from my
09:46 - 09:52insertion. Once I get there, it almost works out that
09:52 - 09:53when I put my hand down, the
09:53 - 09:56direction of my thumb is going perfectly
09:56 - 10:00in that obliquity, that diagonal
10:00 - 10:02that I want to strum these tissues and
10:02 - 10:05I'm a little bit more on top of the neck
10:05 - 10:08or on top of these tissues than I was
10:08 - 10:10for levator scapulae, where my thumb
10:10 - 10:14was way underneath. Now, I'm here. I'm
10:14 - 10:16going to look for the most tender spot,
10:16 - 10:19which I'm thinking is right about there.
10:19 - 10:22I did my strumming across the
10:22 - 10:26fibers and then I went distal to proximal
10:26 - 10:29to find the nodule and now I'm
10:29 - 10:33going to press. The advantage here
10:33 - 10:35comes from the fact that once I
10:35 - 10:40have her in position, I can set my
10:40 - 10:42arms down and essentially let the
10:42 - 10:44friction between my arm and the table do
10:44 - 10:47all the work. I don't have to hold
10:47 - 10:49her head up, once I've moved it there, I
10:49 - 10:51can just let my hand rest on the table,
10:51 - 10:54let her occiput just kind of fall
10:54 - 10:56into my hand, pressing it into the table.
10:56 - 10:59With the pressure here, once I have the
10:59 - 11:01pressure, I can put my forearm down on
11:01 - 11:04the table and the table prevents me from
11:04 - 11:08from being pushed out of her upper
11:08 - 11:11trapezius. I'm not saying this is ideal,
11:11 - 11:15once again, with cervical dysfunction and
11:15 - 11:17working on the neck, it is a little bit
11:17 - 11:19more tiring on the hands than some of the
11:19 - 11:23other techniques we use. I have seen
11:23 - 11:26other videos where individuals work on
11:26 - 11:31the traps in prone. My only problem with
11:31 - 11:34those techniques is the finger on the
11:34 - 11:37marble game; it's very hard to add any
11:37 - 11:41length to the tissues in prone. Not
11:41 - 11:42impossible but a little bit more
11:42 - 11:45difficult. Stay tuned for the close-up recap.
11:45 - 11:47For a close-up recap, in this
11:47 - 11:51video, you can see how this line right
11:51 - 11:54here is actually the border of Melissa's
11:54 - 11:58upper trapezius. If I pull her into a
11:58 - 12:02upper trapezius stretch using that
12:02 - 12:04off-hand at the bottom of occiput, that
12:04 - 12:07border becomes even more clear. I
12:07 - 12:09have the trigger point, the common
12:09 - 12:11trigger point, that is, marked off for the
12:11 - 12:13upper trapezius and you can see how when
12:13 - 12:15my thumb comes in, it automatically
12:15 - 12:19assumes that superior-lateral to
12:19 - 12:23inferior-medial diagonal that I'm
12:23 - 12:25going to use for my strumming and then
12:25 - 12:27I'm going to find the most dense
12:27 - 12:30fascicles I can find and then I can move
12:30 - 12:36from distal to proximal to try to find a
12:36 - 12:38nodule or acute point of hyperactivity
12:38 - 12:39that we're going to assume is the
12:39 - 12:42trigger point so that I can then just
12:42 - 12:46lay my arm down and hold this pressure
12:46 - 12:50for 30 seconds to 2 minutes until I get
12:50 - 12:53a release. I can communicate with my
12:53 - 12:55patient, "Hey Melissa, how does this feel?"
12:55 - 13:00Good. So not too much tenderness,
13:00 - 13:03not too much intensity, not too much pain.
13:03 - 13:07"Is it starting to dissipate?" It'll
13:07 - 13:09start to dissipate after 10-15
13:09 - 13:11seconds. You want to hold it until you get a
13:11 - 13:15nice, complete release and then you can
13:15 - 13:18move on to your next trigger point or on
13:18 - 13:22to the next muscle that you've assessed
13:22 - 13:25as overactive. Once again, I'm just
13:25 - 13:26going to move Melissa
13:26 - 13:28into lateral flexion, a little bit of
13:28 - 13:31flexion here and ipsilateral
13:31 - 13:35rotation. I'll use my superior-lateral
13:35 - 13:38to inferior-medial diagonal to locate
13:38 - 13:41taut bands. I'm then going to go
13:41 - 13:43from distal to proximal to find a
13:43 - 13:45tight nodule and then I'm going to press
13:45 - 13:49in, lay my arm down so that the table is
13:49 - 13:51essentially holding me there and I'm
13:51 - 13:52going to hold to get a release.
13:52 - 13:54So there you have it. Knowing your functional
13:54 - 13:56anatomy will definitely help your manual
13:56 - 13:58technique. It'll help you differentiate
13:58 - 13:59structures so that you can place your
13:59 - 14:01hands where they need to be as well as
14:01 - 14:03make you aware of these sensitive
14:03 - 14:05structures around the tissue that you're
14:05 - 14:07trying to target, things like nerves and
14:07 - 14:10lymph nodes and arteries. Make sure that if
14:10 - 14:11you're going to place your hands on a
14:11 - 14:13patient that you have done an assessment
14:13 - 14:15and have a good rationale for placing
14:15 - 14:17your hands on that patient and if you're
14:17 - 14:19going to assess make sure you reassess
14:19 - 14:21to ensure that your technique was
14:21 - 14:23effective and you have a good rationale
14:23 - 14:25for using that technique again. With
14:25 - 14:29manual therapy, one-on-one, live education
14:29 - 14:32is incredibly important. Please be
14:32 - 14:34looking for opportunities like workshops
14:34 - 14:37and mentorships and maybe even classes
14:37 - 14:40at your local university that can get
14:40 - 14:42you some one-on-one, individual
14:42 - 14:44instruction or at least some live
14:44 - 14:47classroom instruction so that you've had a
14:47 - 14:51chance to be critiqued and mentored by
14:51 - 14:53somebody senior to you with some
14:53 - 14:56experience in manual therapy techniques.
14:56 - 14:59And before you bring this stuff back to
14:59 - 15:02your rehab, fitness or performance
15:02 - 15:06setting, please practice on colleagues.
15:06 - 15:08There is no substitute for practice and
15:08 - 15:11it is going to take a while to get
15:11 - 15:14accustomed to some of the techniques that we
15:14 - 15:16show in these manual technique videos.
15:16 - 15:18Don't expect to learn them in two or
15:18 - 15:21three or even five minutes, you want to
15:21 - 15:24have hours of experience under your belt
15:24 - 15:26working on various different body sizes
15:26 - 15:29and shapes so that when you do get that
15:29 - 15:31first paying client, first paying
15:31 - 15:33customer and you're really trying to
15:33 - 15:36make a good, positive impact, really
15:36 - 15:38trying to promote better outcomes,
15:38 - 15:41you feel comfortable with that technique.
15:41 - 15:43I look forward to hearing about your
15:43 - 15:45outcomes and hearing your questions in
15:45 - 15:46the comments section of this video.
15:46 - 15:50I'll talk with you soon.

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