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Upper Trapezius Static Manual Release (Soft Tissue Mobilization)

Upper Trapezius Static Manual Release (Soft Tissue Mobilization) is a form of manual therapy that utilizes sustained pressure to improve the mobility and flexibility of soft tissues surrounding the scapula (shoulder blade). By using various types of pressure in a repetitive pattern, this mobilization technique increases range of motion, decreases pain and improves proprioceptive feedback. This technique can be used to treat painful and stiff shoulder muscles, cervicobrachial syndrome, shoulder impingement syndrome

Transcript

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This is Brent of the Brookbush Institute
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...blank
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in this video we're bringing you another
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manual technique now if you're watching
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this video I'm assuming you're watching
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it for educational purposes and that you
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are a licensed manual therapists
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following the laws regarding scope of
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practice in your state or region that
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means athletic trainers chiropractors
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physical therapists osteopath licensed
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massage therapists you are likely in the
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clear to do these techniques personal
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trainers this probably does not fall
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within your scope of practice although
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you might be able to use the palpation
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portion of this video to aid in learning
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your functional anatomy in an
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educational setting supervised by a
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licensed manual therapists now before we
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place our hands on a patient or client
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it is important that we assess and have
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a good rationale for doing so and of
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course if we're going to assess then we
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should be reassessing to ensure that the
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manual technique we're using is
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effective and we have a good rationale
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for continuing to use that technique in
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this video we're going to go over static
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manual release of the upper trapezius
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I'm gonna have my friend Melissa come
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out she's going to help me
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demonstrate now all of our manual release
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techniques follow a very similar
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protocol step one is to be able to
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differentiate the target tissue from the
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other tissues around it step two is to
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think about any tissues that might be
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injured or insulted by compression that
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are around the target tissue step 3 is
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we get a little extra bonus for knowing
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our trigger point sites that will help
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with our accuracy of our palpation and
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finding the points that we need to
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release in step 4 is thinking about
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patient and practitioner position so
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that you're in a good position to be
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able to hold the Release Technique long
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enough to actually get the desired
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result now palpation of the upper
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trapezius if you know your functional
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anatomy is not that challenging right
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the upper trapezius is a very
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superficial flat muscle that runs along
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the whole posterior and lateral aspect
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of the neck into the spine of the
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scapula and all the way down onto the
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acromion shelf essentially this well
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what you're seeing is skin but just
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underneath the skin is the upper
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trapezius if you want to get a little
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bit more detailed you can kind of feel
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through here and you'll notice this bony
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ridge that goes all the way to the shelf
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of her shoulder
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when I talk about the shelf of the
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shoulder i'm talking about that bony
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shelf where you don't have any muscle
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regardless of how big your deltoids are
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this is your acromion shelf and then
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this right here is the spine of your
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scapula I can kind of palpate in
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through here fairly superficially follow
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that all the way up into the neck and if
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I let myself kind of fall off this
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this meat on the side of the neck here I
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get an idea of how thick and and and how
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the fibers course for the upper
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trapezius you can kind of feel how flat
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this muscle is unlike the levator
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scapulae which we talked about a
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different video that's very ropey and
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bundley this muscle has like a density
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but no ropeyness to it for lack of a
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better term once I have a good idea of
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how my upper trap feels I need to start
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thinking about well is there anything
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else in here that I should worry about
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before i start strumming these fibers
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and the answer is yes we do have one
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potential issue and that's if I get
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really really anterior on the upper
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trapezius I start to fall right along
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those transverse processes of the
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cervical spine which means I have a just
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a little bit of concern where if I press
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down really really hard I could stretch
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the brachial plexus and that could be
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problematic it's going to be very
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uncomfortable for the patient or client
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number one it might give them burning or
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tingling or a numbing sensation in their
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hands and if they are somebody who has
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had a history of radiculopathy you could
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flare them up a little bit but let's be
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careful let's make sure that we stay a
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little bit more posterior and that we
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don't search from the anterior aspect of
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the neck and then make sure when we're
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pressing we do keep in the back of our
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head that hey this is a superficial
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muscle I don't need to sit here and
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drive down with all the force I have or
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like sink and elbow down into the neck
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like my thumbs and a little bit of
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pressure is going to be fine
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considering the direction of these
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fibers I'm going to assume that the
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direction goes from the spinous process
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the ligaments and nuchi and external
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occipital protuberance which is the
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origin of the trap straight down to the
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spine of the scapula here to strum those
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fibers I'm going to need to go this way
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alright so either from superior lateral
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to inferior medial or from inferior
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medial to superior lateral and remember
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I told you that you get bonus points for
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knowing where the trigger point is the
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trigger point on the upper trap is
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almost right down in the middle of this
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meat here I know you guys can can walk
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up to somebody and kind of know what I'm
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talking about where you got this like
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little little triangular section of
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muscle right here on the side of the
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neck right and down in the middle of
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that tends to be the common sight for
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the trigger point in the upper trapezius
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if you start palpating across this way
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and looking for the most dense fascicles
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and we'll assume those are the most
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overactive fascicles and then you can
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start moving from distal to proximal
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towards the neck to find any nodule any
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increase acute point of increased tissue
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density and I feel one right there how does that
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feel a little more tender than the rest
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of it right alright so this is where I
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would hold my technique and of course
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now we run into the little problem of
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would I actually set myself up my patient
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and myself like this probably not this
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is not very comfortable for either one
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of us I'm kind of having to do this
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thing to see the trap at all I have kind
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of my patients kind of like spacing into
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my neck and chin and this isn't a great
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way for me to get any leverage on the
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traps themselves so holding this
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technique is going to wear my hands out
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so what I have to have Melissa to do
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here is go ahead and put her arm back in
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the sleeve of her shirt we only had it
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out for the benefit of you guys and
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being able to see some of the bony
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landmark's flip around much like the
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levator scapulae I don't have a problem
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palpating or releasing the upper
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trapezius through thin gym clothing or
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even like a t-shirt like there's no
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reason that to have to move around
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clothing and I think with a little
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practice you guys will be able to feel
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the landmarks enough that you won't need
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like to a visual reference on the skin
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per se now this is this isn't a terrible
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way to do it not my favorite way and
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seeted you're definitely better off
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posterior to the patient than you are in
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front of the patient you can kind of do
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the palm the head thing or the headlock
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thing although this is going to get a
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little trickier with the traps because
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the way to stretch the traps and again
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we're going to add lengthening to these
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tissues to try to pin down our
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overactive nodule right we want to we
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want to kind of pull it from either side
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so that when we press down on it it
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doesn't do that flop around thing all
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right we have a little support from
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either side with the upper trap with the
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levator scapulae I went this way which
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is nice because it just kind of falls
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into our arm with upper trap we need
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to go this way and so if you can get
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your hand on somebody's head it makes it
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a lot easier the kind of headlock
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technique we talked about before ends up
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putting you with hands crossed which
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isn't going to be real easy so I can go
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into contralateral flexion a little bit
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of flexion and then it's ipsilateral
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rotation and then I can use this
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hand to once again strum in this
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diagonal alright so superior lateral to
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inferior medial and so this way
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find those tight fascicles find the tightest
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nodule and boom you can see
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Melissa's face change and that's the
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tender point now not a terrible way to
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do this technique but I'm really not
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taking advantage
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of any sort of leverage I can definitely
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control Melissa's head and I can get
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enough pressure in this position but I
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prefer something that didn't require so
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much hand strength for me and maybe
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stabilize Melissa a little bit
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more so what we're going to do is go ahead
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and do this in supine
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and bring the table up just a little bit
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so the table is it about the same height
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as my elbow I can then use this hand
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underneath the occiput and what I'm
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going to do is kind of pull her head
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this way alright so that as I pull her
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head she's rotated in the same direction
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alright so this would be levator
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scapulae letting her fall off this way
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that would lengthen those tissues
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because those tissues connected to the
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transverse process well since these
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connected to since these tissues
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connecting to the spinous process I want
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to pull the spinous process away from my
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insertion now once I get there once
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again I'm going it almost works out that
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like when I put my hand down the
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direction of my thumb is going perfectly
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in that that obliquity that diagonal
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that I want to strum these tissues and
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I'm a little bit more on top of the neck
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or on top of these tissues than I was
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for levator scapulae where my thumb was
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was way underneath now i'm here i'm
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going to look for the most tender spot
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which i'm thinking is right about there
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so i did my strumming and cross the
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fibers and then I went distal to
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proximal to find the nodule and now i'm
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going to press and the advantage here
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guys comes from the fact that once i
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have her in position i can i can set my
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arms down and essentially let the
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friction between my arm and the table do
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all the work like I don't have to hold
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her head up once I've moved it there I
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can just let my hands rest on the table
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let the let her occiput just kind of fall
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into my hand pressing it into the table
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with the pressure here once I have the
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pressure I can put my forearm down on
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the table and the table prevents me from
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from being pushed out of her upper
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trapezius I'm not saying this is ideal
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once again with cervical dysfunction and
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working on the neck it is a little bit
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more tiring on the hands and some of the
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other techniques we use I have seen
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other videos where individuals work on
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the traps in prone my only problem with
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those techniques is the finger on the
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marble game it's very hard to add any
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length to the tissues in prone not
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impossible but a little bit more
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difficult stay tuned for the close-up
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recap out for a close-up recap in this
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video you can see how this line right
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here is actually the border of Melissa's
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upper trapezius if I pulled her into a
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upper trapezius stretch using that that
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offhand at the bottom of her occiput that
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border becomes even more clear now I
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have the trigger point the common
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trigger point that is marked off for the
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upper trapezius and you can see how well
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my thumb comes in it automatically
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assumes that superior lateral to
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inferior medial medial diagonal but I'm
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going to use for my strumming and then
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I'm going to find the most dense
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fascicles I can find and then I can move
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from distal to proximal to try to find a
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nodule or acute point of hyperactivity
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that we're going to assume is the
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trigger point so that I can then just
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lay my arm down and hold this pressure
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for 30 seconds to 2 minutes until I get
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a release I can communicate with my
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patient hey Melissa how does it feel
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good alright so not too much tenderness
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not too much intensity not too much pain
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as it's starting to dissipate but it'll
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start to dissipate after 15 10-15
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seconds you want to hold it until you get a
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nice complete relief and then you can
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move on to your next trigger point or on
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to the next muscle that you've assessed
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as overactive so once again I'm just
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going to move Melissa
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into lateral flexion a little bit of
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flexion here and ipsilateral
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rotation I'm going use my superior lateral
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to inferior medial diagonal to locate
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taught bands I'm going to go then going
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to go from distal to proximal to find a
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tight nodule and then I'm going to press
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in lay my arm down so that the table is
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essentially holding me there and I'm
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going to hold to get a release so there
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you have it knowing your functional
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Anatomy 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
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at your local university that can get
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you some one on one individual
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instruction or at least some live
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classroom instruction so you've had a
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chance to be critiqued and mentored by
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somebody senior to you with some
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experience in manual therapy 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 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
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you feel comfortable with that technique
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I 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
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talk with you soon